If your doctor diagnoses you with advanced, HER2-negative breast cancer, know this: You have options for treating the disease. As you explore them, it helps to understand what it means to have advanced, HER2-negative breast cancer.
Advanced breast cancer, also called stage III or IV, means the cancer is big and has spread beyond the place in your breast where it first started, maybe to several lymph nodes or to other parts of your body. It can also mean your cancer has come back after treatment or that treatment is no longer working.
HER2-negative breast cancer means your tumor cells don’t have a specific protein on their surfaces called HER2. That’s important because drugs that fight cancer by targeting this protein won’t work for you.
Still, there are many treatments you can try. Your doctor will talk with you about the plan that’s best for you. Your choices will depend on the types of treatment you’ve already had, where the cancer is, genes, proteins, and other features of the cancer cells, your overall health, and what you want from your care. Be sure you understand the goal of treatment and what you can expect from it.
Most women with advanced breast cancer get chemo as a main treatment. These drugs kill cancer and other fast-growing cells anywhere in your body. You may take them as pills or as a liquid through a tube (IV) into your vein.
There are many types of chemo drugs. The length of your treatment will depend on how well it’s working and how well you handle any side effects you have. You may switch to another drug if the current one stops working.
You may get chemo along with other treatments. Some women with stage III breast cancer may have surgery and radiation therapy.
Hormones your body makes, like estrogen and progesterone, prompt some types of breast cancer cells to grow. These are called ER (estrogen receptor)-positive or PR (progesterone receptor)-positive cancer. If you have them, hormone therapy may be an option for you.
Many drugs can block hormones or lower the levels you have in your body. That way, the cancer cells can’t use them to grow. You can take these drugs as pills or shots. For many women, a hormone therapy drug will stop working eventually. When that happens, you can try another kind.
Hormone therapy drugs include:
- Tamoxifen (Nolvadex,Soltamox) and toremifene (Fareston)
- Anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
- Fulvestrant (Faslodex)
- Goserelin (Zoladex) and leuprolide (Lupron)
Olaparib (Lynparza) and talazoparib (Talzenna) that block a protein called PARP.
Immunotherapy drugs stimulate your immune system to find and destroy cancer cells.
Atezolizumab (Tecentriq) is an immunotherapy drug used in combination with the chemotherapy drug paclitaxel (Abraxane) to block a protein called PD-L1 in certain tumors that are hormone receptor negative and HER2-negative.
Just as your doctor tested your cancer cells for the HER2 protein, he can also test them to look for other proteins that help them grow. Targeted therapy drugs can block those proteins to keep the cancer cells from growing.
Depending on the proteins on your tumor, you might take:
- Everolimus (Afinitor, Zortress), which targets a protein called mTOR
- Abemaciclib (Verzenio), palbociclib (Ibrance), and ribociclib (Kisqali), which target a protein called CDK 4/6
You’ll only take these pills if your cancer cells are HER2-negative and hormone-receptor positive. They work best when you take them along with hormone therapy.
There’s no single best way to treat this cancer. Because of this, doctors are always looking for better ways to do it. Clinical trials are research studies that help them find new treatments.
Clinical trials look at things like better ways to use the treatments we have, better ways to combine them, and new drugs that may work better than those doctors use today. They can be a way to get a new treatment before it’s widely available.
In any trial, you always get at least the best treatments that are available to everyone. And the study leaders will tell you exactly what the pros and cons are before you agree to join. Talk to your doctor to find out if there are any clinical trials that might be right for you.
No matter what, you have a right to care that makes you feel as good as possible. Palliative treatment focuses on relieving symptoms of your disease or the side effects of your treatment. Everyone with cancer can get it, no matter the stage or type of their disease.
Examples include pain medicine, drugs to help with nausea, nutrition support, and oxygen to help you breathe easier.
Sometimes treatments that slow or stop cancer are part of palliative care, too. For instance, you may get radiation to kill cancer cells in a bone, then have surgery to put in a rod to support that bone. Radiation can also shrink a tumor that’s pressing on a nerve and causing pain.
Your doctor may also suggest drugs to strengthen your bones and ease pain if cancer has spread there.
Palliative therapies don’t fight your disease, but you can take them along with other treatments that do. Talk to your doctor about any problems or concerns you have. Comfort is a key part of good cancer care.