Managing side-effects and symptoms of metastatic breast cancer
Managing any symptoms and side-effects from your treatment allows you live as full a life as possible. There are many effective treatments available for people with metastatic breast cancer.
Some symptoms of metastatic breast cancer can be linked to the cancer itself or you may have side-effects linked to treatment.
Your doctor will be very keen to ensure that any side-effects from your treatment are managed, to give you a good quality of life.
If you have any symptoms that are troubling you, let your doctor or nurse know. There are many treatments that can help to make your life easier.
What are the side-effects and symptoms of metastatic breast cancer.?
Your symptoms will depend on how the metastatic breast cancer has
affected you. You might experience some of the symptoms below.
Pain
Many people with metastatic breast cancer do not have pain. If you do get pain, it can
be helped. Tell your doctor or nurse immediately if you are in pain. Your doctor will try to find out what is causing it so that you get the right treatment.
Painkilling drugs
Your doctor will decide which painkiller is best suited to the type of pain you have. If the medication doesn’t ease the pain, tell your doctor or nurse. If one medicine doesn’t work, your doctor will try something else.
A palliative care specialist who manages pain and other symptoms may also be able to help you. They can arrange for you to try out different painkillers to see which suits you best.
Other drugs
Other drugs can be helpful in reducing
pain. If the pain is due to metastatic breast cancer in the bone, anti-inflammatory drugs can be helpful. Other drugs known as bisphosphonates can also help to relieve bone pain.
Radiotherapy
Radiotherapy is very good for treating bone pain from metastatic breast cancer. It can be given as a single dose or divided over a few days. It usually takes at least 2-3 weeks to work.
Nausea and vomiting
With metastatic breast cancer, you might be sick (vomit) or feel sick (nausea) at some point during your illness. This can make everyday life very difficult to cope with. If you are having problems with feeling sick or vomiting, tell your doctor or nurse.
There are ways to control sickness, depending on what is causing it. You may need a combination of drugs to help prevent nausea and vomiting.
PARP inhibitors
PARP inhibitors can help stop cancer cells from repairing, so that they become too damaged to survive. You may be given a PARP inhibitor if your cancer is HER2 negative with an altered BRCA gene.
Cancer growth inhibitors
Cancer growth inhibitors block the chemical signals that trigger
cancer cells to divide and grow. Lapatinib (Tyverb®)is an example of a cancer growth inhibitor. Some drugs are given as tablets. Others are given into a vein through a drip.
How does my doctor decide on which drugs to use?
Deciding which targeted therapy is best suited for you is determined in a number of ways.
Biology of the tumour
One of the main factors is the biology of the tumour – looking at the cells to see if they have receptors and proteins on their surface that a particular therapy can target. For example, the HER2 protein.
The cells are taken during a biopsy and looked at under a
microscope. Biopsies from an area of secondary cancer may also be checked – it does not have to be breast biopsy. Most people with ER-positive, HER2-negative cancers are treated with CDK4/6 inhibitors and hormonal therapy. About 1 in 5 people will have a HER2-positive breast cancer diagnosis and they will need different drug treatments.
If you had a HER2-positive breast cancer diagnosis and the cancer comes back, it may not be HER2-positive again. This is why biopsies on metastases are done, to check the biology of the tumour.
Other factors
To decide which drugs to use, your doctor may also consider:
- Previous treatments you have had
- How well you have tolerated side-effects
- Any other underlying health issues you have
There is ongoing research looking at different types of targeted drugs for metastatic breast cancer.
Side-effects of targeted therapy drugs
Side-effects depend on the drugs being used and vary from person to person.
Your doctor and nurse will explain your treatment to you in more detail and tell you about any likely side-effects.Common side-effects include:
- Flu-like symptoms – fever and chills
- Nausea
- Headaches
- Diarrhoea
Always tell your doctor or nurse if you don’t feel well or if you are having any symptoms that are troubling you.
Immunotherapy for metastatic breast cancer
Immunotherapy helps the body’s immune system recognise and attack cancer cells.
Immunotherapy drugs may be an option for some types of triple-negative breast cancer.
A test on a sample of your cancer cells can measure how much of a protein called PD-L1 is on the cells. This test can tell your doctors if immunotherapy might be helpful for you.
Immunotherapy is often combined with chemotherapy.
The most commonly used immunotherapy drugs are checkpoint inhibitors like pembrolizumab or atezolizumab. Immunotherapy is usually given as a drip into a vein in a hospital or day unit. Some drugs may be given as an injection just under the skin.
Often you will stay on immunotherapy for as long as it’s working and any side-effects are manageable. Your treating team will go through possible side-effects with you.
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