Metastatic Breast Cancer Treatment

Metastatic, or stage 4, breast cancer most often spreads to the following parts of the body:

• Bones
• Brain
• Lungs
• Liver
• Abdominal cavity

Symptoms of metastatic breast cancer depend on where the cancer has spread.

When breast cancer spreads to the bones, it may cause symptoms such as:

• Bone or joint pain that doesn’t go away
• Broken bones or fractures

When breast cancer spreads to the brain, it may cause:

• Headaches
• Trouble with balance and walking
• Vision changes

When breast cancer spreads to the lungs, it may cause:

• Shortness of breath
• Frequent respiratory infections
• Coughing
• Chest pain

When breast cancer spreads to the liver, it may cause:

• Pain on the right side of the abdomen
• Yellow skin (jaundice)
• Fatigue
• Itchy skin

When breast cancer spreads to the abdominal cavity, it may cause:

• Abdominal pain
• Bloating or swelling
• Unexplained weight loss

Some people with metastatic breast cancer may not have any of these symptoms. Regular follow-up care with an experienced cancer team can help detect early signs of metastatic breast cancer.

No, only cancer that starts in the breast is considered breast cancer. Breast cancer that spreads to other parts of the body, like the bones or brain, is still considered breast cancer.

“Oligometastatic” is another way of saying that breast cancer has spread to a limited number of sites in the body. The number varies, but typically this means a person has five or fewer metastases (tumors that have spread).

The Limited Metastatic Cancer Program at UChicago Medicine specializes in helping people with all types of oligometastatic cancer, including breast cancer, live longer lives. Although there is no cure for metastatic breast cancer, you may still benefit from therapies we offer. This includes promising new medicines that may help extend your life.

Tests used to diagnose and stage breast cancer include:

• Blood tests
• Advanced imaging tests, including:
  • Computed tomography (CT) scans, which use low-energy X-rays to produce 3D images of tissues and organs
  • Bone scans, which use a radioactive tracer that can highlight areas of cancer
  • Magnetic resonance imaging (MRI), which uses a strong magnet to produce detailed pictures of organs and other parts of the anatomy
  • Positron emission tomography (PET) scans, which use a radioactive substance to uncover cancer cells in the body
• Biopsies, which are procedures to remove small tissue samples of your tumor

Because your treatment depends on your type of tumor, getting a complete and accurate tumor profile from your biopsy is important. Unlike many other hospitals, UChicago Medicine has in-house expertise in genetic and molecular testing to analyze your tumor. Your cancer team will work closely with our pathology experts to analyze the specific makeup of your tumor and then build your treatment plan.

Drug therapy is the main treatment for patients with metastatic breast cancer. Our team generally recommends a combination of drug therapies to help shrink tumors and slow the spread of your disease. Some of these drug therapies include:

• Chemotherapy, which fights or kills cancer cells in the body. A new type of treatment that allows your doctor to better direct chemotherapy to cancer cells are antibody drug conjugates (ADCs), which contain an antibody so the chemo can “target” tumor cells. This reduces side effects on the rest of the body. One example is trastuzumab deruxtecan, which combines a chemo drug with a targeted therapy called a monoclonal antibody that binds to the HER2 protein.
• Targeted therapy has been an option to treat metastatic and nonmetastatic HER2-positive breast cancers for decades. But new “personalized medicine” therapies are also emerging for other types of advanced or metastatic breast cancer. Some of the latest drugs are CDK4/6 inhibitors such as palbociclib, ribociclib and abemaciclib. Our team often prescribes these drugs with hormone therapy.
• Hormone therapy (also known as endocrine therapy) can treat ER-positive and PR-positive tumors. Many hormone therapies are pills taken by mouth. Different types of hormone therapy include:
  • Aromatase inhibitors like anastrozole and selective estrogen receptor modulators like tamoxifen, which are used for ER-positive tumors to block how estrogen affects estrogen-sensitive cancers.
  • Selective estrogen receptor downregulators (SERDs), which block estrogen to slow tumor growth. One example is elacestrant, an oral drug approved for patients with metastatic cancer with a mutation on the ESR1 gene. Another is fulvestrant, an injection given into the muscle. Researchers at UChicago Medicine are also actively testing new SERDs in clinical trials.
  • PI3K inhibitors like alpelisib, a pill to treat patients who have a mutation in the PIK3CA gene and have HR-positive, HER2-negative metastatic breast cancer.
• Immunotherapy, which has been studied for more than 30 years at UChicago Medicine. In current clinical trials, physician-researchers at UChicago Medicine are testing immunotherapy in ER-positive breast cancer as well as emerging drugs called poly (ADP-ribose) polymerase (PARP) inhibitors in patients who do not have BRCA mutations. Some examples of immunotherapies include:
  • Pembrolizumab, which is approved to treat metastatic triple-negative breast cancer
  • CAR T-cell therapy, which doctors are studying in clinical trials for patients with HER2-positive metastatic breast cancer. This treatment targets cancer by harnessing the power of the immune system.
  • Bispecific T-cell engagers, a new type of immunotherapy under investigation at UChicago Medicine for metastatic and nonmetastatic breast cancer. These drugs may help the body’s T-cells, a type of white blood cell, fight cancer.
• Clinical trials give patients access to novel therapies that are not currently approved for use in breast cancer. We offer trials of new drugs for patients with cancers that have been very resistant to standard treatments as well as drugs that are being tested in large trials and will likely receive approval soon.

“Localized” therapies like radiation that focus on a specific tumor are not used as often as systemic drugs to treat breast cancer that has spread to multiple sites. So far, these therapies have not been shown to improve survival in people with metastatic breast cancer. Instead, our team uses radiation treatments to help manage cancer symptoms like pain. For example, radiation can help ease the pain caused by a tumor growing in a bone.

Radiation also can treat small brain metastases before they grow and cause harm. Some of the radiation treatments available for metastatic breast cancer include: 

• Intensity-modulated radiation therapy (IMRT), which spares healthy tissue because it allows doctors to “match” the radiation beam to the shape of the tumor. Radiation oncologists at UChicago Medicine were among the first to offer this advanced radiation treatment.
• Stereotactic body radiation therapy (SBRT), which delivers very high doses of radiation to tumors using advanced targeting techniques. It can treat tumors in the bone and other types of metastases. Experts at UChicago Medicine conducted one of the first prospective trials testing the safety of SBRT to treat metastatic cancer.
• Stereotactic radiosurgery (SRS, or gamma knife), which delivers very high doses of radiation to tumors using advanced targeting techniques in the brain. Experts at UChicago Medicine have multiple trials open for brain metastases in the hope to further improve the treatment.

Radiation oncologists and medical oncologists at UChicago Medicine are also working together on clinical trials to see if radiation combined with systemic therapies like immunotherapy are effective against metastatic breast cancer.

Surgery does not slow the spread of metastatic breast cancer. However, in certain circumstances, surgery may help reduce pain and improve other symptoms in some people with metastatic breast cancer. If your medical oncologist thinks you may benefit from surgery as part of the multidisciplinary management of your metastatic breast cancer, they may arrange for a consultation with our breast surgeons at UChicago Medicine.

Surgeons may be an important part of your care team at UChicago Medicine. Often, they review your case alongside our medical oncologists and radiation oncologists. If they think you may benefit, they will suggest surgery to make you more comfortable and improve the quality of your life.

The symptoms and stress of having metastatic breast cancer can affect your entire family. We make sure you don’t have to face your disease on your own. Our supportive oncology team is always available to offer support.

We offer supportive care services such as:

• Pain and symptom management
• Complementary treatments like acupuncture
• Individual and family counseling
• Stress management
• Nutrition support to improve your appetite and strength
• Financial counseling
• Support from social workers

Getting a second opinion on your cancer care can bring you and your family peace of mind. Our breast cancer team is happy to meet with you in-person at any of our cancer care locations or via telehealth.

If your breast cancer is advanced, you may have been told that your options are limited. Our team may be able to offer treatments to help you feel better and even live longer. Drug therapy available at UChicago Medicine may reduce the size of tumors and help prevent them from spreading. Other treatments like radiation and surgery may help you feel more comfortable. We are here to offer support and suggest a treatment plan that fits your needs.