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Stage 4 Cancer

Stage 4, Stage IV metastatic cancer

“Metastases cancer” or stage 4 cancer, is the medical term for describing a condition where a tumor originating in a certain organ, “primary tumor”, is identified in another organ or in a distant location from the original organ, e.g., metastases of breast cancer can be found in the lungs, brain, bones and liver.

It is important to note, metastases are the same type of the original primary tumor, even if its location is in distant organs and so are the treatments regarded as such, for example, a treatment for a metastatic lung cancer that has spread to the liver, is determined by the treatment for metastatic lung cancer and not by the treatment for liver cancer.

Metastases formation

Cancer cells of the primary tumor can be released into the bloodstream and lymphatic system and circulate to distant organs or adjacent organs and tissues to the primary tumor and “settle” in them and grow.

There are different types of cancer which is known where metastases can be formed, for example,

  • Breast cancer can spread to the bones, brain, liver and lungs
  • Lung cancer can spread to the brain, bones, liver and kidney
  • Prostate cancer can spread to the bones
  • Colon cancer, rectal cancer, colorectal cancer can spread to the liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs
Breast cancer can spread to the bones, brain, liver and lungs

Stage IV metastatic cancer and recovery

In the vast majority of the metastatic cases, the treatments do not cure. Treatment goals are slowing tumor growth rate, prolonging life and reducing the symptoms of the disease, improving the quality of life of the patient.

The efficacy of the treatments is affected by many factors, among them are the type of cancer, number of metastases (also called “lesions”) and their location, how much cancer the patient has in his or her body, growth rate of the tumor lesions, medical history of the patient, background diseases, microenvironment between the tumor cells themselves, resistance the tumor has developed to previous treatments and other.

Advanced treatments and clinical trials for stage 4

The National Cancer Institute (NCI) highlights the fact that for a certain group of metastatic cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.

This is also recommended by the USA national comprehensive cancer network, NCCN,  (USA national comprehensive cancer network)

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

Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the Institute.

Advances in cancer therapies may be found in clinical trials prescribing cutting edge, interesting drugs, some of which have already been recognized by the FDA (US Food & Drug Administration) as “breakthrough treatments” and require further information input before being finally and fully approved.

An entire world of clinical trials and compassionate drugs and treatments are open and available worldwide. It is important to know which cutting edge treatments exist which patients can gain far more from them than the standard care offered.

For most patients with stage 4 metastatic cancer, current treatments are insufficiently effective. This gives rise to the need for innovative strategies with greater efficacy in fighting the disease.

Read our publications on innovative treatments for stage 4 metastatic cancer:

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Breast Cancer – Lurbinectadin in BRCA patients

Background

Lurbinectedin, a selective inhibitor of oncogenic transcription, has shown preclinical antitumor activity against homologous recombination repair-deficient (HRD) models and preliminary clinical activity in BRCA1/2 breast cancer.

Introduction

Breast cancer with BRCA1/2 mutations is emerging as a distinctive group of breast cancers that present at an earlier age with hallmarks of genomic instability and accumulation of DNA damage.

Two PARP inhibitors are available as the therapeutic option (Lynparza and Talzenna), but many patients do not derive benefit because of multiple primary and secondary resistance mechanisms and toxicities.

About Lurbinectadin

Lurbinectedin is a selective inhibitor of oncogenic transcription that leads to cell death.  Lurbinectedin has antitumor activity against homologous recombination repair-deficient (HRD) cell lines.

About the Study

In a basket, open label, phase II study, nine cohorts of patients with different tumor types were treated with lurbinectedin.

Based on the results in the Small-Cell Lung Cancer (SCLC) cohort, approval of lurbinectedin was obtained in this indication first in the United States and later in other.

This article focuses on the outcomes in the germline BRCA1/2 breast cancer cohort.

This cohort was evaluated because, in a previous phase II study, lurbinectedin had shown antitumor activity in patients with advanced breast cancer and germline BRCA1/2 pathogenic variants: Response Rate was 41% and median Survival was 20.0 months compared to 9% and 12.5 months, respectively, in patients with BRCA1/2 wild-type or unknown status.

In this current phase II trial evaluated lurbinectedin in a cohort of 21 patients with pretreated germline BRCA1/2 breast cancer.

Results

28.6% of patients had their cancer lesions shrunk (also called Partial Response, PR) and these patients had received a median of two prior advanced chemotherapy lines.

Lurbinectedin was active in both BRCA mutations: four PRs in 11 patients (36.4%) with BRCA2 and two PRs in 10 patients (20.0%) with BRCA1.

47.6% had Stable Disease (SD, meaning the disease was controlled and the lesions stayed the same volume and size)

This brings us to 76.2% of patients with clinical benefit

Median Survival was 16.1 months.

Side effects

The most common treatment-related side effects were nausea, fatigue and vomiting.

These side effects were mostly mild.

The most common harsh toxicity was neutropenia.

Highlights

Lurbinectedin has previously shown antitumor activity in breast cancer patients with mutations in BRCA2.

This phase II basket study included a cohort of 21 patients with BRCA-mutated breast cancer treated with lurbinectedin.

The study showed antitumor activity and clinical benefit to BRCA-mutated patients who failed on previous treatment lines.

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Breast Cancer – Lurbinectadin in BRCA advanced patients
Breast Cancer – Lurbinectadin in BRCA advanced patients

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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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