How Metastatic Breast Cancer Is Treated?
- Actress Mindy Cohn, 57, is best known for her role on “The Facts of Life" but she privately dealt with aggressive breast cancer for five years.
- Cohn did not say what type of breast cancer she had. And while she said that it kept spreading and coming back, she did not say where the cancer spread to.
- When breast cancer spreads to distant areas of the body (like the bones or brain), it’s called stage 4 or metastatic breast cancer.
- Metastatic breast cancer is incurable, but treatments exist to improve quality of life and help women live longer with the disease.
- For example, treatments like immunotherapy, targeted therapy, antibody-drug conjugates, and CDK4/6 inhibitors are improving the lives of women with advanced breast cancer.
"The Facts of Life" star Mindy Cohn, 57, may be best known for her role in front of the camera as Natalie Green on the 1980s sitcom. However, behind the scenes of her entertainment career, the actress privately battled aggressive breast cancer for years.
Cohn's bubbly face became familiar to households on the award-winning "The Facts of Life" show. She portrayed one of the girls going through typical teenage daily challenges while under the care of Edna Garrett.Read More
Her abrupt fatigue was a telltale sign of something more serious. She went to see her doctor and a scan revealed something in her breast.
"It was breast cancerâ€¦I kept that secret for a long time," Cohn said.
It is completely normal for people diagnosed with cancer to feel a wide range of emotions. These emotions can lead some people to keep their diagnosis quiet, while others may feel comfort in sharing it with others.
Remember there is no wrong answer and you should do what makes you feel best.
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Cohn’s journey was not easy on her, and she stepped away from her public career to give it everything she had.
Cohn said her cancer “kept spreading and coming back. I kept waiting for the other shoe to drop, and it would. I was frustrated and enraged. I couldn't control any of this. I couldn't fix it," Cohn explained.
Cohn's battle with breast cancer lasted for five years. During an October 2017 interview, she said she was "cancer free."
The Options for Treating Breast Cancer That Spreads
Mindy Cohn did not say what specific type of breast cancer she had. While she did say that it kept spreading and coming back, she did also did not say where it spread to.
We also don’t know what type of treatment she had.
When it comes to breast cancer, it is considered stage 3 if there is a “relatively larger-sized tumor” that may have invaded nearby tissue and likely affected lymph nodes, according to Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center.
When breast cancer spreads to distant areas of the body, like the bones, lungs or brain, it is called stage 4, or metastatic.
Metastatic breast cancer is considered incurable, but, thankfully, treatments exist that help improve the quality of life for women battling the disease.
"I have so many patients who are living with their cancer," medical oncologist Dr. Elizabeth Comen tells SurvivorNet.
HER2-Positive Breast Cancer
Women with HER2-positive breast cancer have high levels of a protein called HER2 on the surface of their cancer cells. For this type of advanced breast cancer, targeted therapy drugs like trastuzumab (brand name Herceptin) and pertuzumab (brand name Perjeta) are effective at controlling breast cancer once it has spread.
These drugs are often combined with chemotherapy.
And in a major breakthrough in treatment last year, it was determined that cancers classified as HER2-negative may still have some minimal expression of HER2. The new classification of HER2-low opened the door for so many women to receive life-changing treatment they didn’t previously qualify for.
The new targeted drug Enhertu (generic name trastuzumab deruxtecan), known as an antibody-drug conjugate, was approved for metastatic patients with HER2-low breast cancer.
Enhertu “improves outcomes for breast cancer patients, helping them live longer, and hopefully better,” Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center and SurvivorNet medical advisor, previously said in an on-air interview with NewsNation.
Expert Information on Breast Cancer Treatment
- Advances in Metastatic Breast Cancer Treatments Over the Last Year Offer New Hope for Those Fighting
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- HER2-Positive Metastatic Breast Cancer Treatment Options Explained
- FDA Warning: Robotically-Assisted Surgical (RAS) Devices Have Not Been Authorized for Breast Cancer Treatment or Prevention
- Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
- Acupuncture Promising for Pain Relief from Some Breast Cancer Treatment
Triple-Negative Breast Cancer
Women diagnosed with triple-negative breast cancer also have more treatment options. Triple-negative breast cancer is one of the most aggressive forms of the disease because the cancer cells don't have the main drivers: estrogen, progesterone, and HER2 receptors.
Therefore, the cancer doesn’t respond to treatments that target those receptors.
"This means that the most important way we would treat this cancerfor many patientsis with chemotherapy," Dr. Comen told SurvivorNet.
WATCH: Treatment for triple-negative breast cancer.
"It's really important to talk to your doctor about what chemotherapy options are available," Dr. Comen added.
Meawhile, an exciting development, the FDA approved sacituzumab govitecan (brand name Trodelvy) for people with metastatic triple-negative breast cancer who had already had two prior treatments. Trodelvy is an antibody-drug conjugate that's implemented through an IV infusion.
An anti-cancer drug is attached to an antibody that recognizes cancer cells. Once in the bloodstream, the antibodies travel straight to the cancer cells and deliver the anti-cancer drug directly to them.
Trodelvy was shown to double the survival time of patients over chemotherapy.
Traditional chemotherapy doesn't target cancer cells as strictly. It can damage healthy cells at the same time.
When the healthy cells are impacted, that's what causes the side effects for which chemo is well known, such as hair loss.
In many cases, there may be options to mitigate the side effects of cancer treatment. You should talk with your doctor to explore your options.
Trodelvy carries some side effects too. About one in 10 people who take the drug have severe diarrhea. About half hit very low levels of the type of white blood cell (neutrophils) that help fight bacterial infections.
Your doctor may have some resources to help you better manage these potential side effects.
WATCH: How Does Trodelvy Work For HER2-Negative, HR-Positive Metastatic Breast Cancer?
Additionally, immunotherapy has been approved to help treat triple-negative breast cancer.
Immunotherapy is a cancer treatment method that uses the body’s own immune system to combat the cancer.
For women with that expresses the PD-L1 protein, the drug pembrolizumab (Keytruda), may extend survival.
PD-L1 (a type of protein) on the surface of tumor cells communicates with PD-1 on the surface of immune T-cells to convince the immune system not to fight the cancer. Drugs that block PD-1 or PD-L1 help the immune system see the cancer for the threat that it is and launch an attack.
Hormone receptor-positive breast cancer
A class of medications called CDK4/6 inhibitors are being used more and more for women battling a type of metastatic breast cancer called hormone receptor-positive breast cancer.
Estrogen receptor-positive means that this type of cancer needs the hormone estrogen to grow. These drugs work to decrease 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.
There are several different types of CDK4/6 inhibitors currently on the market including Ibrance (palbociclib), Kisqali (ribociclib), and Verzenio (abemaciclib) and all of the drugs are taken orally.
Questions to Ask Your Doctor
If you are facing a metastatic breast cancer diagnosis and want to learn about more treatment options, consider the following questions for your doctor.
- What stage is my breast cancer?
- What features does my cancer have, and what tests are available to find out?
- What treatment options exist for me based on the type of breast cancer I have?
- Am I eligible to receive any of the new medicines on the market?
- How will I feel during treatment?
- What are the most common side effects of treatment and how can I manage them?
- How long should I expect to miss work or daily activities?
- What will my treatment cost? Will my treatment be covered by my medical insurance company?