Your ideal treatment depends on your subtype of breast cancer.
Today, treatment for metastatic breast cancer (or breast cancer that has spread to other parts of the body) involves more than just the traditional chemotherapy. Options like hormone therapy, targeted therapy, and immunotherapy now play major roles in breast cancer treatment.
However, chemotherapy has not disappeared. It’s still frequently used in conjunction with other therapies (to make them even more effective), or in cases where a patient simply isn’t eligible for the newer treatment options.
“There are many different types of treatment available for metastatic breast cancer, and those treatments really depend on your subtype of breast cancer,” says Natalie Berger, MD, hematologist and oncologist at The Mount Sinai Hospital. “While you may hear that somebody you know had X treatment, that one may not pertain to you because you have a different subtype of breast cancer.”
How Do You Know Your Eligibility?
When you are diagnosed with breast cancer, your doctor will tell you your stage and your subtype. Stages range from I to IV, which rates how much the cancer is affecting the body. The higher the stage, the larger the tumor and/or the more likely that the cancer has spread to lymph nodes or other organs.
Then there is breast cancer receptor status. This refers to tiny receptors on the surface of the cancer cell that help fuel the cancer growth. Breast cancer can have estrogen or progesterone receptors (hormone receptor-positive breast cancer), receptors for the growth-promoting protein HER2/neu (HER2-positive breast cancer), or they may contain neither of these three receptors (triple-negative breast cancer).
“The reason we look for these receptors is because we have specific therapies that target these,” says Dr. Berger.
For example, hormone receptor-positive breast cancer can be effectively treated with hormone therapy. These medications either slow the production of hormones by the body, or inhibit the hormones from interacting with the receptors, which slows or stops the growth of these tumors.
HER2-positive breast cancer often uses targeted therapy, which specifically targets cells with HER2/neu receptors. Learn more about how targeted therapy treats breast cancer here.
Neither hormone therapy nor targeted therapy are appropriate for triple-negative breast cancer. This is often when chemotherapy plays a big role in treatment, along with immunotherapy in some cases. Find out how triple-negative breast cancer is treated here.
“Treatments for breast cancer have advanced rapidly over the last few years. Today, treatments are moving further and further away from our traditional chemotherapies, and more toward targeted therapies, personalized medicine, so that the side effects and the tolerability of these treatments are much better today than they were in the past,” says Dr. Berger.
Dr. Berger is a hematologist and oncologist at The Mount Sinai Hospital in New York City.
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There are many different types of treatment available
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for metastatic breast cancer, and those treatments
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really depend on your subtype of breast cancer.
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So while you may hear that somebody you know had X treatment,
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that one may not pertain to you because you have a
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different subtype of breast cancer.
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At the time of diagnosis of breast cancer, your doctor
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will recommend that you go for a biopsy.
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When the biopsy is performed, that tissue specimen
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will go to a pathologist who will look at that cancer
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under the microscope.
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When our pathologists look at the cancer under the microscope,
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they look for three important receptors,
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in addition to many other things.
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The subtypes of breast cancer are hormone receptor-positive
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breast cancer, which is the estrogen receptor
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and/or the progesterone receptor.
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There's also HER2-positive breast cancer,
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as well as triple-negative breast cancer,
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and what triple-negative breast cancer means is that
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the cancer cells don't express the estrogen receptor,
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the progesterone receptor, or the HER2 receptor.
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And the reason we look for these receptors is because
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we have specific therapies that target these.
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Often times the first line of treatment
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of hormone receptor-positive metastatic breast cancer
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is actually a pill form of treatment.
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It's a combination of two pills that you can use
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and take at home, and just follow up with your doctor
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for blood counts and toxicity checks.
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For HER2-positive breast cancer, the first-line therapy
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for metastatic breast cancer often involves a combination
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of chemotherapy with targeted therapies
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against the HER2 receptor itself.
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And often times for triple-negative, the first-line
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treatment will involve chemotherapy
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and it may also involve immunotherapy.
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I tell all of my patients that nobody is going to be
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a better advocate for you than yourself.
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Treatments for breast cancer have advanced rapidly
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over the last few years.
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Today, treatments are moving further and further away
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from our traditional chemotherapies, and more toward
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targeted therapies, personalized medicine,
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so that the side effects and the tolerability of these treatments
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are much better today than they were in the past.
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Breast cancer treatment (adult)(PDQR) - patient version. Bethesda, MD: National Cancer Institute. (Accessed on February 6, 2020 at https://www.cancer.gov/types/breast/patient/breast-treatment-pdq.)
Hormone therapy for breast cancer. Bethesda, MD: National Cancer Institute. (Accessed on February 6, 2020 at https://www.cancer.gov/types/breast/breast-hormone-therapy-fact-sheet.)
Targeted therapy for breast cancer. Atlanta, GA: American Cancer Society. (Accessed on February 6, 2020 at https://www.cancer.org/cancer/breast-cancer/treatment/targeted-therapy-for-breast-cancer.html.)