What Factors Help Guide Metastatic Breast Cancer Treatment Decisions?

What Factors Help Guide Metastatic Breast Cancer Treatment Decisions? from Patient Empowerment Network on Vimeo.

What treatment is best for your metastatic breast cancer? Dr. Halle Moore of Cleveland Clinic reviews important considerations when choosing a therapy, including the role of molecular testing.

Dr. Halle Moore is Director of Medical Breast Oncology at the Cleveland Clinic. Learn more about Dr. Moore, here.

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Transcript

Dr. Halle Moore:

For patients with advanced breast cancer, some of the major factors that affect our treatment decisions are first the receptor results. This includes the ER and PR, which are the hormone receptors, as well as HER2. These receptors really guide the initial treatment options.

In addition, the patient’s overall health status is an important factor in treatment decisions. And then the prior treatment history, what the patient has previously received, either in an earlier stage of disease or previously for their advanced cancer.

Molecular testing for metastatic breast has gone from something that was primarily used only in the research setting to something that is now quite valuable in making treatment decisions every day in the clinic.

The results of molecular testing may indicate whether our patients are eligible to receive certain treatments, such as immunotherapy or certain targeted cancer treatments. We also have an increasing number of clinical trials that are testing treatments targeted to the molecular drivers of an individual’s cancer.

I would say one of the most interesting new approaches in the treatment of metastatic breast cancer is the use of antibody drug conjugates. These combine an antibody against a target that’s likely to be present on cancer cells more so than on normal cells in the body.

And, typically, a very potent chemotherapy drug is combined with the antibody. The antibody then allows for delivery of a high concentration of this chemotherapy drug preferentially to the cancer cells allowing for very effective treatment of the cancer while limiting toxicity from the treatment to the rest of the body.

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know?

COVID-19 Vaccination: What Do Breast Cancer Patients Need to Know? from Patient Empowerment Network on Vimeo.

Is it safe to get the COVID-19 vaccine if you have breast cancer? Dr. Halle Moore of Cleveland Clinic provides valuable insight, including a discussion of side effects and the importance of staying up-to-date with visits and screenings.

Dr. Halle Moore is Director of Medical Breast Oncology at the Cleveland Clinic. Learn more about Dr. Moore, here.

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Transcript

Dr. Halle Moore:

For most adults with cancer or with a history of cancer, vaccination against COVID-19 with one of the newly approved vaccines is definitely recommended.

Common side effects after the COVID vaccinations are a sore arm, which is probably one of the most common side effects that we see. Fatigue and muscle aches can occur. Also, some patients will experience fever and chills, and that seems to be especially after the second dose of the vaccine. Rarely, severe allergic reactions can occur. And also, some people will experience enlargement of lymph nodes, typically in the underarm area or in the neck on the side of the vaccination.

This is particularly important for cancer patients to be aware of since enlarged lymph nodes could also be seen with cancer, and that might be alarming to some patients if they experience this side effect without knowing that that is a normal immune response to the vaccine.

In addition, cancer patients who are getting imaging, either a CAT scan or even a routine mammogram, if they get that imaging soon after the vaccine, the lymph nodes could be seen on imaging, and that might raise a concern as well. So, it’s important that patients let their provider know if they’ve had a recent vaccine and they’re getting any kind of imaging or mammogram.

So, breast cancer patients who are on chemotherapy or other treatments that could affect the immune system should definitely discuss with their oncology team the timing of vaccination with respect to their treatments.

This often needs to be individualized based on the planned duration of the cancer treatment as well as how much that treatment actually affects the immune system. In general, it is safe to get the vaccine during chemotherapy. It’s just that there may be a potential for reduced immune response during certain types of chemotherapy.

On the other hand, some chemotherapies are given more long term. And we don’t generally advise interrupting the chemotherapy for vaccination. So, oftentimes, we will recommend vaccination even in the setting of cancer treatment. Certainly, anti-estrogen treatments, hormonal treatments for breast cancer, or radiation treatment for the breast cancer should not alter either the safety or the effectiveness of these vaccines.

So, some of the ingredients in the various vaccinations that have led to these allergic reactions that we’ve heard about are also present in certain chemotherapy drugs. So, for people who have had a life-threatening reaction to chemotherapy, for instance, an anaphylactic reaction, it would be a good idea to discuss with your oncologist whether you should see an allergist prior to vaccination. This is something that we’re recommending for patients who’ve had severe allergic reactions to try to determine what component the reaction was to and whether vaccination with any of the individual vaccines might be safest.

Delaying care for non-COVID-related health concerns has been a major concern over the past year. It’s important for people to know that hospitals and medical clinics have numerous safety precautions in place. And we are really strongly encouraging everyone to continue to address all of their healthcare needs and to receive important treatments, particularly cancer treatments.

Breast Cancer Before 40: How Can I Preserve My Fertility?

Breast Cancer Before 40: How Can I Preserve My Fertility? from Patient Empowerment Network on Vimeo.

Dr. Stephanie Valente discusses fertility preservation in breast cancer patients under the age of 40 and the potential for pregnancy following treatment.

Dr. Stephanie Valente is the Director of the Breast Surgery Fellowship Program at Cleveland Clinic. More about this expert here.

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Transcript:

Dr. Stephanie Valente:

So, another issue that is really important for young women is discussing fertility preservation. And this really needs to happen at the time of their diagnosis. So, we know that the cytotoxic agents that we can give females just through chemotherapy can decrease the ovary and the ability for these women to have menstrual periods after chemotherapy. So, the ability for them to get pregnant naturally.

As well as some of the medications. So, somebody who has a breast cancer that is estrogen positive, the recommendation is for these women to be on hormone suppressant medicine for five to 10 years after their breast cancer diagnosis and treatment, therefore not being able to be pregnant while on these medications. So, talking with young women when they get diagnosed about their family planning and their fertility options up front before they have surgery or chemotherapy is really beneficial.

And whether or not they need to see a fertility preservation specialist. If they want to consider IVF. Or if they have a gene, looking at genetic testing for their future offspring. So, these are all conversations that really need to happen before these women begin chemotherapy if they need it.

And the good thing is that at the young women’s clinic, these fertility specialists are embedded in the clinic. So, they are able to get an appointment with them right away. And a lot of times if these women do want to undergo fertility preservation, that can happen within 10 days of seeing the specialist. So, it really doesn’t delay their care. And we do know that it is safe even with the breast cancer diagnosis.

The other thing is that we do offer a medicine which is a GRNH agonist which will kind of essentially shut down the ovaries during chemotherapy to help protect them so that when a young woman is done with chemotherapy, it helps the ovary kind of get back to normal a little bit sooner.

So, it sounds good in theory. Unfortunately, it’s not something that is covered by insurance companies right now. And so, fertility preservation is expensive. And so, the good thing is there are a lot of groups that put together packages and stuff for these young women to be able to afford it. But it is pretty pricey. So, for those that can afford it, it is a great option. And a lot of them do take advantage of it. I think there are a lot of misconceptions about it. Number one is that patients don’t really know if it’s safe.

Number two, they are scared about their overall diagnosis and a potential delay and 10 days might make some of them afraid that doing that is a good option. Another thing is when these women come in with a diagnosis of breast cancer, they see a surgeon, a medical oncologist, a radiation oncologist, a plastic surgeon.

And so a lot of times an extra appointment at that point in time is just really overwhelming for these women. So, our goal is to kind of refocus and say, “Hey, the good news is that with our modern therapies you’re going to be here for a long time. So, let’s plan for the future now so that in the future you’ve got options.”

Healing vs. Curing

Healing vs. Curing from Patient Empowerment Network on Vimeo.

Founder and CEO of CanSurround, Meg Maley, alongside a panel of Niki Koesel. MSN, ANP, ACHPN, FPCN, Eric Roeland, MD, and lung cancer survivor Randy Broad discuss healing vs. curing and how a healthcare team should focus on what it means to each individual patient.

Supportive vs. Palliative Care

Supportive vs. Palliative Care from Patient Empowerment Network on Vimeo.

Founder and CEO of CanSurround, Meg Maley, alongside a panel of Niki Koesel. MSN, ANP, ACHPN, FPCN, Eric Roeland, MD, and lung cancer survivor Randy Broad discuss the definitions and differences of supportive and palliative care, and what it means to them