Advanced cancer that progresses during treatment

Advanced cancer that progresses during treatment: Treatment for advanced breast
cancer can often shrink the cancer or slow its growth (often for many years), but after a
time, it stops working. Further treatment at this point depends on several factors,
including previous treatments, where the cancer is located, and a woman's age, general
health, and desire to continue getting treatment.
For hormone receptor–positive cancers that were being treated with hormone therapy,
switching to another type of hormone therapy sometimes helps. If either letrozole
(Femara) or anastrozole (Arimidex) were given, using everolimus (Affinitor) with
exemestane may be an option. If hormone drugs stop working, chemo is usually the next
step.
If the cancer is no longer responding to one chemo regimen, trying another may be
helpful. Many different drugs and combinations can be used to treat breast cancer.
However, each time a cancer progresses during treatment it becomes less likely that
further treatment will have an effect.
HER2-positive cancers that no longer respond to trastuzumab might respond to lapatinib
Lapatinib also attacks the HER2 protein. This drug is often given along with the
chemotherapy drug capecitabine (Xeloda), but it can be used with other chemo drugs,
with trastuzumab, or even alone (without chemo).
Because current treatments are very unlikely to cure advanced breast cancer, patients in
otherwise good health are encouraged to think about taking part in clinical trials of other
promising treatments.

Recurrent breast cancer
Cancer is called recurrent when it come backs after treatment. Recurrence can be local
(in the same breast or in the mastectomy scar) or in a distant area. Rarely, breast cancer
comes back in nearby lymph nodes. This is called regional recurrence. Cancer that is
found in the opposite breast is not a recurrence—it is a new cancer that requires its own
treatment.
Local recurrence: Treatment of women whose breast cancer has recurred locally
depends on their initial treatment. If the woman had breast-conserving surgery, a local
recurrence in the breast is usually treated with mastectomy. If the initial treatment was
mastectomy, recurrence near the mastectomy site is treated by removing the tumor
whenever possible. This is followed by radiation therapy, but only if none had been given
after the original surgery. (Radiation can't be given to the same area twice.) In either case,
hormone therapy, trastuzumab, chemo, or some combination of these may be used after
surgery and/or radiation therapy.
Regional recurrence: When breast cancer comes back in nearby lymph nodes (such as
those under the arm or around the collar bone), it is treated by removing those lymph
nodes. This may be followed by radiation treatments aimed at the area. Systemic
treatment (like chemo or hormone therapy) may be considered after the local treatment as
well.
Distant recurrence: In general, women whose cancer comes back in organs like the
bones, lungs, brain, etc., are treated the same way as those found to have stage IV breast
cancer in these organs when they were first diagnosed (see treatment for stage IV). The
only difference is that treatment may be affected by previous treatments a woman has
had.
Should your cancer come back, our document, When Your Cancer Comes Back: Cancer
Recurrence can provide you with more general information on how to manage and cope
with this phase of your treatment.