In explaining to friends and others what treatment entails with metastatic breast cancer, I encounter many who have the common assumption that all, or perhaps the only, treatment is chemotherapy. In actuality, because of the developments in treatment over the past ten to twenty years, treatment for MBC includes drugs other than chemotherapy. Today’s daily dose focuses on the type of treatment we receive based on just three subtypes of breast cancer. This is a simple explanation, but for anyone new to understanding our treatment, it is a start. The key to understanding treatment for anyone with MBC is that it is unique to the patient based on a lot of variables that include overall health, pre-existing conditions, previous lines of treatment (treatment already received for MBC) and something called subtypes. Subtypes are classifications or groups of factors that, when present or absent, affect both the growth of one’s cancer and the effectiveness of the treatment. My daily dose today will start with the three main subtypes.
Daily dose of awareness
Breast cancer is a complex disease with many subtypes. Each subtype responds differently to treatment. While many drugs and protocols exist for treatment of metastatic breast cancer, some cancers do not respond to treatment based on subtype factors. Three subtypes that help to determine one’s treatment include hormonal sensitivity, or ER and PR status, noted as ER and PR positive (+) or negative (-) and a protein receptor, HER2, also noted as positive or negative. Breast cancer that is ER/PR+ adds additional options for treatment (e.g. Tamoxifen®, Faslodex® and others) other than chemotherapy, and, likewise, breast cancer that is HER2+, while in itself a more aggressive cancer, often responds to treatment with drugs (e.g. Herceptin®, trastuzumab) that target the action of that receptor.
Even when any of these treatments work, their duration of success is unknown. When one treatment fails, the decision looms to find the next treatment that will limit the cancer’s progression and extend survival.
While these are the three main subtypes, other subtypes exist that also influence cancer growth and treatment effectiveness. Research continues to delve into treatments that respond to the various subtypes, and, probably some that are yet unknown. When we think about that miraculous “cure,” it’s important to remember that cancer is as complicated as we are unique. Finding treatment that works for one person is difficult enough; finding treatment that works for all patients with even the same diagnosis will be nothing short of heroic.
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© 2004–2011 Donna Peach. All rights reserved.
Donna Peach 
Good post.
You might adress triple negative in a future post as that is an area where some progress may be forthcoming with the PARP inhibitors, at least for those with advanced cancer.
Thank you, Donna, for a great tutorial. You’re right. Most of us don’t really understand MBC treatment options. And thank you for underscoring how complicated the search for “the cure” is. I sometimes think in our frustration, we’ve forgotten that. Your cancer and someone else’s with supposedly the same stage and cancer may not really be the same, and your cancer today, may not be your cancer tomorrow. All of these illusive and yet fundamental details contribute to making a “one size fits all” cure incredibly difficult.