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Stage IV Breast Cancer

By: Ray Lam. Patients diagnosed with Stage IV or metastatic breast cancers have disease that has spread from the affected breast to one or more distant sites in the body. Historically, metastatic breast cancer has been considered incurable; the goal of treatment has been to provide relief from symptoms and prolong the duration and quality of life. However, there have been some important advances resulting in the addition of many more treatment options for managing this disease. These include the now widespread use of taxane chemotherapy, the development of targeted therapies, and the development of more active hormonal therapy drugs.

Over the years since the original publication describing high-dose chemotherapy for the treatment of stage IV breast cancer, thousands of women have been treated. All of the more recent publications demonstrate that the complete remission rate for high-dose chemotherapy as initial treatment for stave IV breast cancer is 40%-60%, the mortality from therapy has decreased to 1%-5% and the number of patients alive without evidence of cancer recurrence is 15%-25% 4-5 years from treatment. The results from two clinical trials comparing high-dose to lower dose chemotherapy have also been published.

In one clinical trial published in 1997, women in complete remission after induction chemotherapy were treated with high-dose chemotherapy or no further treatment. At 5 years from diagnosis, 24% of the women treated with immediate high-dose chemotherapy survived without disease recurrence, compared to only 8% of the women who did not receive further treatment.

The 3-year survival rates were 38% for those receiving the standard chemotherapy, and 32% for those receiving the high-dose chemotherapy. Twelve percent of those in the standard-dose group had no progression of disease, compared with only 6% in the high-dose group. Furthermore, there were more side effects in the high-dose therapy group, including one treatment-related death.

Early detection is clearly the most important factor in breast cancer survival rates. Breast cancer detected at Stage 1 while it is still localized to the breast has a survival rate of 98%-100%, while metastasized breast cancer first detected at Stage 4 drops down to 16%-20%.

One strategy to improve outcomes is to increase the effectiveness of induction therapy so that patients have significant reduction in the number of malignant cells in the body before high-dose chemotherapy.

Since more treatment kills more cancer cells, increasing the intensity of treatment delivered to the cancer cells by utilizing high doses of anti-cancer therapies or by delivering multiple cycles of high-dose therapy is one strategy to improve cure rates. While increasing the intensity of treatment may kill more cancer cells, this approach may also damage normal cells and increase the toxicity or side effects of therapy.

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