Treatment for metastatic breast cancer
- Medical Review: Douglas Yee, MD, Pallav K. Mehta, MD
At LBBC, we know how overwhelming a metastatic breast cancer diagnosis can be. Coming to terms with being in some form of treatment for the rest of your life is an ongoing process. There’s no right way to feel, and feelings will change and evolve over time.
Metastatic breast cancer treatment has three main goals:
- Helping you live as long as possible while controlling the cancer
- Reducing symptoms caused by the cancer
- Keeping treatment side effects to a minimum
The cancer’s characteristics and location in your body, and whether you’ve had treatment for breast cancer before, can all affect your treatment plan. We know it’s complicated. We’re here for you with information and support as you make decisions with your healthcare team.
As you’re planning treatment, let your healthcare team know what’s most important in your life. Maybe it’s family connections, maintaining a fulfilling career, or going on mountain hikes. Maybe it’s playing with grandkids, making art, or all of the above. Talking with your team about what you want can help in creating a treatment plan that works for your life.
Below, we’ll talk about the different types of medicines and therapies used to treat metastatic breast cancer and when they might be prescribed.
Your treatment team
No matter which treatments you need, a number of experts will be involved in your care. Your healthcare team will work together and meet regularly to discuss your treatment.
Your treatment team may include:
- A radiologist, who looks at images of your body tissues for signs of cancer
- An interventional radiologist, who can perform image-guided biopsies and can also treat areas of metastasis
- A pathologist, who looks at biopsied tissue samples to figure out what kind of breast cancer it is
- A medical oncologist, who diagnoses the cancer and treats it with medicine
- A radiation oncologist, who can treat certain areas and types of breast cancer spread with radiation therapy
- A surgeon, who can perform surgery to treat metastasis-related fractures, spinal cord compression, or to remove areas of brain metastasis
- Nurses, patient navigators, social workers, and therapists, who are all available to help you with treatment, emotional, and practical needs
- Palliative care specialists, who can help you manage pain, symptoms, and significant stress
There are many other experts you may meet along the way. For example, most metastatic breast cancer does not require surgery, but if you need surgery, a surgical oncologist will perform it. If you have a strong family history of breast cancer, you might meet with a genetic counselor to consider genetic testing.
Understanding why your healthcare team may be recommending a particular treatment can help reduce feelings of uncertainty. Here are some questions to get you started:
- What are the benefits of the treatment?
- Why do you believe this treatment is the best option for me?
- What are the short and long-term side effects?
- How is the treatment given?
- Which medicines will I get at which times?
- Will this treatment’s side effects prevent me from enjoying daily activities?
- What side effects mean I should call you immediately?
- If this treatment doesn’t work or has too many side effects, what are my other options?
- Am I eligible for any clinical trials?
Learn more about your treatment team.
Types of treatment
A metastatic breast cancer diagnosis means living with breast cancer in the long term. If you were treated for breast cancer before, you know that diagnosis and the start of treatment can feel sudden and that there’s an end of treatment to focus on. With metastatic disease, the focus is on finding the treatment that works best for you.
Treatments for metastatic breast cancer sometimes may not seem as aggressive as those given for early-stage breast cancer, especially if you’ve been treated for breast cancer before. This is because early-stage treatment is short-term, and the goal is to reduce the risk of a metastatic recurrence. If the disease does recur, the goal of treatment for metastatic breast cancer is to manage the disease over the long term while helping you live with as few treatment side effects as possible. Two things that can help you get the most out of treatment:
- Confirming the type of breast cancer: Whether you’ve had breast cancer before or this is your first diagnosis, your medical oncologist may recommend that you get a biopsy of one or more of the cancer sites. Sometimes, metastatic breast cancer has different characteristics than the type found in a past diagnosis. And even if the cancer is the same type as a past diagnosis, you will often need different treatments than you did before. Cancer cells sometimes stop responding to past treatments. Or, a past treatment may be too toxic to have more than once.
- Creating a flexible treatment plan: Treatment for metastatic breast cancer changes over time as the cancer adapts and builds resistance to medicines. Usually, treatment is used until the cancer grows or travels to a new part of the body, or the side effects become too much to manage. Then, you and your healthcare team will decide on a new treatment. It’s hard to predict how long a specific treatment will work against a certain breast cancer. For some people, a single treatment type will manage the cancer for many years, while others need to change treatments more often.
On this page, we’ll talk about the types of treatments available for metastatic breast cancer.
Hormonal therapy
After a biopsy of an area of metastatic breast cancer, a pathologist will examine the cells to see if hormone receptors for estrogen or progesterone are present. These hormones occur naturally in your body. If receptors are found, it means one or both hormones are helping the cancer cells to grow and multiply. This type of metastatic breast cancer is hormone receptor-positive.
Hormonal therapy treats hormone receptor-positive breast cancer. It’s a medicine that interferes with the way certain hormones work in order to stop the cancer from growing or traveling further. Here, we’ll share examples of hormonal therapies that treat metastatic breast cancer.
If you are a woman with hormone receptor-positive breast cancer, the recommended hormonal therapy will be based on whether or not you’ve started menopause. For women who are premenopausal (have not started menopause) or perimenopausal (have started missing periods, but still sometimes have one):
- Tamoxifen, given in pill form, blocks estrogen from helping hormone receptor-positive breast cancer to grow. There is evidence that tamoxifen may be more effective if combined with ovarian suppression.
- Gonadotropin-releasing hormone agonists (GnRH), also called luteinizing hormone-releasing hormone agonists (LHRH), given as injections, stop ovarian function in premenopausal women. The word “antagonist” is sometimes used instead of “agonist.”
- Aromatase inhibitors stop an enzyme called aromatase from changing other hormones into estrogen. Sometimes called AIs, these treatments come in pill form and include anastrozole (Arimidex and generic), exemestane (Aromasin and generic), or letrozole (Femara and generic). In premenopausal women, and as recommended for men, AIs must be used in combination with ovarian suppression treatments such as GnRH agonists, also known as LHRH agonists. Ovary removal (oophorectomy) is another method of ovarian suppression. While GnRH agonists suppress ovarian function as long as a person is taking them, ovary removal stops ovarian function permanently, putting a woman into permanent menopause.
- Selective estrogen receptor degraders (SERDs), also known as estrogen receptor antagonists (ERAs), include fulvestrant (Faslodex) and elacestrant (Orserdu). These drugs block estrogen from attaching to hormone receptors on breast cancer cells, stopping the cancer cells from growing. SERDs can also break down and inactivate estrogen receptors. Fulvestrant is given as an injection, and in premenopausal women, is given with ovarian suppression medicine. Elacestrant is a pill approved to treat hormone receptor-positive metastatic breast cancer that tests positive for an ESR1 mutation. The Guardant 360CDx blood test is approved for confirming whether the cancer has an ESR1 mutation. Both of these medicines can be taken by premenopausal women who are also taking ovarian function suppression medicines or who have undergone ovary removal.
For postmenopausal women or for men:
- Aromatase inhibitors, including anastrozole, exemestane, and letrozole, work to lower estrogen levels in the body. These medicines are given in pill form. The American Society of Clinical Oncology recommends that men taking AIs also take GnRH/LHRH antagonists.
- Tamoxifen, given in pill form, blocks estrogen from helping hormone receptor-positive breast cancer to grow.
- Toremifene (Fareston), given as a pill, blocks estrogen from attaching to hormone receptors on breast cancer cells.
- Fulvestrant is an injected medicine that blocks estrogen from attaching to hormone receptors on breast cancer cells. Fulvestrant also breaks down and inactivates the receptors.
- Elacestrant, given as a pill, blocks estrogen from attaching to hormone receptors on breast cancer cells, and it also breaks down and inactivates the receptors.
Side effects of hormonal therapy depend on the specific drug but can include menopausal symptoms such as hot flashes, vaginal dryness or discharge, joint pain, weight changes, bone loss, and changes in sexual desire.
Some hormonal therapies, such as aromatase inhibitors and fulvestrant, can be given in combination with targeted therapies to treat metastatic breast cancer. You can learn more about targeted therapy below.
Targeted therapy
Targeted therapy is a type of cancer treatment that targets specific cell characteristics or processes in the body that help breast cancer to grow. Targeted therapy treats the cancer in a focused way, so it’s less likely than chemotherapy to harm healthy cells, and may have fewer side effects.
Hormonal therapy targets the way hormones help hormone receptor-positive breast cancer to grow. Other targets can also be used to interfere with breast cancer growth, including cell proteins, enzymes, and in some cases, blood vessels that supply tumors with nutrients. We’ll walk you through these targeted therapies here.
For hormone receptor-positive, HER2-negative metastatic breast cancer
In addition to hormonal therapies, there are targeted therapies available for metastatic breast cancers that are hormone receptor-positive and HER2-negative. HER2-negative means that the cancer cells have a normal amount of HER2 (human epidermal growth factor receptor-2) proteins, and they don’t grow or spread as quickly as HER2-positive breast cancers.
Here are the targeted therapies available to treat this type of metastatic breast cancer:
AKT inhibitors. This kind of medicine targets the AKT protein, which helps regulate cell growth, division, and survival. To do this, the AKT protein sends signals to PIK3CA and PTEN proteins within the PIK3-AKT pathway, a chain of molecules that acts as a communication network inside a cell. AKT inhibitors stop the AKT protein from working, which interferes with the cancer cells' ability to grow and divide. There is one FDA-approved AKT inhibitor:
- Capivasertib (Truqap) is approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer that tests positive for AKT1, PIK3CA, or PTEN mutations, after the breast cancer grows or spreads while on an endocrine therapy. It's also approved to treat hormone receptor-positive, metastatic breast cancer during or within 12 months of completing treatment for early-stage breast cancer. As with metastatic breast cancer, the tumor must test positive for AKT1, PIK3CA, or PTEN mutations.
CDK 4/6 inhibitors. This type of medicine targets two specific kinases, or enzymes, that help tumor cells grow. These enzymes are called kinase 4 and kinase 6. CDK 4/6 inhibitors block the enzymes from telling cancer cells to multiply, which helps slow the growth or spread of the cancer. If you’ve been diagnosed with hormone receptor-positive, HER2-negative metastatic breast cancer, CDK 4/6 inhibitors may be the first treatment recommended for you.
- Abemaciclib (Verzenio) targets proteins that help cancer cells grow and divide. It’s given in pill form with an aromatase inhibitor or fulvestrant, and can be taken by pre- or postmenopausal women. If the cancer has grown despite treatment with hormonal therapy and chemotherapy, abemaciclib can be given by itself.
- Palbociclib (Ibrance) targets proteins that help cancer cells grow and divide. Palbociclib is given in pill form along with hormonal therapy, such as an aromatase inhibitor or fulvestrant to pre- and postmenopausal women.
- Ribociclib (Kisqali) targets proteins that help cancer cells grow and divide, and is given as a pill with an aromatase inhibitor or fulvestrant to pre- and postmenopausal women.
Pre- or perimenopausal women can take CDK 4/6 inhibitors and an aromatase inhibitor or fulvestrant along with an ovarian-suppressing GnRH/LHRH agonist. In some cases, men are also advised to take a GnRH/LHRH agonist with these treatments.
Antibody-drug conjugates (ADCs). These treatments pair a chemotherapy with an antibody. The antibody delivers the chemotherapy directly to the cancer cells. There is one ADC approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer:
- Sacituzumab govitecan (Trodelvy) is an IV medicine that delivers chemotherapy directly to hormone receptor-positive, HER2-negative and triple-negative breast cancer cells by targeting a protein called Trop-2.
- Trastuzumab deruxtecan (Enhertu) is an IV treatment that delivers chemotherapy directly to metastatic breast cancer that is HER2-low or HER2-positive that has grown after at least two past treatments. HER2-low refers to breast cancers with an immunohistochemical (IHC) score of 1+ or 2+, less than the 3+ needed to be considered HER2-positive. Because hormone receptor-positive breast cancer is often found to be HER2-low, trastuzumab deruxtecan may be an option.
mTOR (mammalian target of rapamycin) inhibitors. There is one mTOR inhibitor approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer:
- Everolimus (Afinitor) stops cancer cells from dividing and may block the growth of blood vessels that tumors need to grow. Everolimus is given as a pill with the aromatase inhibitor exemestane to postmenopausal women with hormone receptor-positive, metastatic breast cancer. Everolimus can also be given to premenopausal women with ovarian suppression medicine and hormonal therapy.
PI3K (phosphatidylinositol 3-kinase) inhibitors. Some breast cancers develop a mutation in a gene called PIK3CA. This mutation can cause PI3K enzymes to become overactive, helping the cancer to grow. PI3K inhibitors block this process. There are two FDA-approved PI3K inhibitors that treat breast cancer:
- Alpelisib (Piqray) is a pill taken with the hormonal therapy fulvestrant. Together, these medicines treat hormone receptor-positive, HER2-negative, PIK3CA mutation-positive advanced or metastatic breast cancer that has grown while taking, or after finishing, hormonal therapy.
- Inavolisib (Itovebi) is a pill taken with the targeted therapy palbociclib and the hormonal therapy fulvestrant. This drug combination is approved to treat hormone receptor-positive, HER2-negative, PIK3CA mutation-positive advanced or metastatic breast cancer that has come back while taking or after finishing hormonal therapy taken after surgery. A study called INAVO120 showed that inavolisib taken with palbociclib and fulvestrant reduced the risk of cancer growth by 57% when compared with palbociclib and fulvestrant alone.
For HER2-positive breast cancer
HER2 is a gene that helps regulate normal breast cell growth. But in some breast cancers, the HER2 gene does not act normally, instead making too many copies of itself (HER2 gene amplification and overexpression). HER2 overexpression signals breast cancer cells to grown and survive. With so many HER2 receptors, breast cancer cells have too many growth signals and start growing too often and too fast. This type of breast cancer is called HER2-positive.
While HER2-positive breast cancer is more aggressive than HER2-negative breast cancer, many effective targeted therapies are available to treat it:
Monoclonal antibodies. In breast cancer treatment, monoclonal antibodies work by attaching to HER2 proteins and blocking signals that help cancer cells grow. Here are the monoclonal antibodies approved to treat HER2-positive metastatic breast cancer:
- Trastuzumab (Herceptin) is an IV treatment that blocks HER2-positive, metastatic breast cancer cells from receiving growth signals. There are also treatments available that are similar, but not identical to, trastuzumab. These medicines, like generic drugs, have been proven to be just as effective as the brand name drug Herceptin, and they may be more affordable. These drugs are called biosimilars, and they include:
- Trastuzumab-anns (Kanjinti)
- Trastuzumab-dkst (Ogivri)
- Trastuzumab-dttb (Ontruzant)
- Trastuzumab-pkrb (Herzuma)
- Trastuzumab-qyyp (Trazimera)
- Trastuzumab-strf (Hercessi)
- Pertuzumab (Perjeta) is an IV treatment used with trastuzumab and the chemotherapy docetaxel to treat metastatic, HER2-positive breast cancer. Pertuzumab blocks HER2 receptors on breast cancer cells from receiving growth signals.
- Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo) is a different way to receive two drugs mentioned above: as a combination of pertuzumab, trastuzumab, and a protein that allows it to be given as an injection. The injection is given at the same time as chemotherapy. This medicine prevents HER2 receptors on the surface of cancer cells from picking up growth signals.
- Margetuximab (Margenza) is an IV medicine that blocks HER2 receptors on cancer cells from receiving growth signals. Margetuximab is given with chemotherapy to treat metastatic, HER2-positive breast cancer after it’s been treated with at least two other kinds of targeted therapy.
Tyrosine kinase inhibitors. These drugs interfere with the HER2 protein’s ability to help cancer to grow. There are three tyrosine kinase inhibitors approved to treat HER2-positive metastatic breast cancer:
- Lapatinib (Tykerb), given as a pill, blocks the activity of the HER2 protein from inside HER2-positive metastatic breast cancer cells. Lapatinib is given with the chemotherapy pill capecitabine (Xeloda). In postmenopausal women with hormone receptor-positive, HER2-positive breast cancer, lapatinib is given with letrozole.
- Neratinib (Nerlynx), given as a pill, irreversibly attaches to HER2 receptors, preventing cancer cells from growing and multiplying. Neratinib is given with the chemotherapy pill capecitabine to treat metastatic, HER2-positive breast cancer that has grown despite treatment with at least two previous targeted therapies.
- Tucatinib (Tukysa) blocks the activity of the HER2 protein from inside the cell. Tucatinib is a pill given with trastuzumab and the chemotherapy pill capecitabine to treat metastatic, HER2-positive breast cancers that have grown after previous HER2-targeted treatments.
Antibody-drug conjugates. These medicines work to deliver chemotherapy directly to cancer cells. There are two antibody-drug conjugates approved to treat HER2-positive, metastatic breast cancer:
- Ado-trastuzumab emtansine (Kadcyla) is an intravenous (IV) treatment that delivers chemotherapy directly to metastatic, HER2-positive breast cancer that has grown despite treatment with HER2-targeted therapy trastuzumab (Herceptin) and taxane chemotherapy.
- Trastuzumab deruxtecan (Enhertu) is an IV treatment that delivers chemotherapy directly to metastatic, HER2-positive and HER2-low breast cancer that has grown after at least two past treatments. HER2-low refers to breast cancers with an immunohistochemical (IHC) score of 1+ or 2+, less than the 3+ needed to be considered HER2-positive.
For triple-negative metastatic breast cancer
Breast cancer that tests negative for hormone receptors and HER2 overexpression is called triple-negative breast cancer. Here are the targeted therapies approved to treat triple-negative, metastatic breast cancer:
- Pembrolizumab (Keytruda) is an IV immunotherapy given with chemotherapy to treat triple-negative breast cancer that overexpresses the PD-L1 protein. Pembrolizumab blocks PD-L1 from interfering with the immune system’s ability to kill cancer cells.
- Sacituzumab govitecan (Trodelvy) is an antibody-drug conjugate IV medicine. It delivers chemotherapy directly to triple-negative and hormone receptor-positive, HER2-negative breast cancer cells by targeting a protein called Trop-2.
- Trastuzumab deruxtecan (Enhertu) is an antibody-drug conjugate IV treatment that delivers chemotherapy directly to metastatic breast cancer that is HER2-low or HER2-positive that has grown after at least two past treatments. HER2-low refers to breast cancers with an immunohistochemical (IHC) score of 1+ or 2+, less than the 3+ needed to be considered HER2-positive. Because triple-negative breast cancer is sometimes found to be HER2-low, trastuzumab deruxtecan may be an option.
For metastatic breast cancer in people who test positive for a BRCA mutation
If you have hormone receptor-positive, HER2-negative breast cancer or triple-negative breast cancer, and you also test positive for a BRCA mutation, there are two targeted therapies available to you. PARP inhibitors stop an enzyme in the body known as poly (ADP-ribose) polymerase, or PARP, from repairing cancer cell DNA. Cancer cells in people with BRCA mutations already have a hard time repairing their own DNA. PARP inhibitors make it even harder, and can cause the cancer cells to die. The two approved PARP inhibitors, given in pill form, are:
Different targeted therapies can cause different side effects. These can include nausea, diarrhea, anemia, low blood cell counts, and fatigue. Learn more in Targeted therapy.
Chemotherapy
Chemotherapy kills rapidly dividing cells in order to slow or stop the growth of cancer. Chemo is often given intravenously (by injection into a vein). Some chemotherapies are available in pill form. For metastatic breast cancer, chemotherapy will often be given after other treatments stop working against the cancer.
Whether you get chemotherapy depends on many factors, such as:
- The specific type of cancer cells
- Your age
- The presence or absence of estrogen and progesterone receptors
- The amount of HER2 protein on the surface of the cancer cells
- Which treatments you had in the past
- Where the cancer is in your body, and how much there is
If you’re receiving chemotherapy intravenously (IV chemotherapy), you will be treated at regularly scheduled appointments at your cancer center. There are different ways you can receive IV chemotherapy:
- Through a vein in your arm
- Through an access port, sometimes called a port-a-cath, placed under the skin in the upper part of the chest, connecting to a major vein
- Through a PICC (peripherally inserted central catheter) line: a long, flexible tube inserted into an arm vein that gives access to larger veins
A port or PICC line allows a person to avoid repeated needlesticks in the arm, and can reduce the risk of IV medicines irritating the blood vessels.
There are many possible side effects of chemotherapy, and there’s no way to know who will experience each one. Some common side effects include:
Your healthcare team can recommend effective ways to manage some side effects with lifestyle changes or medicine. Visit the chemotherapy section to learn more.
Radiation therapy
Radiation therapy focuses the power of high-energy x-rays on specific areas of cancer. It’s a local treatment, which means it impacts only cells at or near the location receiving treatment. Radiation is thought to cause breaks in strands of DNA, which can keep the cancer cells from dividing and growing.
Most often, radiation for metastatic breast cancer is used to:
- Shrink tumors
- Manage pain from tumors in the bone
- Treat or prevent symptoms caused by breast cancer in the brain or lungs
- Lessen pain and prevent injury to nerves by treating tumors of the spine that are pushing on the spinal cord
The side effects of radiation therapy are very specific to the part of the body being treated. If you receive radiation to the liver, for example, nausea or vomiting may be side effects. If the breast cancer has traveled to the brain, radiation therapy can cause changes in thinking and memory. If your healthcare team recommends radiation therapy, you and your radiation oncologist will talk before and during treatment about possible side effects and how to manage them. Visit the radiation therapy page for more information.
Surgery
Surgery is rarely done for metastatic breast cancer, but there are a few reasons your doctor may recommend it:
- If you have pain or bleeding, removing the original tumor can help ease symptoms.
- If there are tumors in places outside the breast that are causing you pain or other symptoms, removing them can help reduce symptoms.
- If you have metastatic breast cancer that has spread to the bones, orthopedic surgery can be done to reduce the risk of bone breaks and to ease pain. Specific situations can include:
- Surgery to insert metal rods within bone to provide stability
- Kyphoplasty, a surgery in which cement is inserted into a bone to ease pain
- If breast cancer has spread to the brain, a surgery called craniotomy is sometimes performed to remove a tumor. Craniotomy is performed by a neurosurgeon and involves removing a small piece of skull to get to the tumor and remove it. Other team members may include a neurologist or neuro-oncologist.
If there is cancer in your bones, lung, liver, or brain, and the cancer is not growing, or is in only one place, talk with your doctor about whether cancer-removing surgery may be an option.
If you’re premenopausal and the cancer is hormone receptor-positive, you may have the option of having your ovaries removed in a surgery called oophorectomy. Having the ovaries removed takes away most of the estrogen in the body, and can greatly reduce the risk of hormone receptor-positive cancer growth in premenopausal women. But it’s important to know that in these women, oophorectomy causes sudden menopause. Side effects include hot flashes, an increased risk for heart disease, bone loss or fractures, and decreased sexual desire.
Talk with your doctor about your individual situation and whether surgery is an option to consider.
Complementary & integrative medicine
Complementary therapies are physical, mental, and spiritual practices used in addition to standard cancer treatment. While complementary therapies do not treat cancer directly, research shows they can ease some side effects, such as nausea, fatigue, anxiety, and depression.
Standard medical care combined with complementary therapies is called integrative medicine. Integrative medicine works to control the cancer with standard-of-care treatment while using complementary therapies to support mental and spiritual well-being.
Complementary therapies include:
- Acupuncture
- Art therapy
- Dietary supplements
- Expressive writing
- Guided imagery
- Hypnosis
- Massage therapy
- Medical marijuana
- Mindfulness-based stress reduction
- Yoga
Yoga
Although yoga is not a treatment for breast cancer, studies suggest practicing yoga during breast cancer treatment can help relieve stress, anxiety, depression, insomnia, and fatigue. Some women who practice yoga have reported less pain, fewer hot flashes, and improved strength and body image.
In general, yoga is safe for people with metastatic breast cancer. But some poses may not be right for everyone, including:
- Twists
- Forward-bending stretches
- Backbends
- Balance poses
- Inversions, poses that place your head lower than your heart
The location of cancer in your body may impact how you practice yoga:
- With bone metastasis, bones may fracture more easily, so ask your doctor about any poses that may put too much stress on an area of bone metastasis.
- With liver metastasis, avoid poses that put tension on the abdomen.
- Some deep-breathing yoga practices may be difficult if you have lung metastasis.
Always discuss new physical activities with your doctor before starting, and listen to your body. If something doesn’t feel right, stop.
Try an all-levels yoga class, featuring instructor Kathy DiGiorgio:
Clinical trials & new drug options
Breast cancer researchers are always working to develop new and better treatment options. Any time you’re considering a treatment is a good time to ask your doctor about opportunities to participate in a clinical trial.
Clinical trials are one way to access promising metastatic breast cancer treatments before they gain FDA approval. You can join a clinical trial at any point during your treatment — not just when other treatment options stop working.
Clinical trials play a key role in discovering new medicines. Some newer treatment types under study are:
- Antibody-drug conjugates: treatments that pair a chemotherapy medicine with a targeted therapy
- Genomically driven treatments: medicines that can target specific genes or mutations
- Immunotherapies such as CAR T-cell therapy and immune checkpoint inhibitors
It’s important to know that by the time clinical trials enroll human participants, researchers have spent many hours learning how safe and effective the medicine is. Visit our clinical trials section to learn how participating in a trial can help, what the risks are, and more. We also have specific information on clinical trials for metastatic breast cancer and a Metastatic Trial Search tool.
Treatment breaks
Metastatic breast cancer means being in treatment for life. But treatment doesn’t have to be life. When you need it, it may be possible for you to take a break from treatment to allow for those significant, positive life experiences we all crave.
You and your doctor can schedule treatment breaks for special events, like vacations or weddings, if it will be hard to get treatment while you’re away or the side effects may prevent you from enjoying the event.
It’s also possible to take treatment breaks just to give your body a rest from treatment and side effects. If you think you may need or want a treatment break, talk with your healthcare team as soon as you can.
Stopping treatment
The goal of treating metastatic breast cancer is to manage the disease for as long as possible. It can be extremely challenging to have conversations with loved ones about stopping treatment. But it can also be a relief to just talk honestly about what you want and need.
Choosing to stop treatment is not giving up, and does not mean the end of all medical care. When you stop treating the cancer, your care team can still continue caring for you, through palliative care or hospice care, to ease symptoms and provide support.
Watch Talking about end of life with oncology psychotherapist Kelly Grosklags, LISCSW, BCD, to learn more about letting your loved ones and your healthcare team know what’s most important to you.
Related news
- Living Beyond Breast Cancer awarded two grants raising $1,985,000 over 5 years
- Enfortumab vedotin shows anti-tumor activity but does not meet trial goals | ASCO 2024
- Trastuzumab deruxtecan beats chemotherapy—even in HER2-ultralow MBC | ASCO 2024
- Abemaciclib shows small benefit after a prior CDK 4/6 inhibitor stops working | ASCO 2024
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- chemotherapeutic agent
- chemotherapy
- chest wall
- chest X-ray
- Chinese meridian theory
- chronic
- chronic pain
- cisplatin
- Claus model
- clergy
- clinical
- clinical breast exam
- clinical practice guidelines
- clinical researcher
- clinical resistance
- clinical series
- clinical stage
- clinical staging
- clinical study
- clinical trial
- clinician
- clodronate
- CMF regimen
- cognition
- cognitive behavior therapy
- cognitive therapy
- cohort
- cohort study
- combination chemotherapy
- comedo carcinoma
- comfort care
- Coming Out
- Community Advisory Board
- comorbidity
- compassionate use trial
- complementary and alternative medicine
- complementary medicine
- complete metastasectomy
- complete remission
- complete response
- complex decongestive therapy
- compliance
- complication
- compression garment
- computed tomography scan
- concomitant
- concurrent therapy
- condition
- consolidation therapy
- constitutional acupuncture
- continuum of care
- contract research organization
- contraindication
- contralateral
- contrast material
- control group
- controlled clinical trial
- controlled study
- conventional medicine
- conventional therapy
- cope
- coping skills
- core biopsy
- core needle biopsy
- corticosteroid
- counseling
- COX inhibitor
- cryoablation
- cryopreservation
- cryosurgery
- CT scan
- cultural competency
- cumulative dose
- cumulative exposure
- cure
- cutaneous
- cutaneous breast cancer
- cyclophosphamide
- cyclosporine
- CYP2D6 inhibitor
- cystosarcoma phyllodes
- cytopenia
- cytotoxic
- cytotoxic chemotherapy
- Cytoxan
- Data and Safety Monitoring Board
- DCIS
- de novo
- debulking
- definitive surgery
- definitive treatment
- dehydration
- denosumab
- depression
- diagnosis
- diagnostic mammogram
- diagnostic procedure
- diagnostic technique
- diagnostic trial
- diameter
- diarrhea
- diaziquone
- DIEP flap
- dietary counseling
- dietary supplement
- dietitian
- differentiation
- diffuse
- digital mammography
- diphenhydramine
- discharge
- disease progression
- disease-specific survival rate
- distant cancer
- distant metastasis
- Distant recurrence
- distress
- DNR order
- docetaxel
- dolasetron
- dose
- dose-dense chemotherapy
- dose-dependent
- dose-limiting
- dose-rate
- double-blinded
- doxorubicin
- drain
- dronabinol
- droperidol
- drug interaction
- drug resistance
- drug therapy
- drug tolerance
- duct
- ductal carcinoma
- ductal carcinoma in situ
- ductal lavage
- duloxetine
- durable power of attorney
- dysfunction
- dysgeusia
- dyspepsia
- dyspnea
- early menopause
- early-stage breast cancer
- edema
- EEG biofeedback
- efficacy
- Eklund displacement views
- electroacupuncture
- electron beam
- eligibility criteria
- Ellence
- emesis
- emetic
- endocrine
- endocrine therapy
- endpoint
- energy healing
- enteral nutrition
- epidemiology
- epirubicin
- ER+
- ER-
- ER
- ER-PR-HER2/neu-
- eribulin mesylate
- erythema
- estradiol
- estrogen
- estrogen blocker
- estrogen receptor
- estrogen receptor-negative
- estrogen receptor-positive
- estrogen receptor test
- estrogen replacement therapy
- etanidazole
- etidronate
- everolimus
- Evista
- excision
- excisional biopsy
- exemestane
- expanded access trial
- experimental
- extranodal
- false-negative test result
- false-positive test result
- familial cancer
- family medical history
- Faslodex
- fast-neutron beam radiation
- fatigue
- FDA
- febrile neutropenia
- FEC regimen
- Femara
- fertility
- fexofenadine
- fibroadenoma
- fibrocystic breast changes
- fiducial marker
- film mammography
- fine-needle aspiration biopsy
- first-degree relative
- first-line therapy
- five-year survival rate
- fluorouracil
- fluoxetine
- FNA biopsy
- focal
- Food and Drug Administration
- Fosamax
- fractionation
- fulvestrant
- functional magnetic resonance imaging
- gadolinium
- Gail model
- gallium scan
- gamma irradiation
- Gamma Knife therapy
- gamma ray
- Gelclair
- gemcitabine
- gene
- gene expression profile
- gene therapy
- general anesthesia
- generalized anxiety disorder
- generic
- genetic
- genetic counseling
- genetic marker
- genetic marker of susceptibility
- genetic predisposition
- genetic profile
- genetic susceptibility
- genetic testing
- genetic testing
- genetics
- genome
- genome-wide association study
- genomic profile
- genomic test
- genomics
- gland
- Good Clinical Practice
- goserelin
- grade
- grading
- granisetron
- gross description
- Halaven
- hazard ratio
- healing touch
- Health Insurance Portability and Accountability Act
- healthcare provider
- healthcare proxy
- healthy control
- helical computed tomography
- HER2/neu
- Herceptin
- hereditary
- hereditary mutation
- heteronormative
- high-dose chemotherapy
- high-dose radiation
- high-energy proton therapy
- high grade
- high-risk cancer
- HIPPA
- histologic examination
- histology
- historic cohort study
- historical control subject
- homeopathic medicine
- hormonal therapy
- hormone
- hormone receptor
- hormone receptor test
- hormone replacement therapy
- hormone responsive
- hormone therapy
- hospice
- hot flash
- human epidermal growth factor receptor 2
- human participant protection regulations
- hydroxydaunorubicin
- hyperalimentation
- hypercalcemia
- hyperfractionated radiation therapy
- hyperfractionation
- hyperplasia
- hypersensitivity
- hypofractionated radiation therapy
- hypofractionation
- hypoxia
- ibandronate
- ibuprofen
- idiopathic
- image-guided radiation therapy
- imaging
- imaging procedure
- immune adjuvant
- immune function
- immune response
- immune system
- immune system tolerance
- immunization
- immunoassay
- immunocompromised
- immunodeficiency
- immunohistochemistry
- immunology
- immunomodulation
- immunosuppression
- immunotherapy
- implant
- implant displacement views
- implant radiation therapy
- implantable pump
- in situ
- incidence
- incision
- incisional biopsy
- indication
- indolent
- induction therapy
- infection
- infertile
- infertility
- infiltrating breast cancer
- infiltrating ductal carcinoma
- inflammation
- inflammatory breast cancer
- informed consent
- infusion
- ingestion
- inherited
- iniparib
- injection
- inoperable
- insomnia
- Institutional Review Board
- intensification therapy
- intensity-modulated radiation therapy
- interfering thought
- internal mammary lymph nodes
- internal radiation therapy
- International Unit
- internist
- interstitial radiation therapy
- intervention
- intervention group
- intra-arterial
- intracarotid infusion
- intradermal
- intraductal breast papilloma
- intraductal carcinoma
- intrahepatic
- intrahepatic infusion
- intramuscular
- intramuscular injection
- intraoperative radiation therapy
- intraoperative ultrasound
- intratumoral
- intravasation
- intravenous
- intravenous infusion
- intravenous injection
- intrusive thought
- intrusive thoughts
- invasive breast cancer
- invasive cancer
- invasive procedure
- investigational
- investigator
- ionizing radiation
- ipsilateral
- IRB
- irradiated
- irradiation
- irreversible toxicity
- ixabepilone
- joint pain
- Karnofsky Performance Status
- laboratory test
- lapatinib
- laser
- laser surgery
- laser therapy
- lassitude
- late effects
- late-stage cancer
- latent
- laxative
- LEEP
- legal aid organization
- lesion
- lethargy
- letrozole
- leukopenia
- levels of evidence
- Lexapro
- libido
- lidocaine
- ligation
- linac
- linear accelerator
- lipoma
- lisofylline
- liver metastasis
- liver scan
- living will
- lobaplatin
- lobe
- lobectomy
- lobular carcinoma
- lobular carcinoma in situ
- lobule
- local anesthesia
- local cancer
- local therapy
- localization
- localized
- locally advanced cancer
- locally recurrent cancer
- lomustine
- loop electrosurgical excision procedure
- loop excision
- lorazepam
- low grade
- lubricant
- lumbar puncture
- lumpectomy
- lung metastasis
- luteinizing hormone-releasing hormone agonist
- lymph
- lymph gland
- lymph node
- lymph node dissection
- lymph node drainage
- lymph node mapping
- lymph vessel
- lymphadenectomy
- lymphadenopathy
- lymphangiogram
- lymphangiography
- lymphatic basin
- lymphatic fluid
- lymphatic mapping
- lymphatic system
- lymphatic vessel
- lymphedema
- lymphography
- lymphoscintigraphy
- Lyrica
- lytic lesion
- macrocalcification
- magnetic resonance imaging
- magnetic resonance perfusion imaging
- magnetic resonance spectroscopic imaging
- mainstream medicine
- maintenance therapy
- male breast cancer
- malignancy
- malignant
- malignant pleural effusion
- malnutrition
- mammary
- mammary dysplasia
- mammary gland
- mammogram
- mammography
- MammoSite
- Mammotome
- mantle field
- MAO inhibitor
- margin
- marker
- mass
- massage therapy
- mastectomy
- mastitis
- maternal
- maximum tolerated dose
- mean survival time
- measurable disease
- medial supraclavicular lymph node
- median
- median survival time
- Medicaid
- medical castration
- medical device
- medical nutrition therapy
- medical oncologist
- Medicare
- medicine
- medullary breast carcinoma
- mega-voltage linear accelerator
- megestrol
- melphalan
- meningeal metastasis
- menopause
- menorrhagia
- menstrual cycle
- menstrual period
- menstruation
- mental health
- mental health counselor
- meridian
- mesna
- meta-analysis
- metallic
- metastasectomy
- metastasis
- metastasize
- metastatic
- methotrexate
- metoclopramide
- metronomic therapy
- microcalcification
- micrometastasis
- microscopic
- milk duct
- mind/body exercise
- mindfulness relaxation
- Miraluma test
- mitigate
- modified radical mastectomy
- molecular marker
- molecular medicine
- molecular risk assessment
- molecularly targeted therapy
- monoamine oxidase inhibitor
- monoclonal antibody
- morbidity
- mortality
- MRI
- MRSI
- MTD
- mTOR
- mucositis
- multicenter study
- multicentric breast cancer
- multidisciplinary
- multidisciplinary opinion
- multidrug resistance
- multidrug resistance inhibition
- multifocal breast cancer
- music therapy
- mutation
- mutation carrier
- myalgia
- myelosuppression
- nanoparticle paclitaxel
- narcotic
- National Cancer Institute
- National Center for Complementary and Alternative Medicine
- National Institutes of Health
- natural history study
- naturopathy
- nausea
- NCCAM
- NCI
- NCI clinical trials cooperative group
- needle biopsy
- needle localization
- needle-localized biopsy
- negative axillary lymph node
- negative test result
- neoadjuvant therapy
- neoplasm
- nerve
- nerve block
- neurocognitive
- neurologic
- neuropathy
- neurotoxicity
- neurotoxin
- neutropenia
- NIH
- nipple
- nipple discharge
- nitrosourea
- NMRI
- node-negative
- node-positive
- nodule
- nonblinded
- nonconsecutive case series
- noninvasive
- nonmalignant
- nonmetastatic
- nonprescription
- nonrandomized clinical trial
- nonsteroidal anti-inflammatory drug
- nonsteroidal aromatase inhibitor
- nontoxic
- normal range
- normative
- NP
- NPO
- NSAID
- nuclear grade
- nuclear magnetic resonance imaging
- nuclear medicine scan
- nurse
- nurse practitioner
- nutrition
- nutrition therapy
- nutritional counseling
- nutritional status
- nutritional supplement
- nutritionist
- obese
- objective improvement
- objective response
- observation
- observational study
- obstruction
- off-label
- olaparib
- oncologist
- oncology
- oncology nurse
- oncology pharmacy specialist
- oncolysis
- ondansetron
- onset of action
- oophorectomy
- open biopsy
- open label study
- open resection
- operable
- opiate
- opioid
- opportunistic infection
- oral
- organ
- orthodox medicine
- osteolytic
- osteonecrosis of the jaw
- osteopenia
- osteoporosis
- OTC
- outcome
- outpatient
- ovarian
- ovarian ablation
- ovarian cancer
- ovarian suppression
- ovary
- over-the-counter
- overall survival rate
- overdose
- overexpress
- overweight
- ovulation
- PA
- paclitaxel
- paclitaxel albumin-stabilized nanoparticle formulation
- paclitaxel-loaded polymeric micelle
- Paget disease of the nipple
- pain threshold
- palliation
- palliative care
- palliative therapy
- palmar-plantar erythrodysesthesia
- palonosetron hydrochloride
- palpable disease
- palpation
- palpitation
- pamidronate
- panic
- papillary tumor
- Paraplatin
- parenteral nutrition
- paroxetine hydrochloride
- PARP
- PARP inhibitor
- partial-breast irradiation
- partial mastectomy
- partial oophorectomy
- partial remission or partial response
- pastoral counselor
- paternal
- pathologic fracture
- pathological stage
- pathological staging
- pathologist
- pathology report
- patient advocate
- Paxil
- peau d'orange
- pedigree
- peer-review process
- peer-reviewed scientific journal
- perfusion magnetic resonance imaging
- perimenopausal
- periodic neutropenia
- perioperative
- peripheral neuropathy
- peripheral venous catheter
- personal health record
- personal medical history
- personalized medicine
- Pertuzumab
- PET scan
- pharmacist
- phase I/II trial
- phase I trial
- phase II/III trial
- phase II trial
- phase III trial
- phase IV trial
- phlebotomy
- photon beam radiation therapy
- phyllodes tumor
- physical examination
- physical therapist
- physical therapy
- physician
- physician assistant
- physiologic
- PI3 kinase inhibitor
- pilocarpine
- pilot study
- placebo
- placebo-controlled
- plastic surgeon
- plastic surgery
- population study
- positive axillary lymph node
- positive test result
- positron emission tomography scan
- post-traumatic stress disorder
- postmenopausal
- postoperative
- postremission therapy
- potentiation
- power of attorney
- PR
- PR+
- PR-
- practitioner
- precancerous
- preclinical study
- predictive factor
- pregabalin
- premalignant
- premature menopause
- premenopausal
- prescription
- prevention
- preventive
- preventive mastectomy
- primary care
- primary care doctor
- primary endpoint
- primary therapy
- primary treatment
- primary tumor
- Principal investigator
- prochlorperazine
- progesterone
- progesterone receptor
- progesterone receptor-negative
- progesterone receptor-positive
- progesterone receptor test
- progestin
- prognosis
- prognostic factor
- progression
- progression-free survival
- progressive disease
- Prolia
- proliferative index
- promegapoietin
- prophylactic
- prophylactic mastectomy
- prophylactic oophorectomy
- prophylactic surgery
- prophylaxis
- prospective
- prospective cohort study
- prosthesis
- protective factor
- protein
- protein-bound paclitaxel
- protein expression
- protein expression profile
- protocol
- proton
- proton magnetic resonance spectroscopic imaging
- pruritus
- psychiatrist
- psychological
- psychologist
- psychosocial
- psychotherapy
- PTSD
- pump
- punch biopsy
- qi
- qigong
- quadrantectomy
- quality assurance
- quality of life
- radiation
- radiation brachytherapy
- radiation dermatitis
- radiation fibrosis
- radiation necrosis
- radiation nurse
- radiation oncologist
- radiation physicist
- radiation surgery
- radiation therapist
- radiation therapy
- radical lymph node dissection
- radical mastectomy
- radioactive
- radioactive drug
- radioactive seed
- radioisotope
- radiologic exam
- radiologist
- radiology
- radionuclide
- radionuclide scanning
- radiopharmaceutical
- radiosensitization
- radiosensitizer
- radiosurgery
- radiotherapy
- raloxifene
- raloxifene hydrochloride
- randomization
- randomized clinical trial
- receptor
- RECIST
- reconstructive surgeon
- reconstructive surgery
- recreational therapy
- recurrence
- recurrent cancer
- referral
- reflexology
- refractory
- refractory cancer
- regimen
- regional
- regional anesthesia
- regional cancer
- regional chemotherapy
- regional lymph node
- regional lymph node dissection
- registered dietician
- regression
- rehabilitation
- rehabilitation specialist
- relapse
- relative survival rate
- relaxation technique
- remission
- remission induction therapy
- remote brachytherapy
- research nurse
- research study
- resectable
- resected
- resection
- residual disease
- resistant cancer
- resorption
- respite care
- response rate
- retrospective cohort study
- retrospective study
- risk factor
- Rubex
- salpingo-oophorectomy
- salvage therapy
- samarium 153
- sargramostim
- scalpel
- scan
- scanner
- scintigraphy
- scintimammography
- sclerosing adenosis
- screening
- screening mammogram
- second-line therapy
- second-look surgery
- second primary cancer
- secondary cancer
- secrete
- sedative
- segmental mastectomy
- selection bias
- selective estrogen receptor modulator
- selective serotonin reuptake inhibitor
- sentinel lymph node
- sentinel lymph node biopsy
- sentinel lymph node mapping
- sepsis
- sequential AC/Taxol-Trastuzumab regimen
- sequential treatment
- SERM
- sertraline
- Serzone
- sestamibi breast imaging
- sexuality
- sibling
- side effect
- silicone
- simple mastectomy
- simulation
- Single-agent therapy
- sleep disorder
- social service
- social support
- social worker
- sodium thiosulfate
- soft tissue
- solid tumor
- somatic
- somatic mutation
- sorafenib
- specialist
- specificity
- spiculated mass
- spinal anesthesia
- spinal block
- spiral CT scan
- spirituality
- sporadic cancer
- SSRI
- stable disease
- stage
- stage 0 breast carcinoma in situ
- stage 0 disease
- stage I breast cancer
- stage IA breast cancer
- stage IB breast cancer
- stage II breast cancer
- stage II breast cancer
- stage IIA breast cancer
- stage IIB breast cancer
- stage III breast cancer
- stage III lymphedema
- stage IIIA breast cancer
- stage IIIB breast cancer
- stage IIIC breast cancer
- stage IV breast cancer
- staging
- stamina
- standard of care
- standard therapy
- statistically significant
- stent
- stereotactic biopsy
- stereotactic radiosurgery
- sterile
- sternum
- steroid
- stress
- strontium
- study agent
- subcutaneous
- subcutaneous port
- subjective improvement
- subset analysis
- supplemental nutrition
- supplementation
- support group
- supportive care
- supraclavicular lymph node
- surgeon
- surgery
- surgical biopsy
- surgical menopause
- surgical oncologist
- survival rate
- symptom
- symptom management
- symptomatic
- synergistic
- synthetic
- syringe
- systemic
- systemic chemotherapy
- systemic disease
- systemic therapy
- TAC regimen
- tai chi
- tailored intervention
- talk therapy
- tamoxifen
- targeted therapy
- taxane
- Taxol
- Taxotere
- Tc 99m sulfur colloid
- technician
- terminal disease
- therapeutic
- therapeutic touch
- therapy
- thermography
- thiethylperazine
- thiotepa
- third-line therapy
- thrush
- time to progression
- tinnitus
- tissue
- tissue flap reconstruction
- TNM staging system
- tomography
- tomotherapy
- topical
- topical chemotherapy
- topoisomerase inhibitor
- total estrogen blockade
- total mastectomy
- total nodal irradiation
- total parenteral nutrition
- toxic
- toxicity
- tracer
- traditional acupuncture
- tranquilizer
- transdermal
- transfusion
- transitional care
- translational research
- trastuzumab
- trauma
- treatment field
- trigger
- trigger point acupuncture
- triple-negative breast cancer
- tumescent mastectomy
- tumor
- tumor antigen vaccine
- tumor board review
- tumor burden
- tumor debulking
- tumor load
- tumor marker
- tumor volume
- Tykerb
- ulcer
- ulceration
- ultrasound-guided biopsy
- ultrasound/ultrasonography
- ultraviolet radiation therapy
- uncontrolled study
- undifferentiated
- unilateral
- unilateral salpingo-oophorectomy
- unresectable
- unresected
- upstaging
- urticaria
- VACB
- vaccine therapy
- vacuum-assisted biopsy or vacuum-assisted core biopsy
- Valium
- vancomycin
- vandetanib
- vascular endothelial growth factor-antisense oligonucleotide
- vascular endothelial growth factor receptor tyrosine kinase inhibitor
- vein
- Velban
- venipuncture
- venous sampling
- Versed
- vertebroplasty
- vinorelbine
- vital
- vomit
- watchful waiting
- wedge resection
- Wellcovorin
- Western medicine
- WGA study
- white blood cell
- whole cell vaccine
- whole genome association study
- wide local excision
- wire localization
- wound
- X-ray therapy
- Xanax
- Xeloda
- xerostomia
- Xgeva
- yoga
- ziconotide
- Zinecard
- Zofran
- zoledronic acid
- Zoloft
- Zometa
Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.