Breast Cancer Metastatis in liver and bone - best treatment option.

I am Dr Sharma from India, a cardio-vascular surgeon. My wife is a female of 40 years with left breast infiltrating duct carcinoma treated with mastectomy, radiation and 6 cycles of Adriamycin and Paclitaxil in 1998. Metastatic tumor in liver (solitary measuring about 10 cm) and bone (BOTH Hip bones) reported a year back; treated with Xeloda & Palmidronate 12 cycles; partial remission of liver tumor (70% reduction)with Sclerosis in right sacro-iliac bone lesion after completion of aforementioned 12 cycles, but no sclerosis in left side acetabular bone lesion. Linear accelerator radiotherapy given to both bone lesions in Nov 2002, and only left acetabular lesion is causing slight pain. Since liver tumor not reducing below 4 cm, and recent MR shows slight increase in liver tumor from 2 cm in Aug 2002 to 4 cm in Nov 2002. Phosphorus spectroscopy done to liver lesion 2 months before and in Nov, 2002 shows decrease in tissue activity and increase in ph, denoting necrosis of the tissue. The treating chemotherapy decided to use Gemcitabine as single drug regime 1 gm/metre square, because this drug group was not used before, and patient responded to xeloda very well, where tumor size reduced to 2 cm after 9 cycles. Hence she may respond to single drug regime- Gemcitabine. First dose given today. Please tell the best treatment options available in the form of chemotherapy, radiofrequency ablation/cryotherapy of liver tumor etc, and monoclonal or immunotherapy in general for micro-metastasis and bone lesions.
The patient is Her/neu - 2 negative; hormone receptors negative

[CCF-RN,MSN-JS]

Dear Dr. Sharma, The goal of treatment of metastatic breast cancer is to control the disease and symptoms.  Decisions regarding treatment are based on the prior treatments, response to prior treatment, overall health of the patient, issues regarding quality of life.  Gemcitabine is a reasonable option.  

Here we are using radiofrequency ablation in select situations to treat metastatic liver tumors from breast cancer.  Some of the criteria used to determine whether this might be of benefit to a patient are: that the patient has had chemotherapy for metastatic breast cancer. The only focus of disease is the liver.  The tumor size, location within the liver, number of tumors as well as amount of the liver that is involved are also taken into account as to whether this would be an option.  At this point with the bone disease present as well as the liver disease a systemic option (chemotherapy) would be a more appropriate treatment.

The monoclonal antibody currently available for treatment of metastatic breast cancer is Herceptin (trastuzumab) which targets the Her2neu receptor.  This would not be an option for your wife as her tumor is negative for this receptor.