Hi aross
Thanks for posting, it sounds like you are having a difficult time at the moment. It’s not unusual for people to feel that their team are giving up on them and often they explain they are confused about the changes in treatment choices made.
When breast cancer has spread to another part of the body, this is called secondary breast cancer (also referred to as metastatic or advanced breast cancer). Currently, secondary breast cancer is treatable but not curable.
Treatments for primary breast cancer such as surgery, radiotherapy and drug treatments are given with the intent of achieving cure, even though doctors can’t say for certain this will happen for each individual.
Systemic therapy (drugs that work throughout the body) are the main treatment used for secondary breast cancer which aims to control and slow down the spread of the cancer, relieve symptoms, maintain health and wellbeing and give you the best quality of life for as long as possible.
Research evidence has helped breast cancer experts across the world agree on the best treatments and their sequencing for different types of secondary breast cancer. The guidance experts produce is updated every couple of years following a consensus meeting when the latest research is examined. You can read the current guidance here ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer☆ (annalsofoncology.org)
Guidance on treatment for management of secondary breast cancer is not made based on how the cancer has spread (through the blood system or lymph nodes), but on factors such as where the secondary breast cancer is in the body, how extensive it is (how many sites and how large), the features of the secondary breast cancer and what previous treatment someone has had. You can read a little more about this here. These factors can also affect your prognosis.
Whilst EC, paclitaxel and Phesgo (trastuzumab and pertuzumab) is a very common drug regime currently used for early HER 2 positive breast cancer, docetaxel and Phesgo is the agreed best regime for those newly diagnosed with secondary breast cancer as you’ll read on page 1481.
Enhertu is available for use on the NHS, but is given to people who have already had one or more treatments specifically for HER2 positive breast cancer.
However, like you, there are a number of people who present with solitary or a small number of secondary cancers often called oligometastatic disease (OMD), some of whom go on to achieve complete remission and a long survival. OMD is not very well understood, but treatment can include several approaches (often referred to as an aggressive approach) used for curative intent such as surgery to the breast and axilla, radiotherapy in additions to treatments such as microwave ablation as @Coddfish mentions, as well as drug treatment to try and achieve the best response. Some drug treatments can be used for both primary and secondary breast cancer such as the combination of abemaciclib and letrozole that @helen39 mentions in her post.
As every situation is different, there is currently no one agreed protocol for managing oligometastatic disease. However, guidance does state that patients with OMD should be discussed by the multidisciplinary team (MDT) to tailor their treatment recommendations to the individual. You can read more about this via the above link to the guidance on page 1488 and 1489.
It sounds as though it would be a good idea to speak with your treatment team again to ask them to explain fully the rationale for the treatment options you mention and ask if this has been discussed by the MDT. If you still have concerns, you may wish to request a second opinion to help you feel you are getting the most appropriate treatment and care.
Do call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen, talk things through and signpost you to more support and information if necessary. Your call will be confidential, and the number is free from UK landlines and all mobile networks. The number is 0808 800 6000, (Relay UK - prefix 18001).
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Best wishes
Catherine
Breast Care Nurse
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