Advanced Breast Cancer

Treatment Strategies

Several treatment options are available for advanced breast cancer. The strategies you and your doctor will consider depend on many factors:

  • Whether advanced breast cancer is the initial diagnosis or is recurrent disease
  • How many metastatic sites there are and where they are located
  • How old you are, what your menopausal status is (if applicable) and how healthy you are overall
  • How quickly or slowly the disease is progressing
  • Whether you have had previous treatment and, if so, what the response was

A key factor in determining the best treatment for you is the results of testing for estrogen (ER), progesterone (PR) and human epidermal growth factor-2 (HER2) receptors in the tumor tissue. When ER and PR testing is positive, it means that these hormones are stimulating the growth of cancer cells. When HER2 testing is positive, that protein is helping cancer cells to grow. Testing for ER, PR and HER2 is recommended in all cases of breast cancer because the results are essential for selecting the most appropriate treatments.

Your treatment plan may include a combination of systemic therapies, such as hormone therapy, chemotherapy and targeted therapy. Radiation therapy or surgery may be recommended for specific situations, but these options are primarily to relieve symptoms, not to treat the disease. You may be a candidate for a clinical trial, which can give you access to the most innovative treatments, such as immunotherapy, that are still in development (see Clinical Trials).

Once you feel educated about your options, consider seeking a second opinion from another doctor who has experience treating advanced breast cancer. The best doctors may have different opinions about the best treatment plan, and hearing more than one expert opinion can help you make a more informed decision.

Types of Treatment

Hormone Therapy

Hormone therapy, also known as endocrine therapy, is the primary choice for tumors that are ER-positive or PR-positive. Hormone therapy shrinks tumors by either lowering the amount of estrogen in your body or blocking estrogen to slow or stop the growth of cancer cells.

Many types of hormone therapy drugs are available (see Table 1). Your doctor will work with you to determine which drug or combination of drugs may be your best option. Most people with advanced breast cancer continue taking hormone therapy for as long as the cancer is not growing and the drug is being well-tolerated. If the tumor grows during hormone therapy, other options may be available. Chemotherapy may be added either at the start of treatment or if disease progresses.

Table 1. Common Hormone Therapy Options

Drug Category
fluoxymesterone Androgen (male hormone)
goserelin (Zoladex), leuprolide (Lupron) Luteinizing hormone receptor hormone (LHRH)
megestrol acetate (Megace) Progestin
tamoxifen Selective estrogen receptor modulator (SERM)
anastrazole (Arimidex), exemestane (Aromasin), letrozole (Femara) Aromatase inhibitor
ethinyl estradiol Estrogen
fluoxymesterone Androgen (male hormone)
fulvestrant (Faslodex) Selective estrogen receptor downregulator
megestrol acetate (Megace) Progestin
tamoxifen, toremifene (Fareston) Selective estrogen receptor modulator (SERM)


Chemotherapy is a treatment option if your cancer cells are triple negative (negative for ER, PR and HER2) or if hormone therapy is unsuccessful. Chemotherapy is also usually given with anti-HER2 agents for HER2-positive breast cancer. Chemotherapy is typically given as a single drug or may be given as a combination of two drugs if the tumor is growing rapidly, if the tumor is large or there are many metastatic sites, or if you have many cancer-related symptoms. Your doctor will discuss the potential side effects of different chemotherapy drugs with you so you can weigh the advantages and disadvantages. Treatment is usually continued if the cancer does not grow, or for as long as the side effects are tolerable. However, if the tumor grows or side effects are too severe, another chemotherapy option may be considered.


Common chemotherapy options

  • capecitabine (Xeloda)
  • carboplatin (Paraplatin)
  • cisplatin
  • cyclophosphamide
  • docetaxel (Taxotere)
  • doxorubicin (Adriamycin)
  • epirubicin (Ellence)
  • eribulin (Halaven)
  • fluorouracil – also known as 5-FU
  • gemcitabine (Gemzar)
  • ixabepilone (Ixempra)
  • liposomal doxorubicin (Doxil)
  • paclitaxel (Taxol)
  • protein-bound paclitaxel (Abraxane)
  • vinorelbine (Navelbine)

Targeted Therapy

The goal of targeted therapy is to slow the progression of disease by pinpointing and blocking the genes, proteins or other substances that help cancer cells develop and grow (see Table 2). Targeted therapy is typically used for HER2-positive breast cancer, and the anti-HER2 agent is usually combined with chemotherapy. Other targeted agents are sometimes used in combination with hormone therapy for ER-positive or PR-positive breast cancer. There are currently no approved targeted therapy drugs for triple negative breast cancer.

A class of drugs currently being explored is poly (ADP-ribose) polymerase (PARP) inhibitors. PARP is an enzyme that cancer cells use to repair DNA damage. PARP inhibitors are designed to disable those enzymes along with enzymes damaged by chemotherapy. PARP inhibitors also promote cancer cell death and make cancer cells more sensitive to other chemotherapy agents, which increases the effect of chemotherapy drugs. Treatment with PARP inhibitors is available only in clinical trials.

Table 2. Targeted Therapy Options

Targeted Therapy Agent Type of Breast Cancer Approved/Recommended Treatment
abemaciclib (Verzenio) ER+/PR+, HER2-, metastatic In combination with fulvestrant (Faslodex) for the treatment of women whose advanced or metastatic disease has progressed after taking hormone therapy; or as a single agent for adult patients with disease progression following hormone therapy and chemotherapy in the metastatic setting
ado-trastuzumab emtansine (Kadcyla T-DM1) HER2+, metastatic For individuals previously treated with trastuzumab and a taxane, separately or in combination
everolimus (Afinitor) ER+/PR+, HER2-, metastatic In combination with exemestane (Aromasin) for postmenopausal women who have already been treated with letrozole or anastrozole
lapatinib (Tykerb) HER2+, metastatic In combination with capecitabine (Xeloda) or trastuzumab (Herceptin), typically after treatment with trastuzumab-based therapy and ado-trastuzumab emtansine
palbociclib (Ibrance) ER+, HER2-, metastatic In combination with letrozole for postmeopausal women as a first hormone-based therapy
pertuzumab (Perjeta) HER2+, metastatic, or as neoadjuvant therapy In combination with trastuzumab and docetaxel in individuals who have not been treated with anti-HER2 therapy or chemotherapy
ribociclib (Kisqali) ER+/PR+, HER2-, metastatic In combination with an aromatase inhibitor as first-line endocrine-based therapy for post-menopausal women
trastuzumab (Herceptin) HER2+, metastatic In combination with paclitaxel as first-line treatment, with other chemotherapy drugs, or with lapatinib for later lines of therapy; as a single agent in patients who have received one or more chemotherapy regimens

Radiation Therapy

Radiation therapy is commonly used for brain metastases. When there is only one small tumor in the brain, treatment is focused on the area of the tumor. This treatment is known as stereotactic radiation, or Gamma Knife surgery. When there are multiple metastatic tumors, whole-brain radiation is given. Radiation therapy can also be used to treat other metastatic sites, such as the bone, if you have symptoms that don’t respond to medical therapy.

Resistance to Treatment

Resistance occurs when breast cancers that were responding to treatment begin to grow again. Resistance may be caused by several factors. Sometimes it occurs after a particular type of drug therapy or long-term use of a drug, and sometimes a tumor may be naturally resistant to systemic therapy. The promising news is that if disease progresses during treatment, a different drug may be an option.

Overcoming drug resistance is a focus in breast cancer research. Scientists are studying different drug combinations, developing new drugs and evaluating the order in which drugs are given (sequential treatment) to see the effect on drug resistance.

Palliative Treatment

Palliative care is treatment focused on symptoms and side effects, such as pain, fatigue, nausea and neuropathy. Ask your doctor about palliative care early on to help manage symptoms, as this has been shown to not only improve quality of life but even lengthen life. Click here to learn more about managing pain and treatment-related side effects.

Palliative care is often mistaken for hospice care. Palliative care accompanies your regular treatment and provides physical and emotional relief. The doctors, nurses, social workers, psychiatrists, dietitians and chaplains who make up your treatment team will work with you to improve your quality of life throughout every part of your treatment.


Checkpoint inhibitors are a type of immunotherapy treatment that are being evaluated in clinical trials for advanced breast cancer. Immunotherapy uses the body’s own immune system to fight cancer cells. Immunotherapy has been successful in treating other cancers, such as melanoma and lung cancer, which has encouraged researchers to evaluate its effectiveness in breast cancer. The immunotherapy drugs most often investigated are known as checkpoint inhibitors. Checkpoints are molecules on certain immune cells that, when activated, start an immune response. Cancer cells can sometimes find ways to use these checkpoints to avoid being attacked by the immune system. Checkpoint inhibitors target checkpoints to ensure that immune cells fight cancer cells. An important advantage of immunotherapy compared with traditional treatments is its "memory" — giving it the ability to remain effective for a long period of time after the end of treatment.

Choosing the Right Path for Yourself

Undergoing continual treatment can take a toll on you. You may reach a point where you feel you need a break, or you might be enjoying a good quality of life and choose to forgo treatment for a while. Talk with your doctor to ensure you understand the pros and cons of interrupting your treatment plan, even for a short time.

You will receive input from your doctors, nurses, family members and friends, but remember — the decision is yours to make. Consider the treatments, their corresponding side effects and how they fit into your idea of a good quality of life. Keep in mind that the treatment you choose initially may need to be adjusted depending on how your body responds and the progression of the disease.

If you reach a time when you choose to stop treatment altogether, talk with your doctor about your feelings. If you make that difficult decision, you are strongly encouraged to consider hospice care, where your care is focused on managing symptoms and supporting you and your family instead of using cancer therapies. Hospice care can take place at home or in a hospice center and offers physical, emotional and spiritual support for you and your loved ones.

Additional Resources


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