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\f0\fs24 \cf0 >>>Dr. Margileth: \f1 \expnd0\expndtw0\kerning0
One of the most common initial places of metastasis in breast cancer is to bone.
Bone and skin and lymph node would be on the better end of metastatic sites that tend to
have better responses and more options for therapy.
The worse sites of metastasis would be sites such as liver and most especially brain.\
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Unfortunately, whenever we have a recurrence of breast cancer in a distant site such as
bone, we are dealing with a situation that in our likelihood is not curable.
There are individual instances of cure, may be in about 1% of such cases, but for the
most part, we are looking at a palliative situation.
In the sense, that we want to provide treatments that maximise life span and of course minimize
toxicity.\ \
Since cure is not a goal again we want to use treatments that are least toxic.
Very commonly bone metastases come from a hormone receptor positive breast cancer and
in that case, one should exhaust all anti-estrogen or hormone-based therapies before moving onto
chemotherapy.
This would be such medications as the aromatase inhibitors or Tamoxifen or Zoladex in the
premenopausal situation or Faslodex in the postmenopausal situation, and then other hormone
therapy such as progestational agents or even high dose estrogen.\
\ Only when hormone modalities have been exhausted
or the tumor is known to be hormone receptor negative, does one then go onto chemotherapy.
Fortunately, in metastatic breast cancer, there are six or seven different drugs, most
of which are fairly effective and most of which are actually not overwhelmingly toxic.
These would include drug such as Halaven, Navelbine, Gemzar, Xeloda, and several others.\
\ In the situation of bony-dominant metastatic
breast cancer, one would most likely go with a single chemotherapy agent, only if a person
has very rapidly progressive visceral, meaning lung or liver metastasis, might one consider
combination chemotherapy in the metastatic setting.\
\ So one would then run through a series of
chemotherapy drugs and obviously hope to get some good response out of each.
But unfortunately in metastatic breast cancer, one ultimately finds that the cancer becomes
resistant to the modalities that we have and at some point, further chemotherapy becomes
more harmful than helpful and at that point it would be to the patient\'92s best interest
to back off on any aggressive chemotherapy and consider comfort care or hospice.\
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\b\fs32 \cf0 \expnd0\expndtw0\kerning0 *****\
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\b0 \cf0 \expnd0\expndtw0\kerning0 Hi, I am Dr. Jay Harness and I want to share
with you an important information that I believe that every newly diagnosed patient with breast
cancer needs to know.\ \
Susan Denver: \'93I am a breast cancer survivor.\'94\ \
Katherine Stockton: \'93I am a breast cancer survivor.\'94\
\ Coree: \'93I am a breast cancer survivor\'85\'94\
\ Susan Denver: \'93\'85and I want every woman
to know\'85\'94\ \
Katherine Stockton: \'93\'85about personalized breast cancer treatment\'85\'94\
\ Susan Denver: \'93\'85and the Genomic Test.\'94\
\ Coree: \'93A test that helps guide a woman
and her doctor\'85\'94\ \
Katherine Stockton: \'93\'85to the best treatment options for her.\'94\
\ Susan Denver: \'93Pass it on!\'94\
}