Treatment for advanced breast cancer may include a combination of approaches, both local and systemic. Local treatments are those which focus on treating the tumor in a specific area of the body, while systemic treatments go throughout the body to treat cancer cells.
How treatment is chosen
The type of treatment that is used is tailored to the individual and is chosen based on several factors, including:
In addition, new treatments are being studied in clinical trials, such as immunotherapy treatments, which aims to boost the individual’s own immune system to fight the cancer.2 Patients should talk with the doctor about whether clinical trials are an option for their specific type of cancer.
Surgery is a form of local therapy. There are a variety of surgical procedures that may be used to treat breast cancer, including surgery to the breast and surgeries to other areas of the body, such as the lymph nodes under the arm (axillary lymph nodes) and the ovaries. Surgery options to the breast include breast-conserving procedures and mastectomy, which removes the entire breast.
For women with metastatic breast cancer (cancer that has spread to other parts of the body), treatment may or may not include surgery to the primary tumor in the breast. Some research studies have found that removing the primary tumor can potentially improve survival while other studies have found little benefit, and surgery for metastatic breast cancer is still controversial. Women with metastatic breast cancer should discuss their options with their doctor to determine the best treatment options for them.3,4
A type of local therapy, radiation therapy uses high doses of radiation to kill cancer cells in a specific area. Cancer cells multiply rapidly and are more susceptible to radiation than healthy cells. Radiation therapy may be used after breast-conserving surgery (such as a lumpectomy), after mastectomy, to treat breast cancer that has spread to the lymph nodes under the arm, or to shrink tumors and improve the symptoms of metastatic breast cancer.5,6
Chemotherapy is a systemic treatment that uses medications to treat cancer cells. Chemotherapy may be used as an adjuvant (after primary therapy) treatment in early breast cancers to reduce the risk of recurrence. Chemotherapy may also be used before surgery in certain cases to reduce the size of a tumor. In advanced or metastatic breast cancer, chemotherapy may be the primary treatment, and it may be used in combination with certain targeted therapies. For metastatic breast cancer, sequential single agents are usually recommended. This method uses one chemotherapy drug at a time, one after another, and the drug is changed to another when the breast cancer no longer responds or begins growing, or the patient can no longer tolerate the specific drug.7,8
Hormone therapy is a systemic treatment used to treat breast cancers that are hormone receptor-positive (HR+). HR+ breast cancers have receptors on the surface of their cells which bind to hormones in the body like estrogen and progesterone. When these hormones connect to the receptors on cancer cells, it can fuel the growth of breast cancer, causing it to grow and spread faster. Hormone therapy aims to block the hormones from attaching or prevent the body from producing hormones to stop or slow the growth of breast cancer.9
Another form of systemic treatment, targeted therapy stops or slows breast cancer by interfering with specific areas of cancer cells that are involved in the cancer cell’s growth processes. There are several types of targeted therapy that are used in treating advanced breast cancer, including10,11:
In addition to the active treatments described above to treat advanced breast cancer, palliative care can be used alongside other treatments to ease the patient’s side effects or symptoms from cancer, and cancer treatment. Palliative care can significantly improve a person’s quality of life while they are undergoing treatment for breast cancer. Palliative care is different than hospice care, which is given near the end of life. Instead, palliative care can aid patients throughout their treatment journey.12
Breast cancer treatment (PDQ). National Cancer Institute. Available at https://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_185. Accessed 10/19/18.
Vonderheide RH, Domchek SM, Clark AS. Immunotherapy for breast cancer: what are we missing? Clinical cancer research: an official journal of the American Association for Cancer Research. 2017;23(11):2640-2646. doi:10.1158/1078-0432.CCR-16-2569.
Tosello G, Torloni M, Mota BS, Neeman T, Riera R. Breast surgery for metastatic breast cancer. Cochrane. Available at https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer. Accessed 10/5/18.
Poggio F, Lambertini M, de Azambuja E Controversies in Oncology: Surgery of the primary tumour in patients presenting with de novo metastatic breast cancer: to do or not to do? ESMO Open 2018;3:e000324. doi: 10.1136/esmoopen-2018-000324
Radiation for breast cancer. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/treatment/radiation-for-breast-cancer.html. Accessed 10/5/18.
Radiation therapy for breast cancer. Mayo Clinic. Available at https://www.mayoclinic.org/tests-procedures/radiation-therapy-for-breast-cancer/about/pac-20384940. Accessed 10/5/18.
Chemotherapy for breast cancer. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html. Accessed 10/4/18.
Chemotherapy for metastatic breast cancer in 2017. OncLive. Available at https://www.onclive.com/insights-archive/bc-targeting-angiogenesis/chemotherapy-for-metastatic-breast-cancer-in-2017. Accessed 10/4/18.
Hormone therapy for breast cancer. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html. Accessed 10/3/18.
Targeted therapy: monoclonal antibodies, anti-angiogenesis, and other cancer therapies. Chemocare. Available at http://chemocare.com/chemotherapy/what-is-chemotherapy/targeted-therapy.aspx. Accessed 9/20/18.
Targeted cancer therapies. National Cancer Institute. Available at https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet. Accessed 9/20/18.
Palliative care in cancer. National Cancer Institute. Available at https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet. Accessed 10/19/18.