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Putting Metastatic Breast Cancer in Perspective

Program: The Treatment Landscape for Metastatic Breast Cancer
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Andrew Schorr:

Well said, and we're going to come back to you along the way and talk about from your point of view as a patient about how to have a successful relationship with your doctor or doctors.  

 

Let's continue our discussion with Dr. Hope Rugo from UC San Francisco.  Dr. Rugo, so the situation is a very variable, isn't it?  Put it in perspective about metastatic breast cancer because again a woman might start by thinking this is the end for me.  Sometimes it moves very fast, but other times it could be many years.  So help put it in perspective. 

 

Dr. Rugo:

I always tell women whether they're diagnosed with early? or late?stage breast cancer that if they are in a room with nine other women who have breast cancer that it's quite likely that there will be nine different varieties of cancer growth, treatment and expected outcome even.  Obviously, what we would like is not to have young woman have recurring breast cancer that Dikla has experienced.  

 

And I think that, you know, this of course is an issue that faces women again when they're making treatment decisions when they first get diagnosed with early?stage cancer, and as Dikla mentioned it really faces women in a very profound way when they get diagnosed with recurrent disease.  We know now that there are many different subtypes of breast cancer, and our goals are to try and treat those subtypes specifically, understanding the biology of that cancer, so that an individual woman would be able to get treated in a way that would be most effective for that cancer's biology.  Of course what we hope in the long run is that what will happen is that women like Dikla won't have recurrent cancer, that we'll cure it up front, you know.  But that's still a little ways off.  We're doing better and better. 

 

So what do we do with metastatic breast cancer?  Well, the goal is to try and start with the treatment that's the least toxic but most effective.  Sometimes we can't get both of them in there, but we try.  And the idea is to try and control the disease with the best quality of life for as long as possible.  So when you're a patient and you thinking, I have recurrent cancer and the doctors told me it's not curable and what am I going to do, the idea is to really understand what your treatment options are up front and understand that treatments have improved tremendously and that for many, unfortunately not all, but for many women who have advanced breast cancer that we can treat the cancer for a number of years with a sequence of different effective treatments. 

 

So as a patient what you really want to know is what kind of biology is my cancer?  What kind of treatment options are there that might be available to me, and why are you deciding as the treating oncologist??like what are the factors that play into your decisions about what treatment you're going to give first second and third.  And then of course, you know, in that whole scheme of things if the treatments that you hear about and the duration that they're expected to work are not what you want to hear, then it's always useful to be thinking about what kinds of clinical trials might be available for you as well that might be thinking outside of the box at new targets.  Because the kind of treatment that Dikla is getting that's working for her came out of lots of clinical trials.  And I know you're talking about this specific topic in another session.

 

Andrew Schorr:

Yes, we are.  We have a whole program with Dr. Gabriel Hortobagyi from M. D. Anderson, Dr. Julie Gralow from the Seattle Cancer Care Alliance.  We'll talk about that in greater detail, and I hope our listeners will check that program out.  Dr. Rugo, along the way we've used this term sometimes, "quality of life," but how do you define that?  What do you mean by that? 

 

Dr. Rugo:

You know, that's a really good question because, you know, it could be defined many different ways, and there are even instruments that are sometimes used to try and make an assessment.  But really what I mean in this??in the context of this conversation is up to

 

the individual.  It's your perception of your quality of life.  How do you feel?  What's your pain, your fatigue?  How can you function?  What's most important to you?  And that's what I mean by saying quality of life for women who have advanced breast cancer.

 

Andrew Schorr:

Dikla, this term "quality of life," what does it mean to you? 

 

Dikla:

I think quality of life is a very subjective term, and for me it means how well do I live my life in the way that I want to.  Can I do everything I want to do and to what extent, and that's how I define quality of life for myself and what I think others would imagine their quality of life to be, could they do what they want to do in their day?to?day routines and in their day?to?day life.

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