Chemotherapy Treatment of Advanced Breast Cancer
Treatment for metastatic breast cancer focuses on extending life and maintaining quality of life.
Your treatment plan is guided by many factors, including:
- The biology of the tumor (characteristics of the cancer cells)
- Where the cancer has spread
- Your symptoms
- Past breast cancer treatments
- Personal goals and preferences
Most patients with stage 4 breast cancer have disease that has already spread and cannot be removed with surgery, so systemic treatment that can kill cancer cells throughout the body is necessary.
Systemic treatment is called chemotherapy. Chemotherapy can also destroy cancer cells that have metastasized to parts of the body away from the original tumor site. Combining two or more chemotherapy agents can be used for treatment of breast cancer, as this will help to provide a better response overall.
Chemotherapy is usually given over 3-6 months. It’s given in cycles, with days or weeks off between treatments. This gives your body a chance to recover.
Most chemotherapy is given by IV through a vein and you will usually need to have a port placed(this port will need to be routinely flushed). Some chemotherapy treatment is in pill form and can be taken orally.
Your schedule depends on the combination of drugs used for treatment.
Chemotherapy drugs for metastatic breast cancer
Below is a list of the most common chemotherapy drugs (used alone or in combination) to treat metastatic breast cancer.
- Capecitabine (Xeloda) pill
- Carboplatin (Paraplatin) IV treatment
- Cisplatin (Platinol) IV treatment
- Cyclophosphamide (Cytoxan) Pill or IV treatment
- Docetaxel (Taxotere) IV treatment
- Doxorubicin (A) (Adriamycin) IV treatment
- Epirubicin € (Ellence) IV treatment
- Eribulin (Halaven) IV treatment
- 5-Fluorouracil (5FU or F) (Adrucil) IV treatment
- Gemcitabine (Gemzar) IV treatment
- Ixabepilone (Ixempra) IV treatment
- Liposomal doxorubicin (Doxil) IV treatment
- Methotrexate (M) (Maxtrex) Pill or IV treatment
- Paclitaxel (t) Taxol IV treatment
- Paclitaxel, albumin bound Abraxane IV treatment
- Vinorelbine (Navelbine) IV treatment
Common chemotherapy drug combinations
Common drug combinations are listed below. Other combinations are also used.
HER2-negative breast cancer
- AC Doxorubicin and cyclophosphamide
- AC – Paclitaxel Doxorubicin and cyclophosphamide followed by paclitaxel
- AC – Docetaxel Doxorubicin and cyclophosphamide followed by docetaxel
- TAC Docetaxel, doxorubicin, and cyclophosphamide
- TC Cyclophosphamide and docetaxel
- CMF Cyclophosphamide, methotrexate, and 5flourouracil
HER2 Positive Breast Cancer
- TCH Docetaxel, carboplatin, and trastuzumab
- TCHP Docetaxel, carboplatin, trastuzumab, and pertuzumab
- AC-Paclitaxel Doxorubicin and cyclophosphamide followed by paclitaxel and trastuzumab
- TH Paclitaxel and trastuzumab
- THP Paclitaxel, trastuzumab, and pertuzumab
All breast cancers are tested for HER2 status to help guide treatment.
If a tumor is HER2-positive, the HER2-targeted therapy drug trastuzumab (Herceptin) is included in the chemotherapy regimen.
Sometimes other drugs that target HER2 are used. Pertuzumab (Perjeta) can be combined with trastuzumab and neratinib (Nerlynx) can be given after trastuzumab. In some cases, ado-trastuzumab emtansine (Kadcyla, T-DM1, trastuzumab emtansine) may be given.
These drugs are not used to treat HER2-negative cancers.
Trastuzumab (with or without pertuzumab) is given by vein (through an IV) or by injection every 3 weeks for one year. It’s usually started with chemotherapy, and then continued after the chemotherapy has ended.
Hormone Therapy If Cancer Comes Back or Has Spread
AIs, tamoxifen, and fulvestrant can be used to treat more advanced hormone-positive breast cancers, especially in post-menopausal women. They are often continued for as long as they are helpful. Pre-menopausal women might be offered tamoxifen alone or an AI in combination with an LHRH agonist for advanced disease.
Sometimes chemotherapy and other treatments can cause side effects. Visit our EASE page to discover helpful hints on how to deal with the possible aftermath of treatment.
Chemotherapy can also be used in combination with immuno-oncology or immunotherapy and some advanced breast cancer may benefit from hormone therapy or a combination of therapies.