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Breast cancer

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Treatment of stage IV breast cancer

The following are treatment options for stage IV 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.

At present, stage IV (or metastatic) breast cancer is not considered curable. The goal of treatment is to help the woman survive (sometimes for several years) and to remain free of symptoms as long as possible.

The type of treatment offered for stage IV breast cancer will depend on:

  • the hormone receptor status of the tumour
  • the HER2 status of the tumour
  • where the cancer has spread
    • bone
    • soft tissues
    • other organs (liver, lung or brain)
  • the woman’s overall health

Treatment options may include one or a combination of the following treatments.

Hormonal therapy

Hormonal therapy may be offered for stage IV breast cancer with:

  • hormone receptor–positive tumours (ER+, PR+ or both)
  • tumours where the hormone receptor status is unknown
  • metastasis in the bone or soft tissues only
  • women who cannot or do not wish to have chemotherapy

The types of hormonal therapy are:

  • aromatase inhibitors – used only in post-menopausal women
    • letrozole (Femara)
    • anastrozole (Arimidex)
    • exemestane (Aromasin)
  • 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.
  • 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


Chemotherapy may be offered for stage IV breast cancer that:

  • is hormone receptor negative (ER–, PR– or both)
  • has spread to liver, lung or brain
  • does not respond to hormonal therapy
  • is progressing quickly or is causing severe symptoms or life-threatening complications

The response of stage IV breast cancer to single chemotherapy drugs or combinations is similar. Single drugs are often given for stage IV breast cancer because they have fewer side effects than combination chemotherapy.

The types of single chemotherapy drugs are:

  • vinorelbine (Navelbine)
  • cisplatin (Platinol AQ)
  • capecitabine (Xeloda)
  • paclitaxel (Taxol)
  • docetaxel (Taxotere)
  • doxorubicin (Adriamycin)
  • 5-fluorouracil (Adrucil, 5-FU)
  • methotrexate
  • epirubicin (Pharmorubicin)
  • etoposide (Vepesid) – given by mouth (oral)
  • cyclophosphamide (Cytoxan, Procytox)
  • gemcitabine (Gemzar)
  • mitomycin (Mutamycin)
  • protein-bound paclitaxel (Abraxane)
    • The protein helps get the active drug (paclitaxel) into the cancer cells more easily.
  • eribulin (Halaven)
    • Eribulin may be used to treat metastatic breast cancer in women who have received at least 2 other chemotherapy regimens for metastatic disease. Previous therapy should have included an anthracycline (such as doxorubicin or epirubicin) and a taxane (such as paclitaxel or docetaxel).

Chemotherapy combinations that may be offered for recurrent breast cancer are:

  • AC
    • doxorubicin and cyclophosphamide
  • docetaxel and doxorubicin
  • FAC (or CAF)
    • cyclophosphamide (by mouth), doxorubicin and 5-fluorouracil
  • CMF – IV
    • cyclophosphamide (intravenous), methotrexate and 5-fluorouracil
  • CMF – PO
    • cyclophosphamide (by mouth), methotrexate and 5-fluorouracil
  • doxorubicin and paclitaxel
  • docetaxel and capecitabine
  • vinorelbine and epirubicin

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

Biological therapy

Biological therapy may be offered for stage IV breast cancer. The primary type of biological therapy given is trastuzumab (Herceptin). Herceptin is offered to women with HER2-positive tumours. It may be used alone or in combination with chemotherapy drugs like paclitaxel or docetaxel. Herceptin is given until the cancer no longer responds to treatment or progresses.

Pertuzumab (Perjeta) is another drug designed to target HER2 proteins that is used with trastuzumab and taxane chemotherapy for treatment of metastatic HER2-positive breast cancer. It is given as an intravenous drug injected into a vein and can be used in women who have not received prior anti-HER2 therapy or chemotherapy for metastatic diasease.

Another biological therapy that may be used to treat women with HER2-positive metastatic breast cancer is trastuzumab emtansine (Kadcyla or T-DM1). It may be used to treat women with HER2-positive metastatic breast cancer  who have received prior treatment with trastuzumab and taxane chemotherapy, separately or in combination.


Bisphosphonates may be used to reduce pain and fractures when breast cancer has spread to the bone (bone metastases).

The types of bisphosphonates used to treat bone metastases from breast cancer are:

  • clodronate (Bonefos)
  • pamidronate (Aredia)
  • zoledronic acid (Zometa, Aclasta)

Women who have pain from the bone metastases may be offered other methods of pain management along with bisphosphonate therapy.

Radiation therapy

External beam radiation therapy may be offered for stage IV breast cancer to relieve pain and other symptoms caused by:

  • bone metastases
  • a blockage of the bronchibronchiThe large tubes, or airways, that branch off from the windpipe (trachea) into the lungs, where they branch into smaller tubes (bronchioles) that end in the alveoli (air sacs). Bronchi carry air to and from the lungs. (bronchial obstruction)
  • brain or spinal cord metastases (rare)
  • painful, open, draining areas on the breast or chest wall


Surgery is sometimes used to relieve pain and other symptoms associated with stage IV breast cancer. It may be used to:

  • remove a lump in the skin
  • remove a single or isolated metastasis in the:
  • fix broken (fractured) bones caused by metastasis
  • treat spinal cord compression caused by metastasis

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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