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
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
. 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
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
Different types of tests are used to check treatment
results. Some assess the status of cancer. Others
assess for side effects of treatment.
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 (
Performance Scale and the KPS (
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 (
ntigen 15-3), and CA 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.
Checking treatment results