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Treatment of stage III breast cancer

The following are treatment options for stage III (locally advanced) breast cancer. The types of treatments given are based on the unique needs of the woman with cancer.

Invasive ductal and invasive lobular carcinomas are treated the same way.

The treatment offered for stage III breast cancer, and the order that it is given, depends on whether the tumour is:

  • operable – can be removed by surgery
  • inoperable – cannot be removed by surgery because:
    • The tumour is attached to the chest wall or skin.
    • The lymph nodes are attached to other structures in the armpit.
    • The cancer has spread to a lymph node above the collarbone (supraclavicular).


Chemotherapy is the primary treatment for stage III breast cancer. It may be offered:

  • after breast cancer surgery
  • before surgery to shrink the breast cancer tumour
    • A smaller tumour is easier to remove during surgery.
    • In some cases, an inoperable breast tumour may respond to chemotherapy so that it can be removed by surgery.

Chemotherapy for stage III breast cancer is not usually given as a single drug. Drugs are more commonly used in combination with one another because this has been shown to be more effective.

The most common chemotherapy combinations used to treat stage III breast cancer are:

  • AC
    • doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan, Procytox)
  • AC – Taxol
    • doxorubicin and cyclophosphamide, followed by paclitaxel (Taxol)
  • AC – Taxol (dose dense)
    • doxorubicin and cyclophosphamide, followed by paclitaxel, with less time between treatments (dose dense)
      • This combination is usually given with filgrastim (Neupogen) or pegfilgrastim (Neulasta).
  • TC
    • docetaxel (Taxotere) and cyclophosphamide
  • TAC (or DAC)
    • docetaxel, doxorubicin and cyclophosphamide
  • FAC (or CAF)
    • cyclophosphamide (by mouth), doxorubicin and 5-fluorouracil (Adrucil, 5-FU)
  • CEF
    • cyclophosphamide (by mouth), epirubicin (Pharmorubicin) and 5-fluorouracil
  • FEC
    • cyclophosphamide (into a vein – intravenous), epirubicin and 5-fluorouracil
  • FEC– T
    • cyclophosphamide, epirubicin and 5-fluorouracil, followed by docetaxel
  • CMF – IV
    • cyclophosphamide (intravenous), methotrexate and 5-fluorouracil
  • CMF – PO
    • cyclophosphamide (by mouth), methotrexate and 5-fluorouracil
  • Taxol – FAC
    • paclitaxel, followed by cyclophosphamide, doxorubicin and 5-fluorouracil

For more detailed information on specific drugs, go to sources of drug information.

The way the cancer responds to chemotherapy will determine the next treatment.

  • If the cancer shrinks, surgery and radiation therapy may be an option.
  • If the cancer does not respond very well to chemotherapy, radiation therapy will probably be given.


Surgery may be offered for stage III breast cancer. It may be done before or after chemotherapy. The type of surgery is usually a modified radical mastectomy.

Radiation therapy

External beam radiation therapy may be offered for stage III breast cancer. It may be given after chemotherapy, and before or after surgery.

Radiation is usually directed at the chest wall and lymph nodes in the armpit and above the collarbone.

Hormonal therapy

After chemotherapy is finished, hormonal therapy may be offered to women who have stage III breast cancer that is hormone receptor positive (ER+, PR+ or both). It may also be offered to women who cannot have, or do not wish to have, chemotherapy.

The types of hormonal therapy offered for stage III breast cancer are:

  • anti-estrogens
    • tamoxifen (Nolvadex, Tamofen) – the most common anti-estrogen
      • Tamoxifen is used to treat both premenopausal and post-menopausal women.
      • Post-menopausal women may be switched to an aromatase inhibitor after a period of time on tamoxifen.
  • aromatase inhibitors – used only in post-menopausal women
    • letrozole (Femara)
    • anastrozole (Arimidex)
    • exemestane (Aromasin)
  • ovarian ablation – may be offered to premenopausal women who do not wish to take other types of hormonal therapy
    • luteinizing hormone–releasing hormone (LHRH) agonists
      • goserelin (Zoladex)
      • leuprolide (Lupron, Lupron Depot, Eligard)
      • buserelin (Suprefact)
    • surgery
    • radiation therapy

For more detailed information on specific drugs, go to sources of drug information.

Biological therapy

Women with HER2-positive stage III breast cancer may also be offered treatment with trastuzumab (Herceptin). It may be given with the chemotherapy, or immediately after completing chemotherapy.

Clinical trials

Women with breast cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.


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