Would really appreciate some advice.......

I am sorry to hear about your lung nodules and was in a similar (but substantially worse) situation physically 5 years ago. My ER+/PR+/HER2- bc recurred after 18 years, and I presented with a litre of malignant pleural effusion, pericardial effusion, and multiple lung nodules. I had a cough, my voice was gone because one of the lung nodules was pressing against a laryngeal nerve that controlled one of my two vocal cords, thus paralyzing it. I also had Horner's disease as a result of the lung nodules since they were in an area that connected to my left eye and caused it to droop.

My oncologist wanted to start me on chemo, and fortunately I sought the opinion of another oncologist who recommended that I start with hormonal therapy since I was otherwise strong and healthy. I will forever be grateful to him, since it turned out to be a good choice for me.

In many cases, patients with hormone receptor positive breast cancer respond well to hormonal therapies.The concept behind hormonal ("endocrine") therapy is to starve the cancer cells of the estrogen hormone they need in order to thrive. For hormone positive mbc patients, hormonal therapies are normally the first-line therapy for both premenopausal and postmenopausal patients. Exceptions are patients experiencing considerable symptoms or life-threatening disease, who have major liver involvement, Central Nervous System (CNS) involvement, multiple tumors in the lung's lymphatic system, who have had early failure on hormone therapy (less than 6 months) or have been off adjuvant hormonal therapy for less than a year should consider chemotherapy and/or other therapies (possibly with hormonal therapy).

I would strongly suggest that you consider hormonal therapy as first-line treatment unless you meet any of the above criteria, which seems doubtful. And at minimum, please consider seeking a second and possibly a third opinion about your treatment.

If you are interested in receiving detailed information about therapies, you (and others) are welcome to request a complimentary copy of my 124-page MBC Guide by visiting: the top of this page: https://community.breastcancer.org/forum/8/topics/831507?page=2#idx_32

With best wishes for success on your treatment, whatever you decide!

Hi MSL, I just wanted to say hi and respond because I see a lot of myself in you. I too am stage IV de novo, only had mets in one place (albeit liver not lungs), and premenopausal. Only you are going to know what you feel comfortable with and what path you want to take, but for what its worth, two things from my experience:

When I was diagnosed, my doctor and a second opinion both recommended hormonal treatment. I was upset, because I wanted to be as aggressive as possible. But I listened to them and I started on hormonals (with ribociclib as part of a trial for four months). Its done amazing in knocking back the tumors- with nearly zero side effects, allowing me to work, be a mom to my son, and have a pretty normal life, all things considering. And itsstill working almost a year later. Again, you dont know how the treatment will work, but it is possible to have a response and also minimal side effects on hormonals. And the option for chemo will still be there in the future, if needed.

When i started the trial, I had to have zoladex shots and couldnt have my ovaries removed. As soon as I was able, I had them removed and am so happy I did. I have a lot more freedom now that I dont have to go in every four weeks for the shot. And, for me, the week after zoladex was terrible in terms of mood swings and hot flashes. It still happens, but no where near as intense as on zoladex. I found the surgery to be relatively easy and felt back to normal just a few days later.

So just some of my experience for what its worth! Good luck with whatever you decide!

MSL, the current "standard of treatment" though it is a brand new standard of treatment, is Femara plus Ibrance. Plus ovarian ablation (whether surgical or medical).

There are two schools of thought among oncologists. One is to do hormonals period. You're ER+ so that settles it. The other school of thought likes to do chemo to "knock back" all the lesions, then switch to hormonals. That's particularly prevalent if you have a heavy cancer burden.

I can tell you that my onc is of school number 1. Your experience may vary. The thing about treating Stage IV patients -- it's more of an art than a science. Often there is no correct answer or wrong answer.

When I was dx with bone mets in 2006, I was of the opinion that I was going to tell the onc that I wanted to hit it hard with the toughest chemo would could and knock this out of the ballpark.  But after a long discussion and lots of opinions from here I learned that MBC is a marathon not a sprint.  They start with the mildest tx and work their way up.  Quality of life is important and there is no need to hit your body extremely hard with aggressive chemo tx options that could cause you to lose your hair and issues with QOL.  If your onc is willing to start with hormone tx I would go that route.  I went at least six years utilizing hormone tx options before moving to an IV chemo.  Thanks to Afinitor I am back with hormone tx options working again.  Afinitor is a newer drug that they found out will jump start the hormone drugs to work again after they have failed you.

One last piece of advice I would give is always seek a second opinion when you are just starting out in this world.  You want to feel comfortable with your onc and seeking another opinion can sometimes help you decide which onc you feel the best with.

I have just last week been DX with return of BC in my liver. I was originally DX with TN but this recurrence is strongly ER+ (95%) My MO has started me on Arimidex. I was wanting to go out with all guns possible, and felt quite unsure about hormone therapy only. Your posts have been very reassuring.

I wanted to ask, how do you know if it's working - do you have regular scans or does your MO use blood tests including tumor markers?

Hi MSL, so glad to hear your appointment went well! That makes me so happy!! :

dear MSL,

Once the route is set, the rest follows and this new normal feels ok and bearable. Happy to read all has been ok so far.. I ditto all, especially Bestbird, who offers great advice always!

Hugs

Ebru