Metastatic Breast Cancer

[dimuzio26]

My mom had breast cancer and both breasts removed.  She was cancer free after that for 5 years.  Then in December of 2005 it showed up on one of her tests in her bones.  She was treated with hormone therapy for the 1st year.  However, it kept spreading through the bones so a few different hormone therapies were tried.  They finally decided to switch to chemo and at the start of it the cancer had spread 3 lesions on the liver & 2 nodules in the lung.  She has now been on the chemo for 11 months straight with no breaks.  The cancer has not progressed and the liver & lung lesions are not showing up.  They are going to keep her on the chemo.  I am glad this is working but is it ok to be on chemo for this long period of time?  Thank you.

[Dennis MD]

Hi.
I’m glad to hear that your mother’s cancer has stabilized.
What is her chemotherapy regimen?  Is she also being given bisphosphonates for the bone metastasis?
Chemotherapy can be continued until disease progression.  Since your mother has stable disease at present, her chemotherapy can be continued.  However, there are ceiling doses of several chemotherapy drugs.  Once the ceiling dose is reached, the drug should be discontinued as there are toxicities involved.  Another point to consider in continuing chemotherapy is the side effect/s being experienced by the patient.  If the chemotherapy has severe side effects to the patient, there may be a need to stop temporarily the sessions.

[dimuzio26]

Hi.
Thanks for your input.  My moms therapy consists of Zometa 1 time a month, Avastin 2 times a month, and Abraxane 3 times a month.  When you say ceiling dose do you mean as in the longest amount of time it can be given?  Or do you mean when they start giving it they give a small dose and then keep increasing the dose as the therapy continues & once it reaches the ceiling dose you need to stop it?  Either way wouldn't the ceiling dose have been reacheed being she has been on it a year this month?  Her WBC's are very low but she comes in for a shot the day after chemo.  She has had a cold that won't go away for months now even, being on antibiotics.  Also bleeds alot when she blows her nose and coughs up blood,  her Hemoglobin was 9.  Is this a side effect of the chemo?  Thanks for your time.

[Dennis MD]

Hi.
Thanks for the update.
Zoledronic acid (Zometa) is a bisphosphonate that is used for bone metastasis.  It can help prevent skeletal events in patients with bone metastasis.  It can also help relieve the bone pains caused by metastasis.
Ceiling dose is the maximum total dose of the drug given to a patient before serious side effects or toxicities develop.  There are certain chemotherapy drugs with ceiling doses.  Example would be the anthracycline doxorubicin.  
Her low white blood cell count is secondary to the chemotherapy.  I’m assuming she’s being given G-CSF since you mentioned that she is being given a shot a day after her chemotherapy.  That can help raise her count.
Is her doctor aware that she is coughing out blood and there’s blood when she blows her nose?  I think you should mention these symptoms to her doctor.