Chemo During Stage IV Cancer
This is another one of those blogs that will either be of intense interest or no interest. Many of you are aware that the standard of care for women with metastatic/Stage IV breast cancer is serial treatments, each one being given for as long as it is useful. What this means for most women in this situation is being on one or another treatment for the rest of their lives. Some of the treatments (like the AIs) are relatively easy to tolerate, while others bring more intense side effects--including the hated hair loss. Whenever a treatment needs to be changed, at the point that it has stopped being effective (reason: cancer cells are unfortunately brillant and eventually figure out how to be resistant to any one drug), it is a psychological crisis: women worry that one more possibility has been spent, and wonder what the side effects/QOL will be on the next.
There is some debate in the medical community about this whole strategy; some oncologists believe that it is sometimes safe to stop treatment for a while. This is an editorial from the Journal of Clinical Oncology about this. I give you the beginning and a link:
How Long Is Long Enough?
Andrew D. Seidman, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
Mrs. Smith, an otherwise healthy 58-year-old woman, is in your office to review the results of a computed tomography- guided needle biopsy of a suspicious lung nodule three years after she completed adjuvant chemotherapy for stage II breast cancer. You empathetically explain to her that the results confirm a diagnosis of metastatic breast cancer (MBC) which, like the primary tumor, lacks hormone and HER2 receptor overexpression. Mrs. Smith coughs a cough that has only developed after her computed tomography scan revealed numer- ous bilateral pulmonary nodules. You explain the role for cytotoxic chemotherapy in attempting to achieve a remission, improving cancer-related symptoms, and you hope, prolonging survival. You explain the laundry list of possible adverse effects from your planned chemotherapy regimen. Mrs. Smith then asks, "Doctor, how long will I need to be on this chemotherapy?"
Depending on who her medical oncologist is and, to some extent, on geography, Mrs. Smith may get different recommendations. For example, one oncologist might say, "We will treat you for 4 to 6 months and then stop and observe. We can always treat you again as the need arises." Another might say, "The duration of your chemo- therapy cannot be determined in advance; it will depend on how well your cancer responds to treatment and how well you tolerate it." Can both approaches be correct, or in fact, is there only one right answer?