What are the treatment options for HR+/HER2+ breast cancer?

Treatment for HR+/HER2+ breast cancer can include surgery, radiation, chemotherapy, and targeted therapy. This specific type of breast cancer is typically treated with a combination of chemotherapy and targeted therapy.

Targeted therapy includes treatments that can target both the HER2+ part of the cancer as well as the HR+ portion. HER2+ targeted therapy is given intravenously and is usually administered at the same time as chemotherapy. The HR+ portion of targeted treatment is typically given as an oral pill following the completion of chemotherapy.

In some instances (and depending on factors like the type of surgery and results from that surgery), radiation therapy may be included in your treatment plan.

It’s best to discuss the specifics of your tumor type with your oncology team.

Will I need to undergo chemotherapy?

In a majority of breast cancer cases, with both HR+ and HER2+ positivity, chemotherapy will be recommended. In rare instances, this specific type of breast cancer may not require chemotherapy, only needing targeted therapies as discussed above. The exact type and length of treatment can vary. These details will be provided to you by your oncology team.

What kinds of side effects might I experience from treatment?

Chemotherapy side effects vary but can include hair loss, nausea, rash, diarrhea, constipation, fatigue, numbness in the fingers and toes, and nail changes. A majority of these changes will go away when chemotherapy is complete.

HR+ targeted therapies are taken in pill form for a number of years after chemotherapy is complete. The side effects of these treatments vary depending on the type prescribed to you. In general, you may experience hot flashes, changes in your period, decreased libido, vaginal dryness or irritation, bone density loss, joint pain, rash, and fatigue.

HER2+ targeted therapies are given intravenously. In rare cases, these therapies can affect the heart’s strength. Your oncology team will assess the strength of your heart before and during treatment. This assessment is typically done with an echocardiogram or multigated acquisition (MUGA) scan.

Will treatment affect my ability to work or take care of my family?

In many cases, the side effects of chemotherapy can be managed with medications called “supportive therapies.” Such treatments enable you to continue working or look after your family.

However, there will likely be tasks too difficult to complete while undergoing chemo. The symptoms that may prevent you from such tasks can vary from person to person, but may include difficulty driving (due to supportive therapies), fatigue, and nausea.

Also, chemotherapy and other targeted treatments will require visits to your oncology team and can impact your ability to fulfill work or family obligations. For these reasons, you may want to consider a lightened workload or taking short-term leave from work. If necessary, you may also want to look into getting extra help for looking after your children or loved ones.

Will treatment affect my fertility?

If you are of childbearing age, discuss any fertility concerns you have with your oncology team before starting treatment. Many of the treatments given (chemotherapy and/or targeted therapies) can impact your fertility. It’s important to consider your plans for childbearing and have candid conversations with your oncology team about your fertility goals.

What types of doctors will I need to consult about my breast cancer treatment?

Your oncology team will likely include a number of doctors, nurse practitioners, and nurses. These different medical professionals will advise on radiation oncology, medical oncology, and surgical oncology.

The radiation oncology team will assist in determining whether you need radiation. If you do undergo radiation, they will guide your radiation treatment and help you manage any side effects from it.

The medical oncology team will determine your treatment plan including therapy for HR+ and HER2+ breast cancers, as well as any chemotherapy. This team will work closely with you to identify the best treatment and to help manage any side effects.

The surgical oncology team will work with you to determine the best surgical option for treating your breast cancer. They will help you prepare for and recover from any surgery you undergo.

How long does treatment last?

Treatment length varies depending on your treatment plan.

In general, chemotherapy typically lasts four or five months. HER2+ targeted therapy usually lasts one year. HR+ (daily pill) therapy can last 5 to 10 years.

Will treatment exacerbate my menopause symptoms?

HR+ targeted therapy, as well as chemotherapy, can cause menopausal symptoms like hot flashes, fatigue, dry skin, vaginal dryness or irritation, and emotional liability. If you haven’t undergone menopause, treatment with chemotherapy can cause your periods to lighten or stop completely. In some cases, your period may restart after chemotherapy is complete. This varies from person to person and can depend on your age.

Are there certain dietary changes I’m expected to make?

In general, you will be asked to keep a healthy diet and avoid alcohol consumption while undergoing chemotherapy. Also, some foods may not taste good or can cause nausea during treatment. During chemo, if you notice certain smells or tastes that make you feel unwell, avoid them. Tell your oncology team if you’re experiencing any symptoms of nausea or other negative reactions to food.

Where can I find more information about joining a support group?

There are many different types of support groups available for you. Your location and preferences for support will typically help you choose which group to join.

Many resources are available to help guide you in making this choice. These resources include those you’ll find from internet searches, online chat rooms or forums, and blogs. In-person meetings are also available in most areas.

Is surgery an option?

Surgery is typically part of your treatment plan. It may be recommended after you finish a portion (or all) of your chemotherapy. The type of surgery recommended is dependent on a number of factors — for instance, the type and size of your tumor, as well as how you feel about breast surgery. This surgery will typically be performed by the surgical oncologist in consultation with the medical and radiation oncologists.

Advice offered by Hope Qamoos, nurse practitioner in women's health. Hope has over 15 years of experience working in women's health and oncology. She has spent her professional career working with key opinion leaders in the field at university hospitals such as Stanford, Northwestern, and Loyola. In addition, Hope works with a multidisciplinary team with the goal of improving the care of women with cancer in Nigeria.