What Happens if Metastatic Breast Cancer Treatment Stops Working?

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by Brian Wojciechowski, Breastcancer.org Medical Adviser

If you’ve been diagnosed with metastatic breast cancer, the first thing to know is that you are not alone — many women and men live long, fulfilling, and productive lives while being treated for metastatic disease.

There are many approaches to treating metastatic breast cancer and new treatments are being tested every day. Each person’s treatment plan will be different because each person is unique and each breast cancer is unique.

Treatment options for metastatic breast cancer

  • Surgery: If breast cancer has spread to another part of your body, surgery many not be recommended because it’s unlikely to remove all the cancer cells. Still, if you have painful lesions in your bones or blockages in your liver, your doctor may recommend surgery. If your first diagnosis of breast cancer was metastatic, called “de novo” by doctors, your doctor may recommend surgery to remove the tumor in the breast.
  • Chemotherapy: If the cancer is growing quickly or is growing even though you’re on other treatments, your doctor will likely recommend chemotherapy. Chemotherapy is a systemic treatment because the medicines affect the entire body. Chemotherapy works by destroying or damaging cancer cells as much as possible.
  • Radiation Therapy: For metastatic disease, radiation is used to:
    • ease pain
    • lower the risk of a cancer-weakened bone breaking
    • reduce internal bleeding
    • improve breathing by opening a blocked airway
    • reduce pressure on a pinched nerve
  • Hormonal Therapy: Hormonal therapy is used to shrink or slow the growth of hormone-receptor-positive disease. Hormonal therapy will not work on hormone-receptor-negative breast cancer.
  • Targeted Therapies: Targeted therapies, as the name suggests, target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow rapidly. Targeted therapies are generally less likely than chemotherapy to harm healthy cells.

In some cases, a treatment may stop working and the cancer may start growing. If this happens, you and your doctor will talk about other treatment options.

How do you know a treatment isn’t working?

If your symptoms change or get worse, or you have new pain, talk to your doctor. It could be a sign that a treatment isn’t working as well as expected.

Your doctor also will closely monitor the results of your scans to make sure your treatments are working.

Things to think about when trying a new treatment

You and your doctor need to be on the same page when it comes to your care. Let your doctor know how aggressive you want your treatment to be and what your priorities are. Some people may want fewer side effects, others may want pain control above all else. Still others may want the most aggressive treatment available, even if the side effects are severe. There’s no right or wrong way. What matters is what’s important to you. At the same time, be sure to ask your doctor about the benefits and risks of each treatment option.

BRCA mutation testing for people with metastatic disease

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 and BRCA2. Women with a mutation in the BRCA1 or BRCA2 gene have up to an 85% risk of developing breast cancer by age 70. Their risk of ovarian cancer also is higher than average. Men with an abnormal BRCA gene have a higher risk of both breast and prostate cancer.

DNA carries genetic information in both healthy cells and cancer cells. Cells can develop DNA damage spontaneously or from exposure to specific things in the environment (too much sun, for example) that make DNA damage more likely to happen. But cells can detect and repair damage to DNA. When DNA is damaged in a healthy cell and the damage isn't fixed, that cell can become cancerous. Mutated BRCA1 and BRCA2 genes are thought to increase the risk of breast and other cancers because these abnormal genes interfere with cells' ability to repair damaged DNA.

The poly ADP-ribose polymerase (PARP) enzyme fixes DNA damage in both healthy and cancer cells. Research has shown that Lynparza (chemical name: olaparib), which interferes with (inhibits) the PARP enzyme, makes it even harder for cancer cells with an abnormal BRCA1 or BRCA2 gene to fix DNA damage. So, a PARP inhibitor like Lynparza makes certain cancer cells less likely to survive their DNA damage. Lynparza is specifically approved to treat metastatic, HER2-negative breast cancer in women with a BRCA mutation.

The takeaway

There are two important things to remember if you’ve been diagnosed with metastatic breast cancer:

  • You are not alone. More and more people are living life to the fullest while being treated for metastatic breast cancer.
  • You can have confidence that there are a wide variety of available metastatic treatment choices. There are many treatment options for metastatic breast cancer, and new medicines are being tested every day. While metastatic breast cancer may not go away completely, treatment may control it for a number of years. If one treatment stops working, there usually is another you can try. The cancer can be active sometimes and then go into remission at other times. Many different treatments — alone, in combination, or in sequence — are often used. Breaks in treatment can make a big difference when the disease is under control and you are feeling good.

For more information, visit the Breastcancer.org Metastatic Breast Cancer Treatment and Planning pages.


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