THE INSIDER’S GUIDE TO METASTATIC BREAST CANCER A Summary of the Disease and its Treatments by Anne Loeser THE INSIDER’S GUIDE TO METASTATIC BREAST CANCER TABLE OF CONTENTS Dedication ........................................................................................................................................................................................................... 0 1. Disclaimer ...................................................................................................................................................................................................... 1 2. Introduction .................................................................................................................................................................................................. 2 3. About the Author ........................................................................................................................................................................................ 3 4. Overview and Suggestions ...................................................................................................................................................................... 4 5. Helpful Hints and Facts ........................................................................................................................................................................... 6 6. Types of Breast Cancer and Related Tests ................................................................................................................................... 10 7. Hormone Receptor Positive MBC, Hormonal Therapies, and Resistance ...................................................................... 17 8. HER2 Positive MBC and Related Therapies ............................................................................................................................... 28 9. Triple Negative MBC and Related Therapies ............................................................................................................................. 32 10. Hormone Receptor Positive, HER2 Positive MBC and Therapies .................................................................................. 35 11. Male MBC ................................................................................................................................................................................................ 38 12. Approved Therapies for Patients with BRCA Mutations .................................................................................................... 42 13. Approved Therapies Based Upon Tumor Characteristics .................................................................................................. 43 14. Biosimilars ................................................................................................................................................................................................ 44 15. Oligometastases ...................................................................................................................................................................................... 46 16. Conditional Survival ............................................................................................................................................................................ 47 17. Tests for Breast Cancer Spread (Metastasis and Progression) ......................................................................................... 48 18. The Microenvironment ....................................................................................................................................................................... 54 19. Personalized Medicine ........................................................................................................................................................................ 56 20. MBC Conventional Therapies Overview .................................................................................................................................... 61 Chemotherapy ............................................................................................................................................................................................ 61 Hormonal Therapy ................................................................................................................................................................................... 69 Targeted Therapy ...................................................................................................................................................................................... 75 21. Chemotherapy Resistance ................................................................................................................................................................. 80 22. Clinical Trials Overview .................................................................................................................................................................... 82 © Copyright 2019 Anne Loeser Updated March 2019 Page 1 THE INSIDER’S GUIDE TO METASTATIC BREAST CANCER 23. Access to Unapproved Medications in the US........................................................................................................................... 86 24. Tumor Biopsy for New Metastatic Sites ...................................................................................................................................... 89 25. Bone Metastasis ...................................................................................................................................................................................... 91 26. Bone Marrow Metastasis ................................................................................................................................................................... 95 27. Liver Metastasis ..................................................................................................................................................................................... 96 28. Lung Metastasis .................................................................................................................................................................................. 101 29. Brain Metastasis ................................................................................................................................................................................. 104 30. Leptomeningeal Metastasis ............................................................................................................................................................ 112 31. Abdominal, Peritoneal, Omentum, and Ovarian Metastasis ........................................................................................... 119 32. Ocular Metastasis ............................................................................................................................................................................... 123 33. Skin (Cutaneous) Metastasis and Ulcerating Breast Tumors ......................................................................................... 125 34. Research and Potentially Helpful Therapies .......................................................................................................................... 128 Research and Potential Therapies for All Categories of Breast Cancer ........................................................................... 128 Research and Potential Therapies for Hormone Receptor Positive MBC ........................................................................ 136 Research and Potential Therapies for HER2 Positive MBC ................................................................................................. 144 Research and Potential Therapies for HER2 Negative MBC (Including TNBC) ......................................................... 147 Research and Potential Therapies Solely for TNBC ................................................................................................................. 148 Research and Potential Therapies for Hormone Receptor Positive, HER2 Positive MBC ........................................ 153 Research and Potential Therapies Solely for Patients with BRCA1 and/or BRCA2 Mutations ............................... 154 Research and Potential Therapies for Patients with Other Tumor Mutations and Biomarkers .............................. 156 35. Therapies for Pain and Neuropathy........................................................................................................................................... 158 36. Therapies to Ease Depression and Anxiety ............................................................................................................................. 169 37. Therapies to Reduce Fatigue and Insomnia ........................................................................................................................... 174 38. Therapies to Reduce Nausea ......................................................................................................................................................... 180 39. Therapies to Increase Appetite ..................................................................................................................................................... 183 40. Therapies to Increase Bone Marrow Production and Blood Counts ..........................................................................