Stage III Breast Cancer Treatment Options

In stage III, the cancer has spread beyond the breast and into nearby lymph nodes. Usually many lymph nodes have cancer cells, or the tumor is so large it grows into the chest wall or skin of the breast. A combination of different treatments often works best.

Treatments

Chemotherapy is a common treatment for stage III breast cancer. Sometimes people have chemo before surgery to shrink a tumor and make it easier to remove. It can help destroy cancer cells that remain after surgery. In cases where surgery isn't an option, chemotherapy may be the main treatment.

You can get chemo several different ways. You may take pills or liquids, but often the drugs are put right into your veins. Depending on the type of treatment, it may be given in cycles that allow your body breaks in between.

Surgery. You might get a lumpectomy, in which a surgeon removes the tumor and some surrounding tissue from the breast. Or you might need a mastectomy, in which the whole breast is removed. The surgeon would also remove lymph nodes. After a mastectomy, you might choose to get breast reconstruction surgery.

Radiation therapy is often recommended for women with stage III following surgery. The treatment can destroy cancer cells that may have been missed.

Hormone therapy can help women with hormone receptor-positive cancers. That means the cancer needs hormones to grow. In these women, medications can prevent the tumor from getting the hormone. These drugs include tamoxifen for all women and aromatase inhibitors anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) for postmenopausal women. Fulvestrant (Faslodex) and toremifene (Fareston) block hormone receptors and are sometimes given to women with metastatic breast cancer.

Women who haven't reached menopause may consider having their ovaries removed to stop them from making hormones that help cancer grow. Medications can also stop the ovaries from releasing hormones.

Targeted therapy is a newer treatment. About 20% of women with breast cancer have too much of a protein known as HER2, and it makes the cancer spread quickly. Women with HER2-positive cancer may be prescribed ado-trastuzumab emtansine (Kadcyla), lapatinib (Tykerb), neratinib (Nerlynx), pertuzumab (Perjeta), or trastuzumab (Herceptin). Along with an aromatase inhibitor or the hormone therapy fulvestrant, a CDK 4/6 inhibitor such as abemaciclib (Verzenio), palbociclib (Ibrance) or ribociclb (Kisqali) is sometimes given in postmenopausal women with certain types of advanced breast cancer. These medications can stop this protein from making the cancer grow and can make chemotherapy more effective. Those who are HER2-negative but have BRCA-mutated breast cancer could be treated by a class of drugs called PARP inhibitors that target a protein that helps cancer cells grow. PARP inhibitors include olaparib (Lynparza) and talazoparib (Talzenna). Everolimus (Afinitor) is a targeted therapy sometimes given to women with HER2-negative breast cancer along with the hormone therapy exemestane (Aromasin).

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Immunotherapy drugs stimulate your immune system to find and destroy cancer cells.  In women with advanced hormone receptor negative and HER2-negative breast cancer the immunotherapy drug atezolizumab (Tecentriq) is sometimes given in combination with the chemotherapy paclitzxel (Abraxane). Atezolizumab blocks a protein called PD-L1.

Clinical trials are something else to consider. They’re open to many women with stage III breast cancer and may give you access to cutting-edge treatments. Talk to your doctor for more information about joining one.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on March 25, 2019

Sources

SOURCES:

American Cancer Society: “How is breast cancer staged?” “Questions about chemotherapy,” “Targeted therapy for breast cancer.”

National Comprehensive Cancer Network: "Guidelines for Patients."

National Cancer Institute: "Breast Cancer PDQ: Treatment, Health Professional Version," "Breast Cancer PDQ: Treatment, Patient Version," "Understanding Breast Cancer: A Guide for Patients," and "What You Need to Know about Breast Cancer," “Adjuvant and Neoadjuvant Therapy or Breast Cancer.”

National Breast Cancer Foundation: “Stages,” “Stage 3.”

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