Does Shannen Doherty Have Triple Negative Breast Cancer: In an interview with ABC News, actress Shannen Doherty told breast cancer survivor Amy Robach that her breast cancer has come back and is now in stage IV. The 48-year-old actress is best known for her roles in the first seasons of “Charmed” and “Beverly Hills, 90210.”
Doherty was first told that she had cancer in March 2015. She was told she had “invasive breast cancer that had spread to at least one lymph node” when she was diagnosed. She had a mastectomy, chemotherapy, and radiation, and then she had surgery to fix the damage. She told a lot of people about her journey on social media. In 2017, she was no longer sick. She said that about a year ago while filming a new version of “90210,” she was again told she had breast cancer after feeling some strange pain. This time, she kept her diagnosis a secret. She worked 16 hours a day on the show and only told one cast member, Brian Austin Green, about it.
She said that Doherty is coming forward now because her diagnosis will be included in court papers. She has filed a lawsuit against State Farm Insurance because the company denied her claims after the Woolsey fire in southern California in 2018 damaged her home. She said that she would rather “people hear it from me.” “I don’t want you to change it. I don’t want it to be used as proof in court.”
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Robach asked Doherty how she was handling this second diagnosis, and she said, “I don’t think I’ve processed it yet.” “In many ways, it’s a bitter pill to swallow.” She also: “I’m scared to death; I’m pretty scared. There are times when I ask myself, “Why me?” Then I ask myself, “Why not me? Who else?’ Who else needs this besides me? No one does.”
Stage IV/Metastatic Breast Cancer
Metastatic breast cancer is another name for stage IV cancer (MBC). Most of the time, breast cancer shows up in the brain, bones, lungs, or liver. About 6% of women with breast cancer are said to have MBC at the time they are first diagnosed (this is called “de novo metastatic breast cancer”). Also, about 30% of women who are first diagnosed with breast cancer in its early stages will get MBC months or years after the first diagnosis.
The signs and symptoms of MBC depend on which organ(s) are affected. These are some of the most common signs:
- Pain that starts all of a sudden
- Ribs, spine, pelvis, and long bones happen most often.
- Pain or trouble in the lungs
- Not enough air to breathe
- cough that won’t stop
- Changes in how we talk or see
- Memory problems
- Midsection pain or discomfort
- Weakness and lack of energy
- Loss of weight or not enough to eat
Even though there is still no cure for MBC, new treatments have helped many people with stage IV breast cancer live longer and better lives. Even though the average time a patient lives has been said to be 18 to 24 months, some patients live for a long time.
Researchers from the National Cancer Institute, Fred Hutchinson Cancer Research Center, and the Metastatic Breast Cancer Alliance found in 2017 that the number of women in the U.S. with MBC is growing. Also, “the median and relative 5-year survival rate for women who are first diagnosed with MBC is getting better, especially for younger women.”
The researchers thought that the 5-year relative survival rate for women diagnosed with MBC between the ages of 15 and 49 doubled from 18% to 36% between 1992 and 1994 and 2005 and 2012. Between 1992-1994 and 2005-2012, the median relative survival time for women diagnosed between the ages of 15 and 49 went from 22.3 months to 38.7 months, and for women diagnosed between the ages of 50 and 64, it went from 19.1 months to 29.7 months.
The study also found that a small but significant number of women with MBC live for a long time after they were first diagnosed. More than 11% of women younger than 64 were diagnosed between 2000 and 2004 and lived for 10 years or more.
Based on their calculations, the researchers thought that the number of women living with MBC rose by 4% between 1990 and 2000 and by 17% between 2000 and 2010. They also thought that the number of women living with MBC would rise by 31% from 2010 to 2020.
Treatment of Metastatic Breast Cancer
As was said, the introduction of newer systemic treatments has made a big difference in how long people with MBC live. As with all patients with breast cancer, the biology of the tumor and the patient’s health play a big role in figuring out a treatment plan.
The molecular markers ER (oestrogen receptor), PR (progesterone receptor), and HER2 overexpression should be looked for in biopsies of lesions that are thought to be cancerous. Should also be looked at are mutations in tropomyosin receptor kinase and microsatellite-high/DNA mismatch-repair deficiency. Patients should also get BRCA1 and BRCA2 mutation testing on their germ cells.
Even if a tumor didn’t have any of the above mutations at first, it is possible for it to become positive, which could change the treatment. A study by Aurilio et al. says that ER, PR, and HER2 receptor mutations can be different between primary breast cancer and a recurrence of cancer in 5–30% of samples. This shows how important it is to do a rebiopsy.
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The goal of treating a disease that has spread is to make the patient feel better. The goals of treatment include making people live longer and making their lives better. Most of the time, treatment suggestions are grouped by the molecular markers that are present.
Human Epidermal Growth Factor Receptor 2 (HER-2) Negative (HR+) and Hormone Receptor Positive (HR+)
Most people with HR+, HER2-negative MBC should start with endocrine therapy instead of chemotherapy. Even though tamoxifen has been used for many years to treat postmenopausal women with newly metastatic HR+ disease, randomized trials show that aromatase inhibitors have the same or better response rates and progression-free survival than tamoxifen.
Several randomized, but not very strong, trials with premenopausal women have tried to find out if combined hormone therapy (luteinizing hormone-releasing hormone agonists plus tamoxifen) is better than either approach alone. Unluckily, the results have been all over the place.
Even though endocrine therapy is recommended for people with metastatic HR+ disease, patients will always become resistant to it.
Mammalian target of rapamycin inhibitors might make endocrine therapies work better, according to lab tests and clinical studies.
Products of the genes CDK4 and CDK6 have been linked to the fact that hormone receptor-positive breast cancer that can’t be treated with endocrine therapy keeps growing. CDK inhibitors have been approved by the FDA to treat advanced HR+, HER2-negative breast cancer in both the first and second lines of treatment. There are currently three oral CDK4/6 inhibitors: palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio).
About 40% of HR+ and HER2-negative breast cancers have mutations in PIK3CA that turn it on.
Alpelisib (Piqray) is a PIK3 inhibitor that works only on alpha-PIK3.
HR-Negative Breast Cancer (HER2-Negative) (Triple Negative)
Chemotherapy is used to treat breast cancer that doesn’t have hormone receptors. Several chemotherapeutic agents have been used to treat MBC, either on their own or in combinations. There is no evidence that combination therapy is better than single-agent therapy for overall survival. Anthracyclines, taxanes, alkylating agents, fluoropyrimidines, antimetabolites, vinca alkaloids, and platinum are all examples of single agents. Combination chemotherapy is often used when there are signs that a disease is getting worse quickly or there is a visceral crisis.
Anti-programmed death-ligand 1 (PD-L1) antibody Atezolizumab (Tecentriq) can be added to first-line taxane-based chemotherapy for patients with advanced triple-negative breast cancer.
Since the 1990s, HER2-positive metastatic breast cancer that has spread has been treated with antibody therapy that targets the HER2 pathway. This has changed the way breast cancer is treated. Several drugs that target HER2 have been approved to treat this disease. These include trastuzumab, pertuzumab, ado-trastuzumab emtansine, and lapatinib.
Germline BRCA Mutation
The oral inhibitor of poly (adenosine diphosphate-ribose) polymerase (PARP) has been shown to work for people with metastatic breast cancer who have a BRCA mutation in their germ cells.
BRCA1 and BRCA2 are tumor-suppressor genes that make proteins that help fix DNA through the homologous recombination repair pathway. PARP is a key part of DNA repair, and it has been looked at as a treatment for people with breast cancer who have a BRCA mutation in their germline. FDA-approved drugs include olaparib (Lynparza) and talazoparib (Talzenna)
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Therapy That Changes Bones
Patients with bone metastases should think about using bone-modifying therapy to make their bones less painful. Randomized trials of pamidronate (Aredia) and clodronate (Bonefos) in people with the disease that has spread to the bones show that skeletal morbidity goes down. Also, Zometa (zoledronate) has worked at least as well as pamidronate.
The receptor activator of nuclear factor kappa beta ligand is stopped by the monoclonal antibody denosumab (Xgeva). A meta-analysis of three phases III trials (NCT00321464, NCT00321620, and NCT00330759) that compared zoledronate to denosumab for treating bone metastases shows that both drugs reduce the risk of a first skeletal-related event in the same way.
You can use an advanced clinical trial search to find cancer clinical trials that are now accepting patients and are supported by the NCI. You can narrow your search by the trial’s location, the type of treatment, the name of the drug, and other factors.
Michele R. Berman, MD, and Mark S. Boguski, MD, Ph.D., are a husband-and-wife team of doctors who have trained and taught at Harvard, Johns Hopkins, and Washington University in St. Louis, among other top schools. Their goal is to report on common diseases that affect unusual people and summarise the evidence-based medicine behind the headlines.
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