Important Patient-Provider Conversations in the Metastatic Breast Cancer Space

The landscape of metastatic hormone receptor (HR)-positive breast cancer continues to evolve, highlighting the necessity of genetic and genomic testing, explained Elisa Krill-Jackson, MD.

In a recent interview with Oncology Nursing News, Krill-Jackson, a breast medical oncologist at the University of Miami Sylvester Comprehensive Cancer Center, discussed these changes, as well as the important conversations patients should be having with their nurses and other members of the care team.

Oncology Nursing News: What advice would you give for someone recently diagnosed with metastatic breast cancer?

Krill-Jackson: For metastatic breast cancer, I think it's important to see what's out there. Get an oncologist who has access to clinical trials, who does mostly breast cancer. Treatment can be very nuanced, very specific to a particular patient, to a particular type of tumor. We have tests that we can do on the tumors to look for specific mutations that help guide us in how to treat a patient.

And I think we all need to be supportive of clinical trials. Clinical trials offer a lot of very exciting opportunities for our patients to get new medicines that can help their prognosis. But I think it's also important for patients to know that many patients do very well for many years with metastatic breast cancer, and they can live an awful long time with metastatic breast cancer and have good quality of life.

What are important questions/conversations to be held between patients and their care team?

[Patients] need to understand what kind of cancer they have. Is it estrogen-receptor positive? Is it progesterone-positive? Is it HER2-positive?

Anybody with metastatic breast cancer should have a genetic test no matter what age they were diagnosed at. We want to know if they have a BRCA mutation in all the cells in their body because that would allow us to treat them with a PARP inhibitor, which is a medication designed especially for patients who have BRCA mutations. It's a pill that can help control their breast cancer.

I also like to test my patients with a genomic test. So, we can test the tumor or we can test cancer DNA in their bloodstream to see if their tumor has particular changes in it. These aren't change that they were born with, these were changes that were made in the cells in the tumor. We have drugs that are targeted to particular changes. For instances, if we find something called PIK3CA mutation, we know that they might be a candidate for a drug called alpelisib (Piqray), which has been shown to improve prognosis in women who have these mutations. If they have a mutation in the estrogen receptor of their tumor, then we know that an aromatase inhibitor isn't going to be a good drug for them, and they can get a different kind of agent or go on a clinical trial for new types of agents.

Patients may be afraid that treatment for their ER-positive breast cancer may affect their quality of life. How can clinicians answer that?

I think everything has side effects. Taking an Advil has side effects. I think that's where a relationship with your oncologist, with the nurse that works with the oncologist is so important.

Yes, there are side effects, but oftentimes we're able to control them. A lot of hormone therapies may have sexual side effects in terms of vaginal dryness, but those are things that we have non-hormonal treatments for. Certainly there is no worse side effect than the symptoms that you can have from an advancing breast cancer. So, I think it's really important to avail our patients of the best therapies possible. Side effects can always be worked on, but you have to keep the cancer under control for someone to have the best quality and quantity of life.

What is the role of the oncology nurse in treating these patients?

A good oncology nurse is really important. They can be the first line in terms of dealing with side effects. So someone who's having a side effect from the medication, the oncology nurse can help give supportive therapy to help the side effect, adjust drug dosage or timing. They're a very good resource for educating the patient.

I think they're really our first line, and they're sometimes easier for the patient to access than their doctors.