Treatments for secondary breast cancer

The aim of treatment for secondary breast cancer is to control and slow down the spread of the cancer, relieve symptoms and give you the best quality of life for as long as possible.

On this page there is information about a number of secondary breast cancer treatments.

When making decisions about how best to treat you, your specialist team will consider:

  • where the secondary breast cancer is in the body
  • how extensive it is (how many sites and how large)
  • any symptoms you have
  • treatment you’ve had in the past
  • the characteristics of the cancer (such as oestrogen receptors)
  • your general health (and any other medical conditions).

A number of different treatments are used to treat secondary breast cancer and your specialist will talk with you about which treatment is right for you. Any recommendations for treatment should be discussed with you taking into account your personal wishes.

 

Listen to a discussion with Claire Ryan (Macmillan Nurse Clinician – Metastatic Breast Cancer) about how secondary breast cancer is treated. 

If you have any questions about treating secondary breast cancer, call our free Helpline on 0808 800 6000 or use our Ask Our Nurses email service.

Here are short descriptions of the main treatments for secondary breast cancer.

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Hormone therapy

Hormone therapies are used to treat breast cancers that are stimulated to grow by the hormone oestrogen. These are called oestrogen receptor positive breast cancers (or ER+). This will usually have been tested on your primary breast cancer, but doctors may discuss taking a sample of tissue from the secondary breast cancer to re-test the hormone receptors. This will depend on your individual situation.

There are a number of different hormone therapy drugs that work in different ways in the body. If you have had hormone therapy in the past you can still have it again. The drug you are prescribed will depend on a number of factors, including whether you have gone through the menopause and how much time has passed since your diagnosis and treatment for primary breast cancer.

Drugs used in hormone therapy treatment:

These hormone therapies are all taken as tablets, apart from goserelin and fulvestrant which are injections.

If your breast cancer is oestrogen receptor negative (ER-), hormone therapy will not be of any benefit to you.

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Chemotherapy

Chemotherapy treatment for secondary breast cancer aims to slow down and control the growth of the cancer and to relieve symptoms.

A number of different chemotherapy drugs are used to treat secondary breast cancer and there are several ways of having chemotherapy, including tablets and injections.

The type of chemotherapy recommended for you will depend on what drugs you have had before and how long ago. You may have them in combinations of different drugs or on their own.

Drugs commonly used in chemotherapy treatment:

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Targeted therapies (sometimes called biological therapies)

This is a group of drugs that work by blocking specific ways that breast cancer cells divide and grow. In secondary breast cancer they aim to slow down the growth of the cancer.

The most widely-used targeted therapy is trastuzumab (Herceptin). You can read more about this in our Trastuzumab (Herceptin) booklet.

Only people whose cancer has high levels of HER2 (called HER2 positive or HER2+), a protein that makes cancer cells grow, will benefit from having trastuzumab. There are various tests to measure HER2 levels, which will usually have been done on your primary breast cancer but occasionally doctors may discuss taking a sample of tissue from the secondary breast cancer to re-test for HER2. This will depend on your individual situation.

Some targeted therapies are not yet approved for use in the NHS and newer drugs are being investigated in clinical trials, so it is likely more will become available in the future. Your specialist will be able to tell you more about whether they might be of benefit to you and whether there are clinical trials you could take part in.

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Bisphosphonates and targeted therapy for secondary breast cancer in the bone

Bisphosphonates are a group of drugs used to treat secondary breast cancer in the bone. Denosumab (Xgeva) can be given as an alternative to bisphosphonates. Denosumab is a targeted therapy specifically for secondary breast cancer in the bone.

Bisphosphonates and denosumab work in slightly different ways but both reduce bone loss and make complications of secondary breast cancer in the bone, such as fractures and spinal cord compression, less likely to happen.

Both bisphosphonates and densosumab are used in secondary breast cancer to:

  • relieve bone pain
  • reduce the risk of complications such as fractures and spinal cord compression
  • control the level of calcium in the blood.

They are taken by mouth daily or given by injection, usually every three to four weeks.

Find out more about treatments for breast cancer in the bone.

Drugs used in bisphosphonates treatment:

  • sodium clodronate (Bonefos)
  • disodium pamidronate (Aredia)
  • zoledronic acid (Zometa)
  • ibandronic acid (Bondronat).

Drugs used as targeted therapy for secondary breast cancer in the bone:

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Radiotherapy

The aim of radiotherapy for secondary breast cancer is to control the progress of the disease and relieve symptoms such as pain.

It is most commonly used when the cancer has spread to the bones or brain and to control regional recurrence (locally advanced) in the skin, neck or under the arm (axilla).

A course of radiotherapy treatment for secondary breast cancer is usually much shorter than for primary breast cancer. You may have a few treatment sessions, or sometimes only one, and it’s often used alongside other treatments.

Side effects will vary depending on which part of the body is being treated and what type of radiotherapy is being used. Radiotherapy carries on working after the treatment has finished, so you may not feel the benefits until one or two weeks later.

Stereotactic radiotherapy (also known as radiosurgery)

Sometimes a very precise radiation treatment may be considered for people with one or more small secondary breast cancers (this is sometimes called oligometastatic disease). Oligometastatic disease refers to small isolated secondary breast cancer(s) that are stable (not progressing) and usually present only in one site of the body.

Stereotactic radiotherapy is most commonly used to treat secondary breast cancer in the brain but can sometimes be used in other areas of the body such as the lungs and liver.

This treatment enables high doses of radiation to be delivered with extreme accuracy over fewer visits. Stereotactic radiotherapy may also be referred to as Gamma Knife or CyberKnife, which are the names of different radiotherapy machines used. It is a very specialist treatment that is available in specialist centres. Your specialist team will be able to tell you if it may be suitable for you.

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Surgery

Surgery is rarely suggested for treating secondary breast cancer because it can be difficult to remove and because there may be other secondary breast cancers elsewhere in the body.

Although surgery will not cure secondary breast cancer, occasionally an oncologist may ask for the opinion of a specialist surgeon. This is more likely if the area of secondary breast cancer is very small, is easy for the surgeon to reach and there is no other secondary breast cancer elsewhere in the body (sometimes called oligometastatic disease).

Surgery is sometimes used to improve symptoms. For example, to strengthen and repair weakened or fractured bones when the breast cancer has spread to the bones.

When secondary breast cancer is your first diagnosis or has happened before primary cancer treatment begins

There is very little evidence that surgery to remove the primary cancer in the breast will slow or stop the spread of the cancer to any other parts of the body.

Your specialist team will tell you whether surgery to the breast is likely to be helpful in your individual situation.

For some people, surgery to remove the primary cancer in the breast is offered if it is thought the cancer may cause bleeding, ulceration or infection.

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Electrochemotherapy

Electrochemotherapy (sometimes called ECT) is a treatment for cancers that affect the skin such as breast cancer skin metastases. It’s a local treatment so it won’t treat any other areas of secondary breast cancer inside the body.

It combines a low dose of a chemotherapy drug and electrical impulses (called electroporation), which are given directly to the area(s) being treated using an electrode.

Electrochemotherapy is a relatively new treatment, but is now available in a number of hospitals in England, Scotland and Wales. Find out more about electrochemotherapy.

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Last reviewed: December 2015
Next planned review begins 2017

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