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Extensive liver mets - 9th line of treatment, any hope?

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Hi everyone, my mum was diagnosed in April 2019 with Stage 4 breast cancer (de novo) with widespread mets to spine, liver and lungs. At the time she was only given 3 weeks to live however by some miracle she learnt to walk again ( after tumours broke her spine) and has been fighting this disease ever since.

She was well in herself up until Aug 2022 when a dose reduction of enhertu lead to very quick progression in her liver. She's tried Eribulin this month but side effects have left her unable to walk, eat or drink due to severe mucositis.

Eribulin, within 3 weeks has completely incapacitated her, her liver numbers are rapidly increasing and her oncologist has said that they will discuss next steps after an urgent liver scan.

I'm looking for hope from any ladies who have been in a similar situation with a similarly bleak outlook given the number of treatments she's already gone through? Her liver is covered (minimal sparing of her right lobe), bone mets are inactive, lungs mets all gone.

As her daughter, my mum is my best friend and her diagnosis out of the blue still seems like a bad dream. I've always kept positive but for the first time in 3 years I am worried the end is near.

She is ER+, PR+, her2 (borderline +). Treatments:

leterezole

Tamoxifen

Herceptin + Taxol

Neratinib

Xeloda

Kadcycla

Enhertu

Eribulin

Comments

  • weninwi
    weninwi Member Posts: 762
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    minp,

    I'm so sorry....I sent up a prayer for your mum and you. Has her doctor done a biopsy yet...either a liver tissue biopsy or a liquid blood biopsy for genomic testing so they know what mutations they are dealing with?

  • concerned_daughter11
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    Hi minp,

    While I'm not stage 4 myself, my mom was diagnosed with stage 4 bc Oct 2021. I noticed your mom has not tried verzenio or any other cdk 4/6 inhibitor. Is that something that might be an option for her?

  • minp
    minp Member Posts: 4
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    hi weninwi, thank you so much for your prayers it helps more than you can imagine. I’ve got that on my list of questions to ask for next week as she has not had a liver biopsy yet. Her original biopsy in 2019 showed no genetic mutations and was her2 low, er+, pr+ but I think something else has changed in her liver now.


    It’s good to know she can have a liquid blood biopsy as she is uneasy with the thought of a liver biopsy so I hope that is an option here in the uk.

    Blessings for your continued good health x

  • minp
    minp Member Posts: 4
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    hi concerned_daughter11, I’m not sure why she was never offered those types of drugs so will ask about that too, thank you for the suggestion. Its

  • weninwi
    weninwi Member Posts: 762
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    I concur with concerned_daughter re if a CDK4/6 inhibitor could be tried? There are three: Palbociclib (Ibrance), Ribociclib (Kisquali), Abemaciclib (Verzenio). I've read that Verzenio is particularly effective against liver mets. Each of these drugs has a discussion thread on this board with lots of tips on how to deal with side effects.

    The hormonal treatment I don't see on your mum's list is fulvestrant (Faslodex). It's an injection into each hip/buttocks given on day 1, day 15, day 28 and then every 28 days until it stops working. it must be given by someone specifically trained to give it. There's a discussion thread for Fulvestrant (Faslodex) also.

    If your find out your mum has the ESR1 mutation, which is common with ER+ and is driven by use of aromatase inhibitor drugs like Letrozole, which your mum was on, then there's a new oral SERD type drug ELASCESTRANT which is effective against that mutation and which is due to get FDA approval in Feb 2023 (I believe).

    I'll continue to keep your mum and you in my prayers.

  • minp
    minp Member Posts: 4
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    This is so helpful thank you so much. I don’t know why they were never offered to her actually. She was brought in as an emergency case (broken spine, cord compression, hypercalecemia) prior to initial diagnosis in 2019.
    She was put on leterezole to buy some time until she was well enough for Taxol. From that point onwards I think the progression in the liver was pretty quick so they moved away from AIs etc and went straight to targeted her2 therapies and chemo (xeloda).

    My concern now is that she’s basically had no treatment that has worked since Aug (1 month break due to the flu and 2 cycles of Eribulin that failed) so I can only imagine what her liver status must be. I just hope they have something to offer and that they don’t think she’s too far gone!