Treatment options
Treatment options for your metastatic cancer will depend on several factors, including the type of cancer, the extent and location of metastasis, your overall health, and your own preferences.
The main goal of treatment for metastatic disease is to slow the growth of the cancer, increase survival length and improve the quality of your life by managing symptoms.
Your treatment team will liaise with one another and you to come up with an individualised treatment plan based on the factors above.
Common treatment options
- Chemotherapy: Cancer treatment that uses drugs to kill or slow cancer cell growth.
- Targeted therapy: Targeted drugs are designed to specifically target certain molecules or pathways involved in cancer growth. They may be used in cancers with specific genetic mutations.
- Immunotherapy: Immunotherapies stimulate the body's immune system to recognize and attack cancer cells. They have been effective in treating certain metastatic cancers.
- Hormone therapy: Hormone therapy is used for hormone-sensitive cancers (e.g., breast or prostate cancer) to block or reduce the effects of hormones that fuel cancer growth.
- Angiogenesis inhibitors: These drugs target the blood vessels that supply tumours with nutrients and oxygen, slowing their growth.
- PARP inhibitors: Used for certain types of metastatic breast and ovarian cancers with BRCA gene mutations.
- Surgery: While it is often not the first choice for metastatic disease, In some cases, surgery may be performed to remove metastatic tumours or relieve certain symptoms.
- Radiation therapy: Radiation can be used to target and shrink metastatic tumours by damaging metastatic cells. It can also be used to alleviate pain and other symptoms caused by cancer spread to the bones or brain.
- Palliative care: Palliative care focuses on relieving symptoms and improving the quality of life for patients with metastatic cancer. It can be provided alongside curative treatment or as the main approach for patients not wishing to pursue further medical treatment.
- Clinical trials: Clinical trials can provide access to experimental and novel treatments and therapies that may not be available otherwise. These trials help advance cancer research and may offer new hope for patients.
- Allied Health: These teams can help manage the side effects of treatment, addressing pain, providing nutritional support, and offering emotional and psychological support to you and your family.
- Alternative and Complementary Therapies: Some patients explore complementary therapies like acupuncture, massage, meditation, or dietary changes to help manage symptoms. It is always essential to discuss these options with your healthcare team to ensure they are safe and do not interfere with your primary treatment.
- Hospice Care: Is provided when the focus shifts from aggressive treatment to end-of-life care and comfort. It provides comprehensive support for patients and their families during the end of life transition.
All treatment decisions for metastatic cancer should be made in close consultation with your medical oncologist and multidisciplinary team. What treatment you are offered will be based on personalised recommendations given your specific diagnosis, stage, and overall health.
Cancer treatment research is an ever changing field. Over time or as the cancer responds or progresses new therapies and treatment might become available. Therefore we encourage ongoing communication with your healthcare team to help make informed decisions and adjust treatment as needed.
Restesting tumors
HER2 (Human Epidermal Growth Factor Receptor 2) is a protein that plays a role in cell growth and division, and its status is a critical factor in the diagnosis and treatment of breast cancer.
If cancer cells have an overabundance of HER2 receptors, the breast cancer is referred to as HER2-positive. Determining the HER2 status of a breast cancer tumour is essential because it helps guide treatment decisions. HER2-positive breast cancers can be more aggressive, but there are targeted therapies specifically designed to block the effects of the HER2 protein.
What current research shows
Research shows that up to 30% of breast cancer relapses can see a change in the of the HER2 status i.e HER2 positive breast cancer may become HER2 negative and vice versa. This suggests that retesting breast cancer recurrence is beneficial.
A recent study by Bergerson et al, 2023 looked at the changes in HER2 status with disease progression and concluded that due to “increased HER2 expression in recurrent tumours compared to primary tumours is relatively common strongly supports the need to retest for HER2 expression at relapse (whether local recurrence or distant metastases)”
It is not just the HER status that can change but there can be a change in the hormone receptor status too which also suggests that retesting is beneficial.
Should I request tumour retesting?
REFERENCES
Bergeron A, Bertaut A, Beltjens F, Charon-Barra C, Amet A, Jankowski C, Desmoulins I, Ladoire S, Arnould L. Anticipating changes in the HER2 status of breast tumours with disease progression-towards better treatment decisions in the new era of HER2-low breast cancers. Br J Cancer. 2023 Jul;129(1):122-134. doi: 10.1038/s41416-023-02287-x. Epub 2023 Apr 29. PMID: 37120672; PMCID: PMC10307899.
Miglietta F, Griguolo G, Bottosso M, et al. HER2-low breast cancer: evolution from primary breast cancer to relapse. Presented at: ESMO Breast Cancer Virtual Congress 2021; May 5-8, 2021; virtual. Abstract 4 MO_PR.
Clinical trials
Clinical trials play a crucial role in advancing cancer research and treatment. Clinical trials are research studies that test new treatments or interventions to advance further and improve cancer care. These treatments may include targeted therapies, immunotherapies, or combination approaches that aim to slow the spread of cancer or even shrink metastatic lesions.
For people with a metastatic or advanced diagnosis, being part of a clinical trial can provide you with access to novel treatment options and offer hope by providing treatments and therapies that can potentially allow you to live well for longer. It also provides you with the opportunity to contribute to ongoing cancer research efforts and support others who are on a similar journey.
Before participating in a clinical trial, it's essential to consider any potential risks and discuss these and your participation in any trial with your medical team. You will need to provide informed consent, which means you fully understand the trial's purpose, procedures, and potential risks.
Finding clinical trials
Australian New Zealand Clinical Trials Registry (ANZCTR):A national database maintained by the Government of clinical trials. You can search for cancer-related trials on their website
Cancer Council Australia: A leading cancer research organisation that often has information about clinical trials on their website.
Australian Rare Cancer Portal: An online portal aimed at health care providers to improve outcomes for those with rare cancers, who provide access to research and clinical trials. They have portal for patients HERE
Australian Cancer Research Foundation: Often have information about ongoing clinical trials on their websites.
Your Hospital or Medical Team: Your medical oncologist will know about any relevant studies that might suit you and your type of cancer. If you want to find or participate in a clinical trial, this can be the best place to start.
Australian Government Cancer Agency: Government database of the latest clinical trials in cancer care.
Breast Cancer Trials: Clinical Trial research focused on finding better treatments for people affected by breast cancer.
Australia and New Zealand Urogenital and Prostate Cancer Trials Group: Clinical Trial research focused on finding better treatments for people affected by urogential and prostate cancer.
Australia New Zealand Gynaecological Oncology Group (ANZGOG): National gynaecological cancer clinical trials organisation for Australia and New Zealand.
Clin Trial Refer: Platform and app that allows you to search for clinical trials that are actively recruiting patients.
