Stage IV breast cancer has traditionally been considered an incurable cancer. In the mid to late 1980’s the average patient with stage IV breast cancer treated with low-dose chemotherapy survived 8-10 months before their cancer relapsed and less than 5% of patients could expect to survive 5 years without their cancer recurring. In 1988, the results of a small clinical trial treating 22 women with stage IV breast cancer treated with high-dose chemotherapy and autologous stem cell transplant were published. Fourteen percent of these patients treated with high-dose chemotherapy survived without their cancer recurring beyond 5 years.
By 1997, these patients had been observed over 10 years and the original 14% remain alive without a relapse of their cancer and appear cured of their disease. It is important to understand that because over 50% of patients with stage IV breast cancer relapse, it is not useful to compare the response rate to chemotherapy, the average duration of survival or time to relapse. When evaluating treatment strategies in stage IV breast cancer, patients should compare the percent of patients alive with or without relapse 3-5 years from treatment to determine whether a treatment is truly superior.
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.
Since this is the most deadly category of breast cancer, it is important to work closely with all the health care providers. New treatments are being developed all the time, and second, or even third opinions may give the patient more information about newly discovered successful solutions.
High-dose chemotherapy and autologous stem cell transplant treatment for previously untreated stage IV breast cancer appears safe; however, the benefit of this treatment approach is currently unknown. It is known that many factors may influence an individual patient’s potential outcome if treated with high-dose chemotherapy. Patients without prior treatment, those with small amounts of cancer, and those whose cancer responds to conventional chemotherapy all do better.
Early detection procedures must include monthly self-examinations done at the same time each month. From age 20-40, healthy women should have clinical breast exams performed by their health care providers every three years. After age 40, the breast exams should be annually and should include a mammogram or similar procedure.
Monoclonal antibodies are a treatment that can locate cancer cells and kill them directly without harming normal cells. Herceptin (trastuzumab) is the first monoclonal antibody approved by the Food and Drug Administration for the treatment of breast cancer. Herceptin recognizes a protein on the cancer cell surface of 1 in 3 patients with breast cancer. In order to be treated with Herceptin your doctor must test the breast cancer cells for the protein that Herceptin recognizes. This protein is called Her 2-neu. Herceptin or other monoclonal antibodies are not substitutes for other cancer treatments but have the advantage of being administered during or after high-dose chemotherapy and killing cancer cells by a different method than chemotherapy with the goal of improving the total treatment. Clinical trials are currently being performed to determine whether monoclonal antibodies administered during or after high-dose chemotherapy can improve survival or cure rates.
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