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Breast Cancer Health Center

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Treatments by Breast Cancer Stage

Treatment Options for Stage IV Breast Cancer

In stage IV breast cancer, the cancer has spread to other sites in the body. Affected areas may include the bones, brain, lungs, liver, or other sites. Because multiple areas may be involved, focused treatments like surgery or radiation alone are not sufficient. By shrinking the cancer, treatment can slow down the progression of the disease, make you feel better, and perhaps help you live longer.

Treatments of stage IV breast cancer include:

  • Chemotherapy . It can slow down the growth of the cancer. Chemotherapy is often used in combination with other chemotherapy drugs, biological therapies, or targeted therapies.
  • Endocrine therapy for women with hormone receptor-positive cancers. These are cancers that need hormones to grow. Tamoxifen has been used to block the effects of estrogen for decades. However, drugs such as the aromatase inhibitors Arimidex and Femara and the aromatase inactivator Aromasin, have replaced tamoxifen as first-line therapy in postmenopausal women with breast cancer that has spread. These drugs reduce the amount of estrogen your body makes. By decreasing the supply of estrogen, you can prevent the cancer from growing. Women who haven't reached menopause may consider having their ovaries removed or taking drugs to stop the ovaries from making hormones that help cancer grow.

  • Biological therapy . In about 25% of women with breast cancer, an excess of a protein known as HER2 makes the cancer spread quickly. Herceptin is a drug that's been approved to treat women with metastatic breast cancer that is HER2-positive. It stops this protein from making the cancer cells grow. It is most often used in combination with chemotherapy, but may be used as a single agent, or with endocrine therapy. An intravenous treatment called Perjeta (pertuzumab) is also approved for late-stage HER2-positive breast cancer. In one study, Perjeta was shown to extend life when combined with Herceptin. The drug Tykerb (lapatinib) is another agent that is used to block the HER2 protein. It is an oral agent, and may be used with Xeloda, Femara, or Herceptin. The FDA recently approved palbociclib to treat HER2-negative and ER-positive breast cancer, a drug that, combined with letrozol, has shown promise in halting tumor growth. Still another treatment option is the drug Kadcyla. It's for use in patients who have already been treated with Herceptin and a class of chemotherapy drugs called taxanes, which are commonly used to treat breast cancer. These drugs may have been used together or separately to treat metastatic breast cancer. For HER2-negative breast cancer in post-menopausal women, Afinitor is used with exemestane after other treatments have been tried. Afinitor is for advanced hormone receptor-positive disease.
  • Palliative care . Surgery and radiation are used in some cases to help treat pain and other symptoms. Other medications may be used to help treat some of the side effects of breast cancer treatment, such as nausea, fatigue, and infections.
  • Clinical trials are open to many women with stage IV cancer. A clinical trial may allow you access to cutting-edge treatments. Many new therapies -- new drugs, new treatments, and new combinations -- are in clinical trials now.

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