Content created by Healthline and sponsored by our partners.​ ​ Learn​ ​more

What Treatment Options Exist for Advanced Breast Cancer?

Medically reviewed by Christina Chun, MPH on March 22, 2017Written by Ann Pietrangelo on March 22, 2017
breast cancer

Having an advanced form of cancer can feel like you have little or no treatment options. But that’s not the case. Find out what options are available to you, and start getting on the right type of treatment.

Hormone therapy

There are several hormone therapies to treat advanced hormone receptor-positive (estrogen receptor-positive or progesterone receptor-positive) breast cancers:

Tamoxifen is a daily oral medication for premenopausal women.

Aromatase inhibitors are oral medications for postmenopausal women. These may be combined with targeted drugs such as palbociclib (Ibrance) or everolimus (Afinitor). The aromatase inhibitors include:

Side effects of hormonal therapies may include:

  • hot flashes and night sweats
  • vaginal dryness
  • lowered sex drive
  • mood swings
  • disruption in menstrual cycle in premenopausal women
  • cataracts
  • increased risk of blood clots, stroke, and heart attack
  • bone loss

Hormonal therapies aren’t effective in treating hormone receptor-negative breast cancers.

Targeted drugs

Several drugs target advanced HER2-positive breast cancer. Note that these therapies aren’t effective treatments for HER2-negative breast cancer.

Trastuzumab (Herceptin) is administered intravenously and often prescribed in combination with chemotherapy. The initial dose usually takes about 90 minutes. After that, doses are smaller and take about half an hour. Among the potential side effects are:

  • infusion reaction
  • fever
  • nausea and vomiting
  • diarrhea
  • infections
  • headache
  • fatigue
  • rash

Pertuzumab (Perjeta) is also administered intravenously. The initial dose takes about an hour. It may be repeated every three weeks in smaller doses. It’s often used in conjunction with chemotherapy. Side effects from pertuzumab with chemotherapy may include:

  • nausea
  • diarrhea
  • hair loss
  • fatigue
  • rash
  • numbness and tingling (peripheral neuropathy)

Another medicine taken intravenously, ado-trastuzumab emtansine (Kadcyla) is administered every 21 days. Among the potential side effects are:

  • infusion reaction
  • fatigue
  • nausea
  • headache and musculoskeletal pain
  • constipation
  • nose bleeds and hemorrhage

Lapatinib (Tykerb) is an oral medication. It can be used alone or combined with chemotherapy or other targeted drugs. Depending on which medicines it’s combined with, lapatinib may cause:

  • diarrhea
  • nausea and vomiting
  • rash
  • fatigue

The following targeted therapies are used to treat advanced hormone receptor-positive/HER2-negative breast cancers:

Palbociclib (Ibrance) is an oral medication used with an aromatase inhibitor. Side effects may include:

  • nausea
  • mouth sores
  • hair loss
  • fatigue
  • diarrhea
  • increased risk for infection

The oral drug everolimus (Afinitor) is taken orally and used in combination with exemestane (Aromasin). It’s usually not used until after letrozole or anastrozole have been tried. Potential side effects include:

  • shortness of breath
  • cough
  • weakness
  • increased risk for infection, high blood lipids, and high blood sugar

Chemotherapy

Chemotherapy may be used for any type of breast cancer. Most of the time, this will involve a combination of several chemotherapy drugs.

There are no hormonal or targeted treatments for breast cancers that are both hormone receptor-negative and HER2-negative (also known as triple-negative breast cancer, or TNBC). Chemotherapy is the first-line treatment in these cases.

Chemotherapy is a systemic treatment. It can reach and destroy cancer cells anywhere in your body. Under certain circumstances, chemotherapy drugs can be delivered directly to a particular area of metastasis, such as your liver or to the fluid around your brain.

The drugs are administered intravenously. Each treatment session can last several hours. It’s given at regular intervals of up to several weeks. This is to allow your body to recover in between treatments.

Chemotherapy drugs are effective because they kill fast-growing cancer cells. Unfortunately, they can also kill some fast-growing healthy cells. That can cause a host of potential side effects, including:

  • nausea and vomiting
  • hair loss
  • loss of appetite
  • constipation or diarrhea
  • fatigue
  • changes to skin and nails
  • mouth sores and bleeding gums
  • mood changes
  • loss of weight
  • loss of sex drive
  • fertility problems

Radiation

In some situations, radiation therapy can help in the treatment of advanced breast cancer. Some examples are:

  • targeting metastasis in a particular area, such as your brain or spinal cord
  • helping prevent fractures in weakened bones
  • targeting a tumor that is causing an open wound
  • treating blood vessel blockage in your liver
  • providing pain relief

Radiation treatment is painless. But it can cause temporary skin irritation and long-term fatigue. It’s usually administered every day for up to seven weeks, so there’s a daily time commitment.

Surgery

Surgery might be part of your advanced breast cancer treatment for a few reasons. One example is surgery to remove a tumor that is pressing on your brain or spinal cord.

Surgery may be used in combination with radiation therapy.

Pain medications

A variety of drugs can be used to treat pain associated with advanced breast cancer.

You can start with over-the-counter pain relievers. Among them are:

Talk to your doctor before using over-the-counter medications. Some can interfere with your other treatments.

For more severe pain, your doctor can prescribe an oral opioid such as:

Side effects may include drowsiness, constipation, and nausea. These powerful medications should be taken exactly as directed.

These are generally used for pain due to bone metastasis:

  • bisphosphonates: zoledronic acid (Zometa) or pamidronate (Aredia), given intravenously
  • RANK ligand inhibitor: denosumab (Xgeva or Prolia), given by injection

These drugs can also help lower the risk of bone fractures. Muscle and bone pain are potential side effects.

Other types of medicines for pain of advanced breast cancer are:

  • antidepressants
  • anticonvulsants
  • steroids
  • local anesthetics

Some people have trouble swallowing pills. In that case, certain pain medications are available in liquid or skin patch form. Others can be administered intravenously or through a chemotherapy port or catheter.

Complementary therapies

Some complementary therapies that may help control pain are:

  • acupuncture
  • heat and cold therapy
  • massage therapy
  • gentle exercise or physical therapy
  • relaxation techniques such as meditation and guided imagery

The bottom line

Treatment for advanced breast cancer will be tailored to your individual needs as well as your disease status. It will likely involve multiple treatments at the same time. It should be flexible, changing as your needs change.

Your doctor will monitor your health and symptoms. You don’t have to continue with treatments that aren’t working.

Good communication with your doctor is essential to achieving the best possible quality of life.

CMS Id: 117798