I'm hearing the phrase curative intent used in oligometastatic setting but I too haven't really seen a good definition. I also heard it thrown around with some of the new HER2 treatments at ASCO this year.

My *guess* is that if you get certain 5 year survival rates, you start thinking of it as curative. I mean baseline early stage is high 70s to high 90s survival at 5 yrs and that's what we think of as curative treatment. There's probably some percentage where they start thinking of it as curative..

For most people 5 years is not really what we're looking for, is it? esp in early stage but even in Stage 4.

I'd like to hear what an MO has to say about this

xbrnxgrl,

I actually think, had you been diagnosed more recently you might have heard curative intent in your case. Forgive me if I have this wrong but didn’t you have a single bone met which was radiated? That would be defined as oligomets and it seems that zap did it’s job. It’s wonderful to think you might be disease free!

It’s a bit tricky with bone mets as the remnants remain. I know, in my case, my MO was not sure about progression as what showed up on CT scans could also have been signs of healing. I’ve not had a PET scan so can’t say what that would show.

Totally understand why you would stay on the AI. I would do exactly the same thing in your circumstances. After all, what if….

It would be interesting to look at the term curative intent through a regional lens. The reason I ponder this is the significant difference in standard treatment depending on where one lives. For instance, local treatment of visceral mets is not an option here in Canada with the exception of instances of oligometastases. And yet, it seems much more common in other countries.

Interesting…

My doctors explained they are utilizing much more aggressive treatment than they used to in the not so distant past for MBC - like Olma said, not just offering palliative care. Particularly for oligometastatic cancer. I talked with my RO about the two intense fractions of SBRT he recommended, we discussed the SABR-COMET clinical trial outcomes (thus far), and the hope that the SBRT could ultimately destroy/silence the met and keep it from spreading in the distant site where it was found. He and my MO (both at Kaiser) basically said, "this is the recommended treatment now, we want to give you the best chance of as long a life as possible". But they did not use the word cure.

I asked my MO what that meant when first DX as he said they were going to treat me with curative intent. He said while I would never be cured by their current definitions, the MBC would be unlikely to be what kills me. And as Mae said their treatment decisions would be more similar to an early stager.That's what he meant by it (at least this is what I recall…happily, it's been 6 years)

From the conclusion of the article:

"Given the growing disconnect between names and expected outcomes with chemotherapy, we recommend a renaming such that the terms curative, life‐extending, and palliative chemotherapy correspond to the current outcomes expected to result from the administration of chemotherapy (Table (Table1).1). In our redefined nomenclature, curative chemotherapy retains its meaning as chemotherapy given with a high likelihood of improving a patient's probability of non‐recurrence. Life‐extending chemotherapy then refers to chemotherapy whose primary intent is to extend a patient's life for a meaningful length of time."

They question the use of chemotherapy as palliative care; that is, to reduce symptoms for patient with a short time left:

"Our own study demonstrated that the use of chemotherapy in settings where there is no evidence to establish its benefit in prolonging survival often leads to a worse quality of life rather than to palliation [13]."

"Our nomenclature would clarify the intent of the chemotherapy to the patient (and family members and health care providers), provide an accurate and less demoralizing language for patients and, by reducing confusion as to the intent of treatment, promote informed decision‐making. In many instances, outcomes produced by chemotherapy have improved dramatically. The time has come for the terms used to describe chemotherapy to reflect the current goals of this type of care more accurately."

I would add that now (the article is from 2017) in breast cancer treatment, we have to consider how all the targeted and hormonal therapies and local treatments fit in with our terminology. In my own case, at the moment I am on two targeted and one hormonal therapy for stage iv. It is not chemo, but it is "nothing to sneeze at" in terms of the toll it takes on me (though totally worth it to me) and in terms of my hope that it might maybe could be curative in the sense that I could have a normal life span. This seems similar to Jen's definition. I base this hope on the success we are seeing with Her2 therapies these days. My treatment is for Her2 mutated rather than amplified (thus the trial), and I hope to see similarly long-term results. Being NED also gives me hope, but I have been NED twice before. But if serial NED or long-term stable can allow us to live a normal lifespan, that would be the next-best thing to cured. Sondra, I think using the term "chronic intent" is a brilliant idea. Chronic is actually starting to seem accurate for some stage iv patients, namely Her2+ And those (like exbrnxgrl) who as oligo patients have been treated with both local and systemic treatment similar to treatment for early stage, as illimae describes. May better treatments be found so that more and more stage iv bc patients can live a normal lifespan with decent quality of life (however they define it for themselves.)

A very good idea to discuss what is meant by "curative" and related terms.

B-A-P wouldn't you prefer another term such as "life-extending intent" or "chronic intent"?

In my medical records, my treatment was described as palliative chemotherapy. This would fit the concept of improving quality of life, because at the time I was losing weight, was extremely weak and in pain and unable to put any pressure on my back (so not much sleep). Two chemo cycles later the back pain was gone. My brother who had advanced pancreatic cancer also fit that box of palliative FOLFIRINOX chemo mentioned in the article, but it didn't work for him, not sure it palliated anything.

I think it's clear if you are dealing with cancer, it's all about intent. My doctors, though, including a second opinion doctor, never mentioned curative. I knew the approach they would take was multi-modal (chemo, radiation, surgery, endocrine therapy). It's possible the chemo was palliative and the rest were curative given that chemo got me to NED. A third opinion doctor I consulted regarding how long to take Zometa was the one who mentioned that my treatment had curative intent. In any case, there are many here who started with one mode of treatment and made the decision depending on the result as to other modes of treatment. Just for expectation management it may be better to frame the decision tree as dynamic.

Even if there is no cure, this is not equivalent to saying some people are not cured. It's just anybody's guess how they got cured or even if they are cured until they die of something else.

Shetland,

I do like " Chronic intent" better to be honest. It has less of a negative connotation that way. I think it's easier mentally when you feel like this is something you live with and manage , but it doesn't equate to death in the near/present moment. Palliative, while it doesn't necessarily mean you're on deaths doorstep, just has such a negative feel to it. It makes me feel worse to hear it. It's a reminder about how crappy this really is and death is likely at some point. To me, sometimes palliative feels like the effort is gone to do everything possible to keep mets at bay, almost as if we are lost causes. I told my MO to not treat me as if I'm dying. I'm young, I can handle a lot .Exbrnxgrl- I think the term " cure" in this world of mbc, is really subjective. For you, you will never label yourself that even if you were to die of something else, and that's okay Some might have a different definition .

Fascinating discussion. I was certainly not treated with "curative intent"-no surgery, chemo (yet) or radiation except to my spine but here I am going strong almost 5 years later. I have no regrets because it seems for some individuals mastectomies, removal of lymph nodes, radiation and heavy chemo like A/C have long lasting negative effects on both the body and emotions. I guess it is a question of the road not taken for me but I am happy where I am at.

How do we know if anyone is "cured" of cancer? I assume they use scans/tumor markers for those whose cancer was caught at earlier stages to declare someone cancer free yet we have seen cancer recur in those who thought they were "cured."

I am an incurable optimist and still hope and pray for a cure for all types of cancer in our lifetime. I think the research work has been amazing and hope they all keep at it.

To All: This is an interesting topic. I always think "palliative" means we will ease the symptoms until you fall off the twig. "That is the best we can do for you" - "curative intent" sounds like there is a possibility that if all goes well, we could be cured of an incurable disease. It is semantics and we will all respond differently to the words. I can handle not being CURED if I feel good, can live the life I lived before DX and just pop in for the scans and my every three weeks infusion.

exbrngrl: My DH and I are always yelling at the telly when someone butchers the language. How did "calculus" become the go-to word when they really mean "calculation"? We've given up yelling at "impact" when the speaker means "affect" How did verbs become nouns and nouns verbs? I'll forgive speakers for saying "I can't put up with that" instead of "Up with which I cannot put" I am not a total language cop.

Like Chicagoan: I hope for cures or better and longer lasting treatments that don't kick our asses along with kicking cancer's ass.

exbrngrl: I agree. I don't want the equivalent of "acadamie francaise" - I don't know if you ever saw the mini-series "The Story of English" . It was fascinating. The language is a hodge podge of languages. I can live with impact/affect but calculus is nowhere near the same as "calculation". I guess it makes me crazier than any of the others. My fear is people won't learn or be able to write actual words . A generation of OMG, LOL, R U Home, I H8 U Lordy. Mayhap, there shall be souls to whom the art of writing still exists. Prithee let it be so

As noted, the main quibble in the article is with the term “palliative” moreso than the term “curative”. I do think they make a very good point in that regard, “life extending” seems more accurate - and more encouraging- than palliative which we patients tend to associate with end of life care.

I have seen the HER2 targeted therapy I receive referred to as “maintenance” treatment and I believe I’ve also seen “maintenance chemo” in some articles. These seem pretty accurate to me also - maintaining the progress gained since the initial treatment. And “maintaining” the state of being alive! Would be okay with this term as well, although “life extending” has more of an optimistic connotation.

“Curative” treatment for Stage IV might be better described as “aggressive” treatment for Stage IV, for us linguistic purists : )

“Aggressive treatment in MBC patients where long term remission is likely to be achieved.”

A cure to me implies you dont need any more treatment a bit like taking a course of antibiotics for an infection. To me what seems to be happening is that it will be controlled for longer and longer current treatment will be tweaked to make them more effective, new treatments will come along, there will be more combinations of treatments but it will be for life so if a woman is MBC in her 60s it could be controlled for 20 years and she will live out her natural life more or less and die with it and not of it, however, the side effects may be challenging and could affect overall health. My husband has a good analogy about this if a huge footballer runs into you and knocks you over and you are 25 you would probably jump up and be alright bar the bruising but if this happened to you at 65 or75 it's more likely to cause some injury. For most people going in for treatment in your 80s even if it was keeping you alive would be somewhat of a challenge. Things like distance to the cancer center and the other challenges of old age.