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Stage IV - no more treatment options?

Hi everyone,

I've posted on here a couple of times. My mom was diagnosed stage IV in oct/Nov. We had a meeting with her oncologist today and it appears that her current line of treatment (piqray and fulvestrant) is not effective either. Her oncologist doesn't seem to think that chemo would be effective, but hasn't ruled it out. She has a pleural effusion, which looks like it excludes her from clinical trials? I guess, in all honesty I'm confused and not really sure where we should go from here. Her Dr. Indicated that it may time to start having a discussion about what our goals for treatment are...


  • moth
    moth Member Posts: 3,293

    concerned_daughter, can you pls list the hormone markers for you mom's cancer as well as all the treatments so far?

  • concerned_daughter11
    concerned_daughter11 Member Posts: 25

    Hi Moth,

    Thank you for the response. My mom's recurrence happened while she was taking verzenio and amirdex in the adjuvant setting (about 1 year after her initial diagnosis of stage 3C).

    HR: 95%, PR 0%, HER2 - (IHC, 2+)

    Mutations: PIK3CA, and D538G (ESR1 mutation)

    Nov-Feb: afinitor/exemestane

    Feb- present: piqray/faslodex

  • concerned_daughter11
    concerned_daughter11 Member Posts: 25

    It looks like my signature line with my mom's medical history has disappeared. I'll need to go in and re-edit my profile to include it again.

  • moth
    moth Member Posts: 3,293

    Hi concerned_daughter,

    Ok I've just looked at the NCCN guidelines & I think preferred next line according to that guideline might be everolimus + hormone blockade

    After that it's systemic chemotherapies. I can send you the screenshot of the recommended chemos as well. Xeloda/capecitabine is an oral chemo that many people start off & has been effective for many & can yield decent quality of life so that's often a first choice in HR+ mets when the cdk4/6 & hormone blockades have stopped working

    Where are her mets?

    Can you consider a second opinion?

    hope this helps a bit


  • concerned_daughter11
    concerned_daughter11 Member Posts: 25


    Thanks so much. This helps alot. My mom's doctor did mention xeloda. I've scheduled a second opinion with MSK, so hoping to see what the Drs there will say.

  • figtree
    figtree Member Posts: 33


    You mentioned your mom has 2+ on Her2?? Could her doctor get Enhertu for her off label? it has shown great results for Her2 low tumors, and it probably will be FDA approved soon. There are so many ADCs in clinical trialsfor Her2 low right now. But I understand you said she might not be in the position for trials. I’m hoping she can get Enhertu now or very soon!

  • concerned_daughter11
    concerned_daughter11 Member Posts: 25


    Thanks. Yes - My mom has an appointment today with her oncologist so I will bring it up. I also saw that article that showed that enhertu was successful for patients with her2 low tumors. It appears this cancer is progressing pretty quickly, her tumor markers went from 302 to 890 in less than one month. Her liver numbers are also all out of wack. I'm hoping there is a treatment that might be able to tame this beast :(