Most
women with Metastatic Breast Cancer are treated with systemic
therapy. This
may include hormone therapy, chemotherapy, targeted therapy, or some
combination of these. Local treatments such as surgery or radiation
might also be used to help prevent or treat symptoms.
Stage
IV cancers have spread beyond the breast and nearby lymph nodes to
other parts of the body. When breast cancer spreads, it most commonly
goes to the bones, liver, and lungs. It may also spread to the
brain or other organs.
Treatment options for metastatic breast cancer
For
women with stage IV breast cancer, systemic (drug) therapies are the
main treatments. These may include:
- Chemotherapy (chemo)
- Targeted drugs, such as trastuzumab (Herceptin) and pertuzumab (Perjeta)
- Some combination of these
Treatment
can often shrink tumors (or slow their growth), improve symptoms, and
help women live longer. These cancers are considered incurable.
Systemic (drug) treatments for metastatic breast cancer
The
types of drugs used for stage IV breast cancer depend on the hormone
receptor status and the HER2 status of the cancer:
- Hormone receptor-positive cancers: Women with hormone receptor-positive (ER-positive or PR-positive) cancers are often treated first with hormone therapy (tamoxifen or an aromatase inhibitor). This may be combined with a targeted drug such as palbociclib (Ibrance), ribociclib (Kisqali), or everolimus (Afinitor). Women who haven’t yet gone through menopause are often treated first with tamoxifen. Because hormone therapy can take months to work, chemo is often the first treatment for patients with serious problems from their cancer spread, such as breathing problems.
- Hormone receptor-negative cancers: Chemo is the main treatment for women with hormone receptor-negative (ER-negative and PR-negative) cancers, because hormone therapy isn’t helpful for these cancers.
- HER2-positive cancers: Trastuzumab (Herceptin) may help women with HER2-positive cancers live longer if it’s given along with chemo or with other medications such as hormonal therapy or other anti-HER2 drugs. Pertuzumab (Perjeta), another targeted drug, might be added as well. Another option is the targeted drug ado-trastuzumab emtansine (Kadcyla), which is given alone or with lapatinib.
Treatment
often continues until the cancer starts growing again or until side
effects become unacceptable. If this happens, other drugs might be
tried.
Local or regional treatments for metastatic breast cancer
Although
systemic drugs are the main treatment for stage IV breast cancer,
local and regional treatments such as surgery, radiation therapy, or
regional chemotherapy are sometimes used as well. These can help
treat breast cancer in a specific part of the body, but they are very
unlikely to get rid of all of the cancer. These treatments are more
likely to be used to help prevent or treat symptoms or complications
from the cancer.
Radiation
therapy and/or surgery may also be used in certain situations, such
as:
- When the breast tumor is causing an open wound in the breast (or chest)
- To treat a small number of metastases in a certain area, such as the brain
- To help prevent bone fractures
- When an area of cancer spread is pressing on the spinal cord
- To treat a blood vessel blockage in the liver
- To provide relief of pain or other symptoms
In
some cases, regional chemo (where drugs are delivered directly into a
certain area, such as into the fluid around the brain and spinal
cord) may be useful as well.
If
your doctor recommends such local or regional treatments, it is
important that you understand their goal—whether it is to try to
cure the cancer or to prevent or treat symptoms.
Relieving symptoms of advanced breast cancer
Treatment
to relieve symptoms depends on where the cancer has spread. For
example, pain from bone metastases may be treated with radiation
therapy, drugs called bisphosphonates such as pamidronate (Aredia) or
zoledronic acid (Zometa), or the drug denosumab (Xgeva). For more,
see our information about the treatment
of bone metastases.
Advanced cancer that progresses during treatment
Treatment
for advanced breast cancer can often shrink the cancer or slow its
growth(sometimes
for many years), but after a time, it tends to stop working. Further
treatment options at this point depend on several factors, including
previous treatments, where the cancer is located, and a woman's age,
general health, and desire to continue getting treatment.
Progression while on hormone therapy
For
hormone receptor-positive (ER-positive or PR-positive) cancers that
were being treated with hormone therapy, switching to another type of
hormone therapy sometimes helps. For example, if either letrozole
(Femara) or anastrozole (Arimidex) were given, using exemestane,
possibly with everolimus (Afinitor), may be an option. Another option
might be using fulvestrant (Faslodex), along with a CDK
inhibitor such
as palbociclib (Ibrance) or abemaciclib (Verzenio). If the cancer is
no longer responding to any hormone drugs, chemotherapy is usually
the next step.
Progression while on chemotherapy
If the
cancer is no longer responding to one chemo regimen, trying another
may be helpful. Many different drugs and combinations can be used to
treat breast cancer. However, each time a cancer progresses during
treatment, it becomes less likely that further treatment will have an
effect.
Progression while getting HER2 drugs
HER2-positive
cancers that no longer respond to trastuzumab (Herceptin) might
respond to lapatinib (Tykerb), another drug that attacks the HER2
protein. This drug is often given along with the chemo drug
capecitabine (Xeloda), but it can be used with other chemo drugs,
with trastuzumab, or even alone (without chemo). Other options for
women with HER2-positive cancers include pertuzumab (Perjeta) with
chemo and trastuzumab, or ado-trastuzumab emtansine (Kadcyla).
Because
current treatments are very unlikely to cure metastatic breast
cancer, if you are in otherwise good health, you may want to think
about taking part in a clinical trial testing a newer treatment.Treatment of Metastatic Breast Cancer
