Doherty captioned her recent podcast recap, “I am very proud of this episode. This is Dr Lawrence Piro, my oncologist and one of the most intelligent, compassionate and skilled humans I know.

“I hope this episode brings insight and a deep understanding of cancer for not just the person with it, but those who stand beside us thru the journey. Happy new year. Link is in my bio.”

Speaking to Doherty on her “Lets Be Clear” podcast, Dr. Piro explains, “I always say that, you know, it’s important to think of each therapy as a horse. And you wanna ride in a horse race.

“You wanna ride every horse as long as it rides.”

Responding to Dr. Piro’s wise worse, Doherty continued, “There are so many different things right now, and you and I always talk about the fact that like that we just need to squeeze out another three to five years.

“And then there’s going to be T-cell therapy, or there’s going to be this, or there’s going to be that, like whatever it is, there’s going to be as lot more options that will give another five years. Then in those five years, there’s a whole other group of options, and then eventually there’s going to be a cure.”

RELATED: Shannen Doherty, 52, is a ‘Horse Protector’ Who May Form a New Foundation For Animal Protection– Keeping Her Passions Going In Hard Times

She added, “So I always look at it as I’m … the horse analogy is really a good one, like I’m constantly chasing, I’m riding those horses so that I get to the fresh set of horses. And I’m trying to get the one that I’m on right now to last for as long as humanely possible.

Shannen Doherty’s Cancer Battle

Shannen Doherty first received a breast cancer diagnosis in 2015 after she discovered a lump in her breast. For treatments the first time around, she underwent hormone therapy, a single mastectomy (the removal of all breast tissue from one breast), chemotherapy and radiation.

Sometimes Bad Things Happen — Enjoying Life, Even With Cancer

Then in 2017, Doherty was deemed to be in remission, however, the cancer returned just two years later in 2019 as metastatic, or stage four, breast cancer.

There is technically no cure for metastatic breast cancer, but that doesn’t mean people can’t live good, long lives with this stage of disease, thanks to hormone therapy, chemotherapy, targeted drugs and immunotherapy, as well as a combination of treatments.

RELATED: Shannen Doherty’s Cancer Has Spread to Her Brain: Brave Actress Shows Unwavering Strength Amid Stage 4 Breast Cancer

Doherty took to Instagram earlier this year to recap how her cancer fight is going. She underwent her first round of radiation to her head on Jan. 12, 2023, followed by brain surgery to remove and biopsy a tumor on Jan. 16, 2023. The surgery she underwent is called a craniotomy.

Several neurosurgeons tell SurvivorNet that the procedure can allow patients with cancer in their brain to live longer, more vibrant lives, and this appears to be the case with Doherty who has recently been taken to Instagram to share photos and videos of her recent Italian getaway

Understanding Stage 4 (Metastatic) Breast Cancer

Stage 4, or metastatic breast cancer, means that the cancer has spread to distant areas of the body. Even though there is currently no cure for metastatic breast cancer, doctors have many options to treat this stage advanced stage of breast cancer. Shannen Doherty is a perfect example as to how people can live happily despite battling the disease.

Hormone therapy, chemotherapy and targeted drugs are all options to talk to her doctor about, depending on your individual needs. Sometimes surgery and/or radiation is considered as part of the treatment, but mainly it is important to focus on improving your quality of life.

The treatment plan for metastatic breast cancer patients depends on the specific needs of the woman, whether they need an aggressive chemotherapy or depending on the doctor’s assessment, they may benefit from another medication.

For hormone receptive positive cancer breast cancer patients, doctors try to see how long they can keep patients on oral therapies. Very often, newly diagnosed metastatic hormone receptive-positive breast cancers (where cells have either estrogen (ER) or progesterone (PR) receptors or both) respond best with different hormonal medications, and sometimes for many many years.

Treating Metastatic Breast Cancer

Dr. Erica Mayer, a medical oncologist at Dana-Farber Cancer Institute, says clinical trials have shown that hormone medicines are more effective when paired with targeted therapies. At some point, chemotherapy will be introduced. And according to Dr. Mayer, it’s delivered at a dose and schedule that’s as well-tolerated as possible.

“We are so lucky in breast cancer that we have so many effective and well-tolerated treatments,” Dr. Mayer tells SurvivorNet. I’m so gratified to see that patients are doing better and living longer today with metastatic breast cancer than they have ever done before.”

Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options

Bottom line, there are more and more options becoming available for patients to manage symptoms of advanced stage disease, and it’s best to talk about specific treatment plans and what is best for you with your own doctor.

Metastatic Breast Cancer Treatment Options

Treatment for metastatic breast cancer focuses on decreasing the spread of cancer cells, as well as relieving symptoms and improving quality of life. Individual treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive. There is no one size fits all treatment.

Treatment can include a combination of:

• Chemotherapy: Oral or IV medications that are toxic to tumor cells
• Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
• Targeted therapies: Drugs that target your tumor’s specific gene mutations
• Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
• Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
• Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
• Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes

If the initial breast cancer treatments fail to work, it’s important to know there are new treatments that have recently reaped success. For example, early results from a recent study released at a European oncological conference show that ENHERTU—a type of drug called an antibody conjugate, which could be a game changer for women with HER2 positive metastatic breast cancer—is reducing the risk of disease progression or death by 72 percent when administered as the second line of treatment compared to the current standard of care drug.

RELATED: New Hope for Breast Cancer Warriors: ENHERTU Therapy

Additionally, a new treatment option, Trodelvy, is also offering breast cancer warriors hope.

Trodelvy (molecular name sacituzumab govitecan) is also what’s known as an antibody-drug conjugate. It works by becoming attached to an antibody that recognizes cancer cells and delivers the cancer-killing medicine directly to the cancer cells.

RELATED: How To Treat Metastatic Breast Cancer: The Drug Trodelvy Shows A Promising Boost In Survival Rates

Meanwhile, cancer treatment drugs trastuzumab (brand name Herceptin) and pertuzumab (brand name Perjeta) are drugs often combined with chemotherapy, and together, they have proven effective at controlling breast cancer once it has spread.

For women with hormone-receptor-positive and HER2-negative breast cancer new drug treatments are available. The drugs are called CDK4/6 inhibitors. The FDA approved three of these kinds of drugs:

• palbociclib (Ibrance)
• ribociclib (Kisqali)
• abemaciclib (Verzenio)

These drugs are effective at decreasing the amount of estrogen that can be taken into a cancer cell with the goal of slowing the rate at which that cancer cell can expand. For women who are estrogen receptor-positive, their cancer needs estrogen to grow. These CDK4/6 inhibitors mitigate that growth.

An Overview of Treatment Options for Metastatic Breast Cancer

Clinical Trials Offer Hope, but They’re Not for Everyone

Doherty previously revealed she’s exploring clinical trials with hopes of finding a new treatment to aid her on her metastatic breast cancer journey. To learn more about clinical trials for breast cancer, check out SurvivorNet’s Patient Pathfinder.

Studies of new treatment options are called clinical trials, and they are an essential part of medicine for two reasons:

1. Clinical trials help doctors better understand cancer and discover more effective treatment methods.
2. They also allow patients to try a treatment before it’s approved by the U.S. Food and Drug Administration (FDA), which can be life-changing.

WATCH: Clinical Trials Help Find New Treatment Options

Dr. Beth Karlan is a gynecologic oncologist at UCLA Health. She says the goal with clinical trials is to advance cancer research to a point where the disease becomes akin to diabetes, where it becomes a manageable condition.

“Clinical trials hopefully can benefit you, but is also providing very, very vital information to the whole scientific community about the effectiveness of these treatments,” Dr. Karlan said. “They can be lifesaving. In the last few years, we’ve seen many children and adults who have participated in trials and had miraculous results.”

Understanding the Process Behind Clinical Trials

Within the U.S., all new drugs must go through clinical trials before the FDA approves them. Although the rewards of clinical trials can be great, they also come with risks. Talking to your doctor about this before enrolling in a trial is important. Some risks to consider include:

• The risk of harm and side effects due to experimental treatments
• Researchers may be unaware of some potential side effects of experimental treatments
• The treatment may not work for you, even if it has worked for others

Before you enroll in a trial, you must be allowed to read the consent documents thoroughly and to ask any questions you may have. The documents will likely contain the following:

• The purpose of the research
• Any risks and benefits expected from the research
• Information about procedures that may cause discomfort (like frequent blood tests)
• Any alternative procedures the patient might consider instead
• How the patient’s information will be kept private
• How long the study is expected to take
• A form confirming you are participating in research voluntarily
• Whether any compensation or additional medical care is available if some injury occurs
• The patient’s rights (like the right to stop research in the middle of the trial)
• Contacts for any patient questions

Patients are allowed to walk away at any time during the trial. Understanding your rights as a voluntary patient is important before you participate in a clinical trial, and understanding that the treatment may not work is also crucial.

Costs of Clinical Trials

Clinical trials may also have no extra cost for the participants, as the study’s sponsor may pay for the treatment and any additional care. Some sponsors even pay for travel to and from appointments or treatment centers. Patients should ask what will be paid for before signing up for a trial.

The Affordable Care Act also mandates that health insurance companies cover routine patient care costs while people are enrolled in clinical trials.

The ‘Placebo’

During the treatment of an experimental drug in a clinical trial, while some participants receive the real thing, others do not. These participants received a placebo.

The placebo is “an inactive substance or other intervention that looks the same and is given the same way as an active drug or treatment being tested. The effects of the active drug or other intervention are compared to the effects of the placebo,” as defined by the National Cancer Institute.

In some cancer clinical trials that are “randomized,” patients who enroll are randomly assigned to receive either a placebo or the new experimental drug being studied. If the clinical trial is “double-blinded,” neither the patients nor the doctors running the clinical trials know who’s in which group. This is an important part of a clinical trial design because it safeguards against bias and the possibility of skewed results.

It’s important to know that getting zero treatment isn’t usually the reality of the “placebo arm” anyway.

Instead, when patients with life-threatening cancers enroll in randomized clinical trials, the two groups are often broken into the new, experimental drug and a “control” group that receives the “standard-of-care” treatment.

Treatments considered standard of care are those that experts accept as the go-to treatment for specific cancers. Standard-of-care, in other words, is the most used treatment.

In many cases, it might involve a combination of chemotherapy, surgery, or radiation, but not always.

Do Clinical Trials Have Limits on Who Can Participate?

It’s important to remember that just because you’re willing to participate in a clinical trial doesn’t necessarily mean you will be able to join. These trials have specific criteria that patients need to meet to take part.

Ultimately, even though these trials can have incredible results and provide you with access to cutting-edge therapies, these are controlled experiments.

For each trial, there will be certain inclusion and exclusion criteria.

Sometimes, patients may be excluded from certain trials if their cancer has spread to their brain. If the metastases aren’t under control, the patient may be unable to participate because researchers are concerned that they won’t be able to complete the whole study.

“Because of the way the study needs to be done, not only for safety reasons but also for scientific reasons where we’re trying to actually answer a question, we have to set up criteria for who can participate in the trial, even though it makes it difficult to find the patients who are eligible,” Dr. Alana Welm from the Huntsman Cancer Institute Research South, previously explained to SurvivorNet.

“If we were to do a trial where we didn’t have certain inclusion or exclusion criteria, the result would not be interpretable,” Dr. Welm added.

How to Find a Clinical Trial

If you want to participate in a clinical trial, your first step should be to talk with your doctor. They can address many of your initial questions and help determine whether you would be a good participant.

Another crucial part of clinical trials is finding the right one for you. SurvivorNet has a resource to help with this called the Clinical Trial Finder.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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