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36

NCCN Guidelines for Patients

®

:

Breast Cancer – Metastatic (STAGE IV), Version 2.2017

pertuzumab) with either docetaxel or paclitaxel.

These options extend life the most. If neither is an

option, ado-trastuzumab emtansine may be used first

to treat metastatic cancer. Other options are listed in

Guide 7.

The cancer may worsen during treatment with

trastuzumab. In this case, keep taking a HER2

signal–blocking treatment. Research has shown

HER2 treatment still helps. Options are listed in

Guide 7.

Stopping chemotherapy

. Chemotherapy may not

be helpful in two situations. It may not help if there

were no benefits during 3 back-to-back regimens.

It may do more harm than good if you get too sick.

At this point, think about stopping chemotherapy.

Supportive care alone may be received.

Checking treatment results

Your doctor will want to know how well treatment is

working. The cancer might improve (response). It

may stay the same (stable disease). It could also

worsen (progression).

Cancer progression occurs because treatment

doesn’t work. Drug treatment may not work when

first given. For some people, drug treatment works

at first but then stops working. This is called drug

resistance. Resistance to endocrine therapy occurs

often.

Different types of tests are used to check treatment

results. Some assess the status of cancer. Others

assess for side effects of treatment.

Guide 8

lists

the types and frequency of tests that are advised by

NCCN experts. How often these tests are given may

differ based on how well treatment is working.

Your doctor will ask you about any new or worse

symptoms. He or she will also perform a physical

exam and measure your body weight. Your state

of general health will be rated using a performance

status scale. The two scales commonly used are

the ECOG (

E

astern

C

ooperative

O

ncology

G

roup)

Performance Scale and the KPS (

K

arnofsky

P

erformance

S

tatus). For either scale, your doctor

will choose a score that best represents your health.

Blood samples will need to be drawn to perform three

tests. CBC is used to assess the extent of cancer

growth within bones. Liver function tests are used to

assess the extent of cancer growth within the liver

and other organs.

Your blood may also be tested for proteins that can

indicate whether treatment is working. These proteins

are called tumor markers. Examples of tumor

markers include CEA (

c

arcino

e

mbryonic

a

ntigen), CA

15-3 (

c

ancer

a

ntigen 15-3), and CA 27.29 (

c

ancer

a

ntigen 27.29).

One increase in tumor markers doesn’t always mean

that the cancer has progressed. Your doctor will

look for rising levels across a series of tests. Tumor

markers may be more helpful than imaging tests

when metastases are mainly in bone. Changes in

bone lesions are hard to assess on imaging tests.

Three imaging tests may be used to check treatment

results. CT with contrast of your chest, abdomen,

and pelvis and a bone scan are advised. PET/CT

is an option. These scans can show larger or new

areas of cancer.

3

Treatment guide

Checking treatment results