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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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Esophageal Cancer – Tislelizumab Beats Chemotherapy

Background

Patients with advanced or metastatic esophageal cancer of squamous cell type have poor prognosis. For these patients, treatment options are limited after first therapy.

Tislelizumab is a humanized monoclonal antibody directed against PD-1. It prevents PD-1 from binding to the ligands PD-L1 and PD-L2. It is being investigated as a treatment for advanced cancers.

Purpose of the RATIONALE-302 Study

Evaluate Tislelizumab versus chemotherapy as second treatment for advanced or metastatic esophageal cancer of squamous cell type (RATIONALE-302): A randomized phase III study.

The primary end point was Survival in all patients.

The secondary end point was Survival in patients with PD-L1 tumor area positivity (TAP) score ≥ 10%.

Patients and Methods

In this phase III clinical study, patients with advanced or metastatic esophageal squamous cell carcinoma, whose tumor progressed after first systemic treatment, were randomly assigned to receive Tislelizumab or chemotherapy (investigator’s choice of Taxol, Taxotere, or Irinotecan).

Results

In total, 512 patients were recruited.

At final analysis, the Survival was significantly longer with Tislelizumab versus chemotherapy in all patients (8.6 vs 6.3 months) and the risk of death decreased by 30%

In patients with TAP ≥ 10%, the Survival was 10.3 vs 6.8 months and the risk of death decreased by 46%.

Treatment with Tislelizumab was associated with higher response rate (20.3% vs 9.8% of patients who experienced disease control and/or decrease in lesion volume due to the treatment) and a more durable antitumor response (7.1 vs 4.0 months) in all patients.

Fewer patients experienced harsh treatment-related side effects (18.8% vs 55.8%) with Tislelizumab versus chemotherapy.

Conclusion

Tislelizumab significantly improved Survival compared with chemotherapy as second-line therapy in patients with advanced or metastatic esophageal squamous cell carcinoma.

Tislelizumab demonstrated a tolerable safety profile.

Patients with PD-L1 TAP ≥ 10% also demonstrated significant Survival benefit with Tislelizumab versus chemotherapy.

Take-Home Message

These findings suggest that Tislelizumab is an effective and safe therapy in patients with advanced or metastatic ESCC after progression on first-line therapy and should be considered in this patient population.

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Esophageal Cancer - Tislelizumab Beats Chemotherapy
Esophageal Cancer – Tislelizumab Beats Chemotherapy

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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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