Breast Cancer Stage IV

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.

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 general, women who have advanced breast cancer at the time of diagnosis live approximately 18 months after diagnosis (median survival rate). Those who are still alive five years after their diagnosis of advanced breast cancer can live an additional 3.5 years (median survival rate) according to the American Cancer Society.

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.

Additional clinical trials directly comparing conventional chemotherapy treatments to high-dose chemotherapy treatments are currently ongoing to help determine which patients may benefit most from high-dose chemotherapy treatment.

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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