Navigating the ‘Ever-Evolving Trajectory’ of Metastatic Breast Cancer

Effective metastatic breast cancer management requires a multidisciplinary approach, strong patient-doctor communication, and tailored treatments based on biomarkers.

Although patients with metastatic breast cancer benefit from many factors including a multidisciplinary approach to care and thorough education to make treatment decisions, one of the most critical tools throughout this entire process is communication between patients and their care teams, an expert said.

In a recent CURE® Educated Patient® Updates in Metastatic Breast Cancer, a panel of experts from Miami Cancer Institute in Florida discussed the space including information on initial and subsequent treatments, biomarkers and other areas that may be helpful for patients with the disease.

CURE also spoke with Dr. Jane Emilie Mendez, chief of breast surgery at Miami Cancer Institute in Florida, who chaired the event, to learn more about how information like this can be beneficial for patient outcomes.

“[Cancer isn’t] one street,” Mendez said in an interview with CURE. “It’s not your doctor wants to do this and that's that, because we need to know that we're keeping a balance between our efforts to cure you — at least keep your metastatic disease at bay — and your quality of life. … Even [if] we're keeping the cancer at bay but you're miserable with the side effects, what have we gained? … Ultimately, it's all about quality [of life].

Biomarkers to Tailor Treatment

Mendez added that multidisciplinary care that is often applied to patients with metastatic breast cancer is not “one size fits all.”

“We need to tailor the therapy to the specific characteristics of the tumor,” she said. “We have now so many ways that we can do that, either with tissue biopsy or liquid biopsy (with blood), tissue sampling, and how far we’ve come in terms of trying to better define all the subtleties about the tumors.”

With the identification of biomarkers, cancer teams can steer the treatment of patients with metastatic breast cancer in a direct that may be more effective.

“What are the characteristics within the particular tumor that the patient has that will allow us this ability to look for other potential treatments once they failed the standard and the minimally invasive [option],” Mendez said in an interview.

Even though treatment often starts with hormone therapy, which is minimally invasive and is often tolerated the best before systemic treatments, Mendez said, tumors may mutate over time. Thus, tumors should be checked periodically for any changes in biomarkers.

“It’s really more important to check that the tumor hasn’t mutated,” Mendez said. “And that will open the ability for us to find other potential treatments for the patient. It’s an ever-evolving trajectory. We cannot assume, and each patient is unique as well as their cancer. So those continued biopsies, when indicated, we see progression, that's our avenue for what else can we use.”

Educating Oneself During Breast Cancer

Knowing all of this information while navigating the treatment landscape of metastatic breast cancer is help so that patients can advocate for themselves and feel empowered along the way.

“[Patients should] know, if they're at a place that they're not seeing this type of activity or this type of [treatment] flow, they can seek out other opportunities so that they can get what's best for them, given their circumstances,” Mendez said. “At least be aware, because knowledge is power.”

Even with education, there may be a risk of overwhelming patients with information, some of which may also be misinformation.

“If [patients are] tech savvy, they can go to the computer, but a lot of [the information] might not be applicable to them, but be misinformation,” Mendez said. “And how do you know, as a patient, to discern what's real and what's not? And how do we, as people who are in the business, control that? Dr. Google is very famous, so that's a big problem that we have.”

In addition to misinformation, the educational material patients read should also be tailored to their educational level.

“There’s a lot of people who don’t even understand the word ‘cancer,’” Mendez said. “So how do you simplify that information so that they get it, and they can feel even that they have power with what’s happening to their body. It’s really hard.” 

Building Confidence to Discuss Side Effects

Patients have many members on their care team including the oncologist, the advanced practice provider (like nurse practitioners), a nurse and patient navigators, in some instances. As long as patients voice any concerns — no matter how big or small they may seem — to someone on that team, it should be then discussed with the member of the team who makes treatment decisions. 

Mendez said that patients should feel comfortable to discuss their side effects, ask questions and communicate with their team, even though some patients may be like to discuss their concerns than others.

“Not all patients have the same needs,” she said. “Some patients are very, very self-sufficient, and they'll be very vocal. It's more about the patient who doesn't want to impose upon the doctor. They feel that they would be bothering the doctor by calling. But in reality, if we don't know, we cannot do anything about it.”

Once made aware of any concerns, care teams may be able to help address them either with pharmaceutical modalities or even adjusting doses of the cancer treatments.

“A lot of these side effects occur not when you're at the doctor's office; they occur when you're taking the medication at home,” Mendez said. “You might be having dehydration. You might have diarrhea. You might be having fatigue. You don't want to do anything. You might be depressed. Whatever the reason might be, if we don't know, how can we change that or adjust the treatment to make it more palatable for the patient?”

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