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Definition of Stage IV Breast Cancer

by: RayLam
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Stage IV breast cancer has traditionally been considered an incurable cancer. In the mid to late 1980's the average patient with stage IV breast cancer treated with low-dose chemotherapy survived 8-10 months before their cancer relapsed and less than 5% of patients could expect to survive 5 years without their cancer recurring. In 1988, the results of a small clinical trial treating 22 women with stage IV breast cancer treated with high-dose chemotherapy and autologous stem cell transplant were published. Fourteen percent of these patients treated with high-dose chemotherapy survived without their cancer recurring beyond 5 years.

Up to 5% of white women in the U.S., and up to 9% of black women have advanced breast cancer spread to distant tissue at the time of first diagnosis (SEER). This difference is usually attributed to poverty and lack of health insurance.

Researchers from several medical centers, however, more recently treated 553 women, ages 18 to 60 years, with 4 to 6 cycles of a standard-dose chemotherapy combination. Then, patients in a complete or a partial remission were assigned to receive additional therapy with either continued standard-dose chemotherapy or a single course of high-dose chemotherapy. Results showed that, of the 553 women treated, 10.5% had a complete response and 46% had a partial response to the initial standard-dose chemotherapy. Then, 110 patients were assigned to receive the additional high-dose chemotherapy and 89 patients were assigned to receive the additional standard-dose chemotherapy.

This study suggested that there were no differences in survival between the standard-dose and high-dose chemotherapy regimens in women with metastatic breast cancer who had a complete or partial response to initial standard-dose therapy. However, the number of women treated in this trial does not allow the identification of any subsets of women that might benefit more than the overall group from the high-dose regimen.

Additional clinical trials directly comparing conventional chemotherapy treatments to high-dose chemotherapy treatments are currently ongoing to help determine which patients may benefit most from high-dose chemotherapy treatment.

The main reason patients with breast cancer fail treatment is relapse. Relapse of breast cancer occurs because the high-dose chemotherapy is either unable to kill all the cancer cells in the patient and/or because cancer cells "contaminating" the stem cells are infused back into the patient. The majority of relapses occur because all the cancer cells were not destroyed by the high-dose chemotherapy treatment. However, some relapses may be due to infusion of breast cancer contaminated stem cells. Doctors are performing clinical trials designed to improve the treatment of breast cancer with high-dose chemotherapy that include the following approaches alone or in combination:

Monoclonal antibodies are a treatment that can locate cancer cells and kill them directly without harming normal cells. Herceptin (trastuzumab) is the first monoclonal antibody approved by the Food and Drug Administration for the treatment of breast cancer. Herceptin recognizes a protein on the cancer cell surface of 1 in 3 patients with breast cancer. In order to be treated with Herceptin your doctor must test the breast cancer cells for the protein that Herceptin recognizes. This protein is called Her 2-neu. Herceptin or other monoclonal antibodies are not substitutes for other cancer treatments but have the advantage of being administered during or after high-dose chemotherapy and killing cancer cells by a different method than chemotherapy with the goal of improving the total treatment. Clinical trials are currently being performed to determine whether monoclonal antibodies administered during or after high-dose chemotherapy can improve survival or cure rates.

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Definition of Stage IV Breast Cancer

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