Explore Treatments for Metastatic Breast Cancer

Learn more about each treatment option, and what to ask your doctor about them.

You have many choices for treating your metastatic breast cancer. You and your care team can work together to choose the options that will help you live longer and feel as good as you can each day.

The right treatment for you depends on:

  • Where your cancer has spread
  • Genes, proteins, or other features of your cancer cells
  • Your symptoms
  • Other treatments you’ve already tried
  • Your overall health
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  • Hormone Therapy

    What is Hormone Therapy?

    Hormones your body makes, like estrogen and progesterone, prompt some types of breast cancer cells to grow. Hormone therapy lowers levels of those hormones in the body or blocks cancer cells from using them.

    To know if this treatment will work for you, your doctor will test your tumor for estrogen or progesterone receptors, called ER-positive or PR-positive breast cancer. If you have them, the options depend on:

    Have you been through menopause?

    Have you had hormone therapy before?

    Hormone Therapy Treatments

    You often take a hormone therapy drug for several years. Most stop working at some point. When that happens, you can switch to another one. Medicines include:

    • Tamoxifen: This daily pill blocks breast cancer cells from using estrogen. It can slow or stop the growth of those cells and may shrink some tumors.

      It often causes side effects like hot flashes and vaginal discharge or bleeding. Other issues are rare but can include uterine cancer, cataracts, and blood clots.

    • Aromatase inhibitors (AIs), like anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara): These daily pills lower the amount of estrogen that your body makes.

      They can cause hot flashes, vaginal dryness, muscle pain, and stiff joints. Sometimes, switching to a different AI drug helps. These drugs can also affect bone strength, so your doctor may test your bone density while you take them.

    • Fulvestrant (Faslodex): This drug blocks hormone receptors on breast cancer cells. Doctors recommend it after other hormone therapies, like tamoxifen and AIs, have stopped working. It’s an injection you get twice every 2 weeks, then once a month after that.

      Side effects don’t last long but can include hot flashes, night sweats, headaches, nausea, bone pain, or pain where the needle entered your skin.

    You often take a hormone therapy drug for several years. Most stop working at some point. When that happens, you can switch to another one. Medicines include:

    • Tamoxifen: A daily pill that blocks breast cancer cells from using estrogen. It can slow or stop the growth of those cells and may shrink some tumors.

      It often causes side effects like hot flashes and vaginal discharge or bleeding. Other issues are rare but can include uterine cancer, cataracts, and blood clots.

    • Toremifene (Fareston): This drug is similar to tamoxifen. It’s not likely to work after you take tamoxifen.

    • Aromatase inhibitors (AIs), like anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara): These daily pills lower the amount of estrogen that your body makes.

      They can cause hot flashes, vaginal dryness, muscle pain, and stiff joints. Sometimes, switching to a different AI drug helps. These drugs can also affect your bone density, so your doctor may check your bones while you take them.

    You can try one of these treatments at a time, or both together.

    • Ovarian suppression: This treatment keeps your ovaries from making estrogen, so it won’t prompt breast cancer cells to grow. You can take medicines to do that or have surgery to remove your ovaries.

      But either way, you’ll have the symptoms of menopause: hot flashes, night sweats, vaginal dryness, and mood swings.

    • Tamoxifen: A daily pill that blocks breast cancer cells from using estrogen. It can slow or stop the growth of those cells, and it may even shrink some tumors.

      It often causes side effects like hot flashes and vaginal discharge or bleeding. Other issues are rare but can include uterine cancer, cataracts, and blood clots.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Targeted Therapy

    Targeted Therapy

    Some breast cancer cells have genes, proteins, or other features that doctors can target with specific medicines. A common one is a protein on the surface called HER2. To know if targeted therapies will work for you, your doctor will test your breast cancer cells and let you know:

    Is your cancer HER2-positive?

    Is your cancer hormone receptor-positive?

    Targeted Therapy Treatments

    If your breast cancer cells have HER2 proteins and hormone receptors, your doctor may recommend a few different targeted medicines:

    • Trastuzumab (Herceptin): This drug targets HER2 proteins. You get it through an IV into a vein, either once a week or once every 3 weeks. Your doctor may prescribe it along with hormone therapy -- that combination can help you live longer.

      Women can take trastuzumab for as long as it works against their breast cancer. For some, it slightly raises the chances for heart problems, so your doctor will need to monitor your heart while you take it.

    • Pertuzumab (Perjeta): Your doctor might add this drug to trastuzumab and chemotherapy medicines. You get it through an IV.

      It can cause diarrhea, and some women also have higher odds for heart trouble while they take it.

    • Ado-trastuzumab emtansine, or TDM-1 (Kadcyla): If you’ve already taken trastuzumab with chemotherapy, your doctor might try this drug. You get it through an IV once every 3 weeks.

      It also raises your chances of heart problems slightly while you take it, so your doctor will watch for any issues.

    • Lapatinib (Tykerb): This drug blocks chemicals called tyrosine-kinase enzymes, which cancer cells use to grow. It’s a daily pill for women who’ve already taken trastuzumab and chemo.

      Lapatinib along with the hormone therapy drug letrozole can help women with HER2-positive, ER-positive breast cancer. Some people also take it with trastuzumab or TDM-1.

      It can cause diarrhea or sore, red, blistered skin on your hands and feet.

    If your breast cancer cells have HER2 proteins but not hormone receptors, your doctor may recommend a few different targeted medicines:

    • Trastuzumab (Herceptin): This drug targets HER2 proteins. You get it through an IV into a vein, either once a week or once every 3 weeks. Your doctor may prescribe it along with chemotherapy -- that combination can help you live longer.

      Women can take trastuzumab for as long as it works against their breast cancer. It slightly raises some women’s chances for heart problems, so your doctor will need to monitor your heart while you take it.

    • Pertuzumab (Perjeta): Your doctor might add this drug to trastuzumab and chemotherapy medicines. You get it through an IV.

      It can cause diarrhea, and some women also have higher odds for heart trouble while they take it.

    • Ado-trastuzumab emtansine, or TDM-1 (Kadcyla): If you’ve already taken trastuzumab with chemotherapy, your doctor might try this drug. You get it through an IV once every 3 weeks.

      It also raises your chances of heart problems slightly while you take it, so your doctor will keep an eye on you.

    • Lapatinib (Tykerb): This drug blocks chemicals called tyrosine-kinase enzymes, which cancer cells use to grow. It’s a daily pill for women who’ve already taken trastuzumab and chemo.

      Your doctor might prescribe it along with the chemo drug capecitabine. Some people also take it with trastuzumab or TDM-1.

      It can cause diarrhea or sore, red, blistered skin on your hands and feet.

    If your breast cancer cells have hormone receptors but not HER2 proteins, your doctor may have started your treatment with hormone therapy. But you can also try a few targeted medicines:

    • Abemaciclib (Verzenio): This drug stops cancer growth by targeting proteins called CDK4 and CDK6. It’s a twice-daily pill for women who’ve been through menopause.

      You might take it along with a type of hormone therapy drug called an aromatase inhibitor. If your cancer got worse after hormone therapy, your doctor might give it to you on its own or with the drug fulvestrant.

      It might make you tired and lower your numbers of white blood cells.

    • Palbociclib (Ibrance) and ribociclib (Kisqali): These drugs also target CDK4 and CDK6 proteins. They’re for women who’ve gone through menopause.

      You take them as a pill once a day for 3 weeks, followed by a week off. You can take them along with other hormone therapy drugs, like fulvestrant or an aromatase inhibitor.

      They have the same mild side effects as abemaciclib.

    • Everolimus (Afinitor, Zortress): For women past menopause, this daily pill blocks the mTOR protein, which fuels cancer cell growth. It seems to help hormone therapy drugs work better.

      Doctors prescribe it along with the drug exemestane (Aromasin) for those whose cancer grew while taking a hormone therapy drug, like letrozole or anastrozole.

      It can cause mouth sores, diarrhea, feeling tired, and shortness of breath. It may also raise your cholesterol and blood sugar, as well as your risk for infection.

    If your breast cancer is HER2-negative, ER-negative, and PR-negative, you have triple-negative breast cancer.

    HER2-targeted therapies and hormone therapies won’t work for you. In most cases, chemotherapy is the best option. Some women also get radiation.

    Doctors are also studying more targeted treatments for this type of breast cancer.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Chemotherapy

    Chemotherapy

    Medicines travel through your bloodstream to kill cancer cells anywhere in your body. There are many chemotherapy drugs for metastatic breast cancer.

    • Who should have it: This is the main treatment for women whose tumors test negative for hormone receptors, called ER-negative and PR-negative tumors.

      Your doctor also may prescribe it along with other medicine, like targeted therapies. You might also get it if your cancer is causing serious problems, like trouble breathing.

    • How do you get it? You can take chemo medicines in pill form or through a tube (IV) that goes into a vein. Your doctor will set a schedule for your treatment, such as once a week or once every 2-3 weeks, followed by a break.

      Most women with metastatic breast cancer get one chemo drug at a time. If it stops working, you can try a different medicine. How long you get treatment depends on how well it works and the side effects you have.

    • How will it make you feel? Side effects are common with chemotherapy. The ones you have depend on the drug you’re getting, the dose you take, and for how long.

      Common issues include feeling tired, hair loss, mouth sores, changes in your weight or appetite, nausea, vomiting, and diarrhea. You might get bruises or infections more easily, too.

      Your care team can help you ease these side effects.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Radiation

    Radiation

    In this treatment, high-energy X-rays destroy cancer cells in a specific part of the body. It may not get rid of metastatic cancer, but it can shrink a tumor or slow its growth.

    • Who should have it: Radiation can help if your cancer has spread to your brain or bones, or if you’re having pain or other uncomfortable symptoms.

    • How do you get it? There are a few types:

      • External beam radiation therapy: a machine delivers the X-rays to a specific part of your body.
      • Brachytherapy: your doctor puts radiation inside your body near a tumor for a little while

      Newer methods, like stereotactic radiosurgery, can deliver radiation more precisely with fewer doses.

      Your doctor will decide how many radiation treatments you need, and how often.

    • How will it make you feel? It depends on the type of radiation you have and where you get it. But you might feel tired and have some skin problems, like red or peeling skin.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Surgery

    Surgery

    Surgery isn’t a main treatment for metastatic breast cancer. But it can remove cancer in certain parts of your body, slow down its spread, or relieve some of the symptoms it can cause. Sometimes, women get radiation therapy along with surgery to make tumors easier to remove.

    Your doctor may recommend surgery if you have a tumor that’s causing pain or other symptoms, or blocking a major blood vessel. It can also be an option to treat cancer that’s spread to your brain.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Clinical Trials

    Clinical Trials

    Clinical trials are research studies where doctors test new treatments or new ways to use existing ones. They help scientists see if new options are safe, how well they work, and how they compare to other treatments. You and your doctor can decide if there’s one that is a good fit for you.

    • Should you join one? The answer will be different for everyone. You’ll need to spend time talking to your doctor about the pros and cons of joining a trial, as well as other treatment options you have.

    • How do you enroll in a trial? If you find one you want to join, the team will first describe all of the details of the study to you and answer your questions. This process is called informed consent.

      Once you’ve signed a consent form, you’ll give your medical history, get a physical exam, and have blood tests, imaging scans, or both. These help the research team see if you’re a good fit for the trial.

    • Other things to think about: Some insurance plans cover the costs of joining a clinical trial, and others don’t. Check with your insurance company to find out what’s covered.

      Also, some trials take place at specific medical centers, which may be far from your hometown. Think about if you’ll be able to handle the arrangements and costs of traveling for care.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

  • Palliative Care

    Palliative Care

    This type of treatment aims to ease any symptoms from your cancer or your treatment. It can include medicines, help with nutrition, emotional support, relaxation, and support for your family. Other treatments, like radiation and chemotherapy, can also be part of palliative care.

    • Who should have it: Many people think of palliative care as a last resort. But anyone with cancer or another serious condition can get it at any time. It often works best when you start it early in your cancer care.

    • How do you get it? Your cancer care team usually starts palliative care by treating and managing your symptoms. If you need more help, your doctor can refer you to palliative care specialists – doctors, nurses, social workers, and others. You can have this care for as long as you need it.

    What to Ask Your Doctor

    These questions can help you learn more about this treatment. Click to save them to your Doctor Discussion Guide, so you can take them to your next visit.

SOURCES: American Cancer Society: “Hormone Therapy for Breast Cancer,” “Chemotherapy for Breast Cancer,” “Treatment of Stage IV (Metastatic) Breast Cancer,” “Targeted Therapy for Breast Cancer,” “Surgery for Breast Cancer,” “Making the Decision About Clinical Trials,” “What’s It Like to Be in a Clinical Trial,” “A Guide to Palliative or Supportive Care.” American Society of Clinical Oncology: “Breast Cancer – Metastatic: Treatment Options,” “Breast Cancer – Metastatic: About Clinical Trials,” “Breast Cancer – Metastatic: Palliative Care.” Susan G. Komen Breast Cancer Foundation: “Treatments for Metastatic Breast Cancer.” BreastCancer.org: “Treatment for Triple-Negative Breast Cancer.” RadiologyInfo.org: “Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT).”
Your Doctor Discussion Guide
    Add questions to take to your next doctor’s visit.

    Reviewed by Laura J. Martin, MD on December 11, 2017

    Sources:

    SOURCES:

    American Cancer Society: “Hormone Therapy for Breast Cancer,” “Chemotherapy for Breast Cancer,” “Treatment of Stage IV (Metastatic) Breast Cancer,” “Targeted Therapy for Breast Cancer,” “Surgery for Breast Cancer,” “Making the Decision About Clinical Trials,” “What’s It Like to Be in a Clinical Trial?” “A Guide to Palliative or Supportive Care.”

    American Society of Clinical Oncology: “Breast Cancer – Metastatic: Treatment Options,” “Breast Cancer – Metastatic: About Clinical Trials,” “Breast Cancer – Metastatic: Palliative Care.”

    Susan G. Komen Breast Cancer Foundation: “Treatments for Metastatic Breast Cancer.”

    BreastCancer.org: “Treatment for Triple-Negative Breast Cancer.”

    RadiologyInfo.org: “Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT).”

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