Mastectomy for metastasis breast cancer.

Koushik

Hi All,

After my mother's initial diagnosis of metastasis breast cancer(Lungs alone) in March, she had undergone 4 chemo cycles (Paclitaxel and trastuzumab)so far and she in due to PET-CT scan this week to evaluate the response of the so far treatment. Our MO mentioned if there is good response and tumors in lungs were disappeared they will perform breast surgery (mastectomy).Also, they mentioned if there was no complete response (i.e tumors left in lungs but pretty good response) they will continue with the 4 chemo as curative intent but with different chemo drug and perform PET and decide on the mastectomy after.

I wanted to know from you all about possibility of mastectomy in metastasis stage,

In general, after how many cycles of chemo(after 3 months or 6 months) from initial diagnosis of mastectomy can be done?I agree this will be performed only after finding good response during her chemo treatment..

Your experiences pleaseeeeee

Thanks All

Anonymous

Surgery at Stage IV is not a simple decision as it is with earlier stage cancer. Many women don't actually receive it - I still have a breast tumor and axillary tumor and despite a strong response to the hormonal treatments, MO will not consider putting me forward for breast surgery unless the breast tumor starts to grow. The cancer in the breast is not the concern ad stage IV because that is not what will kill the patient, its the external mets and escaped cells and those need to be managed ahead of the breast.

The studies on the potential of surgery to have survival benefit are not clear one way or another, so its just not a standardized approach. It also is something that depends on the patient (overall health and ability to handle surgery), type of cancer (triple negative or HER2+ seem to get surgery but they leave ER+ women alone), and in some cases the grade, type, location, and number of the mets before treatment.

There are also risks involved, which include being off treatment in order to heal and in case of infection. If your mom was on chemo to clear the lungs that is different from having to take ongoing pills which would need to be stopped for surgery.

I guess what I am getting at is this is a highly personalized decision by care teams and the patient depending on a lot of factors and it may be difficult to find ladies with similar experiences because its such a unique situation. If your mother's team want her to have the mastectomy pending good results then I would want to be absolutely clear and on the same page of potential risks from the surgery and how the expected benefits outweigh those risks.

jensgotthis

I echo Sondra that there isn’t one clear path. I was dx with MBC (bones) and did 6 rounds of chemo then had a mastectomy followed by radiation. My MO chose this as I had just met and had a complete response to chemo. The evidence base isn’t strong enough to suggest one way over the other

NineTwelve

Third this. I got my MBC diagnosis almost 7 years ago, and was told that mastectomy is not recommended. I still have not had any surgery.

There are risks with surgery, and no clear evidence that it will increase overall survival time for those with multiple mets.

moth

Breast surgery is not standard of care in metastatic setting. There are some clinical trials investigating whether it confers advantage. If it was within a trial, I would consider it but otherwise, there would have to be really compelling other reasons.

Where is your mother receiving treatment? I know there are some drs pursing very aggressive treatment for de novo HER2+ like your mom's

Is she feeling well, I hope?

illimae

Currently, studies and trials are not conclusive on the benefits of surgery or not but it is more common in stage IV patients with good overall health and minimal cancer spread.

Also, she may not have to be off treatment. If surgery is done after her initial chemo, she may continue on Herceptin while recovering. In my case, I had surgery following chemo with no treatment for 1 month but since Herceptin is given every 3 weeks, the delay was really only 1 week. After that, I had breast radiation and continued on with maintenance therapy. I found it all pretty tolerable but I was only 41 and pretty active. Each situation is different but I have no regrets.

Koushik

Hi All, Thanks very much for sharing your experiences and thoughts,

I wanted to give an Update that, Her follow-up PET-CT was done Yesterday, and the report showed complete response to the ongoing therapy.

Due to this, her Med Onco wants to give her the complete benefit and opted for mastectomy, he also mentioned it not is definitive that it is going to completely cure here, he said he does not want to miss the benefit out of surgery.

For now, I asked them couple of days of time and meanwhile looking for expert as 2nd opinion.

Koushik

Hi Moth,

Thanks for sharing your experience.

We are from India, as of now, my mother is doing okay. she is having some SE's like diarrhea, especially after including pertuzumab in her treatment.