Metastatic Breast Cancer Symptom Management: 5 Things to Know

Kate M. O'Rourke


June 18, 2020

4. Neuropathy in patients with MBC can cause pain, numbness, and loss of sensation.

Peripheral neuropathy is commonly associated with surgery, radiation therapy, hormonal therapy, taxane-based therapy and many other chemotherapy drugs, and many targeted therapies. Such agents as gabapentin, pregabalin, and duloxetine have proven useful in reducing neuropathy.

"Neuropathy is something we have to monitor for regularly, particularly in our patients with metastatic disease who are going from one chemotherapy to the next," Tolaney said. "To treat neuropathy, sometimes we will hold the drug until the neuropathy improves and then restart with a dose reduction. Usually it is a drug-related toxicity that really takes holding drug or reducing drug dosing to help."

5. For patients receiving myelosuppressive chemotherapy, neutropenia is a common adverse effect that leaves patients vulnerable to infectious diseases.

Many chemotherapy drugs cause neutropenia, but this side effect is also associated with some targeted therapies, such as CDK4/6 inhibitors. "All of our chemotherapy drugs cause neutropenia to varying degrees, but also CDK4/6 inhibitors in terms of nonchemotherapy drugs are associated with high rates of neutropenia, which can lead to dose modifications," Tolaney commented.

Treatments for neutropenia depend on what is causing this adverse event and often include growth factor support. "For chemotherapy, we will often reduce the dose of chemotherapy or use growth factor support," Tolaney said. "Whereas with CDK4/6 inhibitors, for example, we are not using growth factors, but reducing the dose of the drug to help." Growth factor support drugs, including filgrastim and pegfilgrastim, are effective for managing neutropenia.

Dr Tolaney disclosed relationships with AbbVie, Anthenex, AstraZeneca, Bristol-Myers Squibb, Celldex, Cyclacel, Eisai, Exelixis, Genentech/Roche, Immunomedics, Lilly, Merck, Nanostring, Nektar, Novartis, Odonate, Paxman, Pfizer, Puma, Sanofi, Seattle Genetics, and Silverback Therapeutics. Dr Winer disclosed relationships with Genentech, GlaxoSmithKline, Lilly, Roche, and Seattle Genetics.

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