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Stage 4 Cancer

Metastatic Cancer or Stage 4 Cancer, Stage IV

Metastatic cancer, or stage 4 cancer, is a medical term describing a condition where the tumor that started in a specific organ is detected in another organ or location distant from that source organ, also called the “primary tumor”. For example, breast cancer metastases can be diagnosed in the lungs, brain, bones, and liver.

It is important to note that a metastasis is the same tumor as the original tumor, even if it has settled in another organ, and the treatment is addressed accordingly. For example, treatment for lung cancer that has metastasized to the liver will be determined according to the treatment for metastatic lung cancer, not according to the treatment for liver cancer.

The Process of Metastasis Formation

Cancer cells from the original, primary tumor can be released into the bloodstream and lymphatic system, flow through them to distant organs or those adjacent to the primary tumor, “settle” there, and grow.

There are types of cancer for which it is known where metastases can form, for example:

  • Breast cancer can send metastases to the bones, brain, liver, and lungs.
  • Lung cancer can send metastases to the brain, bones, liver, and kidney.
  • Prostate cancer can send metastases to the bones.
  • Colon and rectal cancer can send metastases to the liver and lungs.
Breast cancer metastasis formation process

Chances of Recovery from Metastatic Cancer, Stage 4

In the vast majority of metastatic cases, treatments are not curative. The therapeutic goals are slowing the tumor growth rate, extending life, reducing disease symptoms, and improving the patient’s quality of life.

The efficacy of treatments is affected by multiple factors, including: cancer type, number and location of metastases, tumor burden in the patient’s body, growth rate of cancerous lesions, the patient’s treatment history, background diseases, the tumor microenvironment among the cancer cells themselves, resistance the cancer has developed to previous treatments, and more.

Innovative Personalized Treatments and Clinical Trials in Metastatic Stage 4 Cancer

For most cancer patients, existing treatments do not cure the cancer, hence the need for innovative and effective strategies to fight the disease.

The National Cancer Institute in the USA, the NCI, recommends that patients with advanced-stage cancer participate in one of the many clinical trials existing worldwide to increase therapeutic success chances. Joining this recommendation is the umbrella organization of leading US cancer centers, the NCCN, emphasizing that every patient should be encouraged to participate in clinical trials at every stage of the disease:

“Patients with cancer should be encouraged to participate in clinical trials during all aspects of their diagnosis and treatment”

Today, every patient will be treated with the standard protocols mentioned above, and sometimes the oncologist will offer to join trials open at their institute.

Advancement in cancer treatments lies in clinical trials, where the most advanced and interesting drugs are found, some of which have even earned FDA recognition as “Breakthrough Therapies,” with more data required from studies until final official approval.

A whole world of trials and compassionate use treatments is open and available globally, and it is important to know which treatments from the forefront of science exist worldwide that the patient can benefit from much more than any conventional treatment offered.

For most patients with malignant cancer, existing treatments do not cure the cancer, hence the need for innovative and effective strategies to fight the disease.

You are invited to read our publications about innovative and breakthrough treatments from around the world for metastatic stage 4 cancer >>


Common Questions about Stage 4 Cancer (Summary)

Q: What is the difference between metastatic cancer and primary cancer?

Metastatic cancer (Stage 4) is a condition where cells from the original tumor have migrated to other organs. Treatment is always determined by the origin of the primary tumor, not the organ where the metastasis was detected.

Q: Are there treatments beyond the standard protocol?

Yes. Beyond the standard protocol, there are clinical trials worldwide, compassionate use drugs, and advanced biological treatments (Off-label) that may suit the specific characteristics of the tumor.

Q: Why does the NCI recommend clinical trials?

Because that is where progress lies. Clinical trials allow access to breakthrough drugs that have not yet reached final approval and may be more effective than existing standard treatment.

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What is “Hyperprogression” in metastatic lung cancer?

Recently, on September 6, 2018, it was published in one of the world’s most prestigious medical journals, the JAMA, a very worrisome article presenting the results of a study conducted at eight leading medical centers in France, including the leading cancer center in Europe, Gustave Roussy.

What is “Hyperprogression”?

Hyperprogression is the accelerated progression of cancerous tumors following treatment the patient receives.

The study examined Hyperprogression in patients with advanced lung cancer and metastatic lung cancer patients, stage 4, who were treated with immunotherapy.

Although immunotherapy has revolutionized the treatment of lung cancer and other cancers, doctors have noticed that immunotherapy is harmful to some patients to the extent that there are more deaths with immunotherapy than chemotherapy!

Doctors believe that immunotherapy can cause accelerated growth of cancer, and this is based on earlier publications.

The study compared 406 metastatic lung cancer and stage 3 and 4 patients, who were treated with immunotherapy to 59 stage 3 and 4 lung cancer patients who received chemotherapy for their disease.

Results showed that 14% of patients treated with immunotherapy experienced Hyperprogression compared with 5% of patients receiving chemotherapy.

Hyperprogression occurred mainly in stage 4 metastatic lung cancer patients with over 2 metastases.

The researchers of this work claim that if they included in their calculations patients who developed new metastases under treatment, patients who had unmeasurable metastases, for example, bone metastasis and very deteriorated patients, the percentages in both immunotherapy and chemotherapy were even higher!

All patients received second treatment for their advanced disease, “second line”. For a lung cancer patient who developed Hyperprogression, life expectancy was only 3.8 months, compared to 6.2 months in a lung cancer patient who did not develop Hyperprogression.

The problem is that there is currently no marker to predict which patients may develop Hyperprogression under immunotherapy and who may not. Therefore, after starting immunotherapy, it is recommended to do CT faster than normally done and if there is Hyperprogression, replace treatment immediately.

In addition, combination of chemotherapy plus immunotherapy in patients with stage 4 lung cancer, seem to prevent the development of Hyperprogressions in the high percentages observed in the study.

On the other hand, if that’s the case, we did not get rid of chemotherapy and that is one of the goals of immunotherapy, as long as it proves to be better.

Read the article:

https://jamanetwork.com/jo…/jamaoncology/fullarticle/2698845

To hear a podcast discussing the results of the study:

https://jamanetwork.com/learning/audio-player/16733676

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Improving therapeutic success, extending life and quality of life are our main business. We extend to metastatic cancer patients and patients with brain tumors, the most advanced treatment options in the world and the best experts in Israel and abroad.

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