Which First-Line Breast Cancer Therapy Is Right for Me?

Primary therapies for noninvasive breast cancer

Hormonal therapies

The primary treatment for advanced hormone receptor-positive (estrogen receptor-positive or progesterone receptor-positive) breast cancer is usually hormone therapyTrusted Source.

Current therapy is typically an aromatase inhibitor (anastrozole, letrozole, or exemestane) in combination with a CDK 4/6 inhibitor.

If this combination is given to a premenopausal person, an ovarian suppression (Zoladex, Lupron) treatment must also be given. The aromatase inhibitors only work when the ovaries no longer produce estrogen.

Other anti-estrogens include fulvestrant and tamoxifen, generally given with a targeted partner medication.

A particular line of anti-estrogen therapy is given as long as it’s working and the patient tolerates it. When one line stops working, a second hormonal therapy is typically tried.

Side effects of hormone therapy vary with each drug but can include:

• hot flashes and night sweats
• vaginal dryness
• loss of sex drive
• changes in mood
• joint pain

Targeted therapies

Targeted therapiesTrusted Source for HER2-positive breast cancer include:

• trastuzumab (Herceptin)
• pertuzumab (Perjeta)
• ado-trastuzumab emtansine (Kadcyla)
• trastuzumab deruxtecan (Enhertu)
• tucatinib (Tukysa)
• neratinib (Nerlynx)
• lapatinib (Tykerb)

Some may be more effective when used in combination with chemotherapy.

Some hormonal and targeted therapies are available in pill form.

If side effects get overwhelming, or your cancer continues to progress while taking hormonal or targeted therapy, changing drugs is a good strategy.

If you’ve already done that and cancer is still progressing, you may have to switch to chemotherapy alone.

Chemotherapy

When breast cancer tests estrogen receptor-negative, progesterone receptor-negative, and HER2-negative, it’s called triple-negative breast cancer.

No hormonal or targeted therapies exist for this type, so chemotherapy is the mainstay of treatment.

Chemotherapy may also be used for other types of breast cancer when more targeted therapies are no longer working.

Chemotherapy drugs are designed to kill fast-growing cellsTrusted Source, which is why they’re so effective in destroying cancer. But other fast-growing cells in your body can be affected in the process, including:

• hair follicles
• cells in your bone marrow that help form blood
• cells in your mouth, digestive tract, and reproductive system
• nerve cells

Chemotherapy has many potential side effects. Some people only experience a few, while others go through more. Symptoms range from mild to severe and can include:

• hair loss
• loss of appetite
• nausea and vomiting
• diarrhea or constipation
• numbness and tingling
• changes to fingernails and toenails
• fatigue
• weight loss or gain

Medications, such as anti-nausea medications, can minimize some side effects. Immune boosters are also available to help your bone marrow make more healthy white blood cells to prevent infection.

The chemotherapy drugs are administered intravenously at certain intervals, which could be weekly, or every 2 or 3 weeks. Each session may last several hours. Side effects are usually the worst a few days after treatment.

First-line treatments for MBC

Surgery

Doctors may use surgery to remove tumors in affected organs when other methods don’t relieve symptoms. Surgery to relieve pressure around your spinal cord is one example.

Radiation therapy

Radiation is a targeted, first-line therapy that destroys cancer cells in a specific area of the breast if your cancer is metastatic.

BreastCancer.org reports that radiation therapy can’t be repeated if you have previously had radiation to the same area.

Radiation therapy is usually administered every day for several weeks. It’s a painless procedure but can cause temporary side effects such as fatigue and skin irritation.

Other treatments

Your oncologist can refer you to a palliative care specialist to help manage pain and other symptoms.

Other symptom management options may include drugs to treat:

• nausea and vomiting
• numbness and tingling (neuropathy)
• constipation or diarrhea
• insomnia
• mouth sensitivities and ulcers
• swelling
• menopausal symptoms

You can also look into some complementary therapies such as:

• massage
• meditation and other relaxation techniques
• physical therapy
• acupuncture

Things to consider

If you have stage 4 breast cancer, it’s spread beyond the breast and nearby lymph nodes.

When breast cancer metastasizes, it usually goes to your bones, liver, and lungs. It can sometimes spread to your brain.

If you were previously treated for breast cancer and it’s returned, it’s called recurrent breast cancer. When formulating a treatment plan, your oncologist will review your prior treatment history.

Stage 4 breast cancer is difficult to treat. Treatment is designed toTrusted Source:

• slow the spread of cancer
• shrink existing tumors
• lengthen your life
• maintaining a good quality of life for as long as possible

Because the cancer is growing in several locations, you’ll need systemic drug therapy.

Targeted therapies depend on your hormone receptor and HER2 status. Chemotherapy, hormone therapy, and targeted drugs can be used alone or in combination.

You can continue these treatments as long as the cancer is not progressing and side effects are tolerable.

If your current treatment is no longer effective or the side effects become too much, you can try other therapies. Talk with your doctor to see if they recommend clinical trials for your condition.

Takeaway

Discuss the pros and cons of each breast cancer treatment with your doctor. Be frank about how they fit into your lifestyle and treatment goals.

Which treatment will work best depends on your staging, preferences, and biomarkers.

Your overall quality of life is important and something only you can assess.

Even if you decide to stop treatment for cancer, you can still receive treatment for pain and other symptoms.