Most women need chemotherapy when they have advanced breast cancer. But it's likely to be easier to handle than before. "Our aim is to keep the cancer under control for as long as possible, with as few side effects as possible," says Borges.
You may get one drug at a time, rather than a combination. "A combination of drugs will get you a faster response, but not one that lasts longer," Borges says.
One exception is an urgent threat to your health, such as serious liver problems or trouble breathing. "Then it makes sense to accept those side effects to pull you back from the ledge with a quick response. But otherwise, you'll probably get just one drug at a time."
There are several chemo drugs your doctor may choose from, depending on your particular case.
Ask your doctor which options might be best for you. Some drugs come in pill form, while others are given through an IV tube in your arm.
Some people would rather take a daily pill than have an IV. Others may prefer the weekly IV, for the sake of convenience.
If your cancer is fueled by hormones (ER/PR-positive), you may need hormonal therapy. There are various types of these drugs that you and your doctor may choose from.
You may stay on hormonal therapy for many years. "I have a few patients who had quiet bone metastases back when I first started specializing in breast cancer more than 15 years ago," says Gralow. "They've been on hormone therapy all that time, although I've switched the drugs around a bit."
One "target" for these drugs is the HER2/neu protein. Some women with breast cancer have tumors that make too much of this protein. There are several drugs that target HER2.
Another target is the mTOR protein. A drug that blocks this protein can stop cancer cells from growing.
You may take one of these drugs indefinitely, unless you have side effects.
If the cancer is in your bones, you may need a bone-strengthening drug, such as denosumab, pamidronate disodium or zoledronic acid. These drugs are given by IV. Though they do not directly treat the cancer itself, they can relieve bone pain and prevent fractures.
Keep your personal goals in mind as you discuss treatment options with your doctor. Drug side effects, your family, and even your age will help you decide how best to treat your cancer.