Advanced breast cancer treatments: Benefits vs. side effects

The FDA has issued a warning about some new novel therapies for advanced/metastatic/Stage IV breast cancers. The three named drugs are called CDK4/6 inhibitors and are generally prescribed along with hormone or anti-estrogen therapies for women with ER positive advanced breast cancers. The three drugs are palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). The risk is the possible development of either pneumonitis or interstitial lung disease (ILD).

This is a difficult and not rare occurrence. The FDA is careful to say that the possible benefit of these targeted therapies, to slow the growth of metastatic breast cancer, is greater than the possible risk of developing serious lung disease. We all know that cancer drugs are very powerful, and we are familiar with the less dangerous, but certainly unpleasant, side effects of many: GI issues, hair loss, fatigue, etc. When we accept treatment for cancer, we discuss the range of possible effects with our doctors and sometimes are asked to sign consent forms.

Cancer treatment is serious business. It is scary to realize that a treatment may make us more ill or introduce a new medical problem. It is also scary, maybe scarier, to understand that the treatment is probably better than the alternative. Untreated advanced cancer will continue to progress and cause death. Our goal is to delay that outcome as long as possible and to maintain a good quality of life.

A real change in recent years has been many advanced cancer patients, not just those with breast cancer, living for years. This new way of life, not exactly sick, but not exactly well, is challenging and uncharted. In one of my groups for women with metastatic cancer, someone commented: "We are all living on borrowed time." Another woman quickly retorted: "It’s not borrowed time. It is rented time because we are paying a high price for it."

The FDA announcement is a good example of one very high rent.