Most women need chemotherapy when they have advanced breast cancer. And it's likely to be easier to handle than in the past. "Our aim is to keep the cancer under control for as long as possible with as few side effects as possible," says Virginia Borges, MD, of the University of Colorado-Denver School of Medicine.
Unless you have an urgent condition, like serious liver problems or trouble breathing, you'll probably get one drug at a time. "A combination of drugs will get you a faster response, but not one that lasts longer," Borges says.
There are several chemo drugs your doctor may choose from, depending on your particular case. Some are pills. Others you get through an IV tube in your arm. Talk with your doctor about what you prefer.
If your cancer is sensitive to hormones such as estrogen, you may need to take hormonal therapy. There are various types of these drugs that you and your doctor may choose from. They can lower the amount of estrogen your body makes so it's not available to fuel your breast cancer.
There are different types of hormonal therapies for breast cancer:
Tamoxifen and toremifene (Fareston) block estrogen from stimulating cancer cell growth. Doctors call these drugs "SERMS," which stands for selective estrogen receptor modulators.
Letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) stop the body from making estrogen in women who have gone through menopause.
Fulvestrant (Faslodex) counters estrogen throughout the body, not just in cancer cells. You get it by injection. It's approved for use in postmenopausal women with advanced breast cancer who have already tried tamoxifen or toremifene.
Goserelin (Zoladex) and leuprolide (Lupron) stop the ovaries from producing estrogen. Doctors may consider these drugs, along with other hormone drugs, in women who have not yet been through menopause. After stopping these drugs, the ovaries may or may not make estrogen again.
There are drugs that target specific proteins related to cancer.
Everolimus (Afinitor) targets a protein called mTOR, and palbociclib (Ibrance) targets a protein called CDK 4/6. They are approved to treat advanced breast cancer in women after menopause if:
- Their breast cancer is sensitive to estrogen. Doctors call this “ER-positive.” Most breast cancers are ER-positive.
- Their cancer is not sensitive to the HER2 protein. Your doctor may call this “HER2-negative” breast cancer. Most breast cancers are HER2-negative.
Some breast cancers -- about 20% -- make too much of the HER2 protein. They are more aggressive than other cancers. Drugs that target HER2 include:
- Trastuzumab (Herceptin) blocks the HER2 protein from stimulating cancers cells to grow. You get it by IV once a week or every 3 weeks as a bigger dose. One of the risks is congestive heart failure, so your doctor will closely watch your heart's health if you take it.
- Ado-trastuzumab emtansine (TDM-1, Kadcyla) is like trastuzumab with a chemo drug added to it. You get it by IV every 3 weeks.
- Pertuzumab (Perjeta) works similarly to trastuzumab by blocking HER2. Doctors often give it along with the chemo drug docetaxel (Taxotere) and trastuzumab.
- Lapatinib (Tykerb) may be an option if chemo and trastuzumab aren't working.