Breast Cancer in Men: Types of Treatment

Approved by the Cancer.Net Editorial Board, 09/2020

ON THIS PAGE: You will learn about the different types of treatments doctors use for men with breast cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for men with breast cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment.

Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. There are 3 phases of clinical trials. Phase I clinical trials help learn if a new drug or treatment is safe for people. Phase II clinical trials tell doctors how safe the treatment is and how well it works, including for a specific type of cancer. Phase III clinical trials test treatments that worked well for volunteers in a phase II clinical trial. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

Treatment overview

In cancer care, doctors specializing in different areas of cancer treatment work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others.

The biology and behavior of a breast cancer affects the treatment plan. Some tumors are small but grow fast, while others are large and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including:

  • The stage of the tumor

  • The tumor’s subtype, including hormone receptor status (ER, PR) and HER2 status (see Introduction)

  • Genomic markers, such as Oncotype DX™ or Mammaprint™ (see Diagnosis)

  • The patient’s age, general health, and preferences

  • The presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2

Even though the breast cancer care team will specifically tailor the treatment for each patient and the breast cancer, there are some general steps for treating breast cancer.

For both DCIS and early-stage invasive breast cancer, doctors generally recommend surgery to remove the tumor as the first treatment. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor. Although the goal of surgery is to remove all of the visible cancer, microscopic cells can remain after surgery, either in the breast or elsewhere. In some situations, this means that another surgery could be needed to remove remaining cancer cells.

For larger cancers, or smaller cancers that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant or preoperative therapy. There may be several benefits to having other treatments before surgery:

  • Surgery may be easier to perform afterwards

  • Your doctor may find out if certain treatments work well for the cancer

  • You may be able to try a new treatment through a clinical trial

After surgery, the next step in managing early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells in the breast or elsewhere in the body. If present, these cancer cells are undetectable but are believed to be responsible for both local and distant recurrence of cancer.

Treatment given after surgery is called adjuvant therapy. Adjuvant therapies may include:

  • Radiation therapy

  • Chemotherapy

  • Targeted therapy

  • Hormonal therapy

Whether adjuvant therapy is needed depends on how likely it is that any cancer cells could still be in the breast or body and how well a specific treatment is likely to work to treat the cancer. The choice of adjuvant therapy depends on the cancer’s stage, features, and a patient’s health and preferences. Although adjuvant therapy lowers the risk of recurrence, there will still be some risk of recurrence.

Along with staging, other tools can help estimate prognosis and help you and your doctor make decisions about adjuvant therapy. There are also tests that can predict the risk of recurrence for your specific tumor by testing the tumor tissue (see Diagnosis). These may also be used to better understand the risks from the cancer and whether chemotherapy will help reduce those risks.

Descriptions of the common types of treatments used for breast cancer in men are listed below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect during and after treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit your goals for your care. Shared decision making is particularly important for breast cancer because there are multiple different treatment options. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is also used to examine the nearby underarm or axillary lymph nodes. A surgical oncologist is a doctor who specializes in treating cancer with surgery. 

  • A lumpectomy is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor. If there is not a lot of breast tissue, a lumpectomy may not be an option.

  • A mastectomy is the surgical removal of the entire breast. This is the more commonly performed procedure in men.

When surgery to remove the cancer is not possible, it is called inoperable or unresectable. The doctor will then recommend treating the cancer in other ways. Chemotherapy, targeted therapy, radiation therapy, and/or hormonal therapy may be given to shrink the cancer (see below). 

Lymph node removal and analysis

Cancer cells can be found in the axillary lymph nodes in some cancers. It is important to find out whether any of the lymph nodes near the breast contain cancer. This information is used to determine treatment and prognosis. Most patients with invasive cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection.

  • Sentinel lymph node biopsy. In a sentinel lymph node biopsy (also called a sentinel node biopsy or SNB), the surgeon finds and removes 1 to 3 or more lymph nodes from under the arm that receive lymph drainage from the breast. This procedure helps avoid removing a larger number of lymph nodes with an axillary lymph node dissection (see below) for patients whose sentinel lymph nodes are mostly free of cancer. The smaller lymph node procedure helps lower the risk of several possible side effects, including swelling of the arm called lymphedema, the risk of numbness, and arm movement and range-of-motion problems. Such side effects are long-lasting issues that can severely affect a person’s quality of life. Importantly, the risk of lymphedema increases with the number of lymph nodes and lymph vessels that are removed or damaged during cancer treatment. This means that men who have a sentinel lymph node biopsy tend to be less likely to develop lymphedema than those who have an axillary lymph node dissection (see below).

    In a sentinel lymph node biopsy, the surgeon finds and removes a small number of sentinel lymph nodes from under the arm that receives lymph drainage from the breast. To find the sentinel lymph node, the surgeon injects a dye and/or a radioactive tracer into the area of the cancer and/or around the nipple. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. The surgeon can find the lymph node when it turns color if the dye is used, or when it gives off radiation if the tracer is used. The pathologist then carefully examines these lymph nodes for cancer cells.

    If the sentinel lymph node(s) are cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer. This means that no more lymph nodes need to be removed. If only 1 or 2 sentinel lymph nodes have cancer and you plan to have a lumpectomy and radiation therapy to the entire breast, an axillary lymph node dissection may not be needed. In general, for most men with early-stage breast cancer that can be removed with surgery and whose underarm lymph nodes are not enlarged, sentinel lymph node biopsy is the standard of care. However, in certain situations, it may be appropriate to not undergo any axillary surgery. You should talk with your surgeon about whether this may be the right approach for you. 

    A sentinel lymph node biopsy alone may not be done if there is obvious evidence of cancer in the lymph nodes before any surgery. In this situation, a full axillary lymph node dissection is preferred (see below).

  • Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. These are then examined for cancer cells by a pathologist. The actual number of lymph nodes removed varies from person to person. An axillary lymph node dissection may not be needed for all men with early-stage breast cancer with small amounts of cancer in the sentinel lymph nodes. Men having a lumpectomy and radiation therapy who have a smaller tumor (less than 5 cm) and no more than 2 sentinel lymph nodes with cancer may avoid a full axillary lymph node dissection. This helps reduce the risk of side effects and does not decrease survival. If cancer is found in the sentinel lymph node, whether additional surgery is needed to remove more lymph nodes depends on the specific situation.

Most people with invasive breast cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. However, these procedures may be optional for some patients older than 65. This depends on how large the lymph nodes are, the tumor’s stage, and the person’s overall health.

Summary of surgical options

To summarize, surgical treatment options include the following:

  • Removal of cancer in the breast through either lumpectomy or mastectomy
  • Lymph node evaluation through sentinel lymph node biopsy and/or axillary lymph node dissection

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using a probe in the operating room, it is called intra-operative radiation therapy. When radiation therapy is given by placing radioactive sources into the tumor, it is called brachytherapy. Although the research results are encouraging, intra-operative radiation therapy and brachytherapy are not widely used for breast cancer. These types of radiation therapy are typically only used for a small cancer that has not spread to the lymph nodes. 

Adjuvant (after surgery) radiation therapy is recommended for some men depending on the type of surgery, the size of their tumor, the number of cancerous lymph nodes under the arm, and the width of the tissue margin around the tumor removed by the surgeon.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, redness and/or skin discoloration or hyperpigmentation, and pain or burning in the skin where the radiation was directed, sometimes with blistering or peeling. Very rarely, a small amount of the lung can be affected by the radiation, causing pneumonitis, a radiation-related swelling of the lung tissue. This risk depends on the size of the area that received radiation therapy, and it tends to heal with time. In the past, with older equipment and radiation therapy techniques, people who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease. Modern techniques, such as respiratory gating, which uses technology to guide the delivery of radiation while a patient breathes, are now able to spare the vast majority of the heart from the effects of radiation therapy.

Learn more about the basics of radiation therapy.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for breast cancer include:

  • Chemotherapy

  • Hormonal therapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

Chemotherapy is given to reduce the risk of recurrence of breast cancer. When it is given before surgery it is also used to try to shrink a large tumor and make surgery easier. This is called neoadjuvant or preoperative chemotherapy. When it is given after surgery it is called called adjuvant chemotherapy.

A chemotherapy regimen, or schedule, usually consists of a specific treatment schedule of drugs given at repeating intervals for a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every 2 weeks, once every 3 weeks, or even once every 4 weeks. Common types of chemotherapy that are used to treat early stage, locally advanced, or metastatic breast cancer include:

  • Capecitabine (Xeloda, available as a generic drug)

  • Carboplatin (available as a generic drug)

  • Cisplatin (available as a generic drug)

  • Cyclophosphamide (available as a generic drug)

  • Docetaxel (Taxotere, available as a generic drug)

  • Doxorubicin (available as a generic drug)

  • Pegylated liposomal doxorubicin (Doxil, available as a generic drug)

  • Epirubicin (Ellence, available as a generic drug)

  • Eribulin (Halaven)

  • Fluorouracil (5-FU, available as a generic drug)

  • Gemcitabine (Gemzar)

  • Ixabepilone (Ixempra)

  • Methotrexate (Rheumatrex, Trexall, available as a generic drug)

  • Paclitaxel (Taxol, available as a generic drug)

  • Protein-bound paclitaxel (Abraxane)

  • Vinorelbine (Navelbine, available as a generic drug)

A patient may receive 1 drug at a time or combinations of different drugs given at the same time. Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. The following combinations of drugs may be used as adjuvant therapy to treat breast cancer:

  • AC (doxorubicin and cyclophosphamide)

  • AC or EC (doxorubicin and cyclophosphamide or epirubicin and cyclophosphamide) followed by T (paclitaxel or docetaxel)

  • CAF (cyclophosphamide, doxorubicin, and 5-FU)

  • CEF (cyclophosphamide, epirubicin, and 5-FU)

  • CMF (cyclophosphamide, methotrexate, and 5-FU)

  • EC (epirubicin and cyclophosphamide)

  • TAC (docetaxel, doxorubicin, and cyclophosphamide)

  • TC (docetaxel and cyclophosphamide)

Therapies that target the HER2 receptor may be given with chemotherapy for HER2-positive breast cancer (see "Targeted therapy," below).

The side effects of chemotherapy depend on the individual, the drug(s) used, and the schedule and dose. These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, numbness and tingling, and diarrhea or constipation. These side effects can often be very successfully prevented or managed during treatment with supportive medications, including medications to boost the immune system, and most side effects usually go away after treatment is finished. Some side effects, such as numbness and tingling of the fingers and toes and loss of fertility, can continue after treatment. Rarely, long-term side effects may occur, such as heart damage or secondary cancers. Many patients feel well during chemotherapy and are active taking care of their families, working, and exercising during treatment. But each person’s experience is different. Talk with your health care team about the possible side effects of your specific chemotherapy plan.

Learn more about the basics of chemotherapy.

Hormonal therapy

Hormonal therapy, also called endocrine therapy, is a very important treatment for tumors that test positive for either estrogen or progesterone receptors (called ER positive or PR positive; see Introduction). Hormone receptor-positive tumors use hormones to fuel their growth. Blocking the body’s hormones may then slow the growth of the tumor and kill the cancer cells. Because most men with breast cancer have ER-positive disease, hormonal therapy is often part of the treatment plan.

ASCO recommends that men who have had surgery to remove a hormone receptor-positive breast cancer receive hormonal therapy for at least 5 years. It may be taken for up to 10 years, especially if the cancer has a higher risk of returning. How long to continue hormonal therapy depends on the stage of cancer, the risk of it returning, and any side effects you are experiencing.

Hormonal therapy after surgery may be used by itself or after chemotherapy. Hormonal therapy options for men include:

  • Tamoxifen (available as a generic drug) is the primary hormonal therapy that ASCO recommends for men with all stages of hormone receptor-positive breast cancer. Tamoxifen blocks estrogen from binding to breast cancer cells. If a man with breast cancer has taken tamoxifen for 5 years without serious side effects and still has a high risk of the cancer coming back, 5 more years of tamoxifen therapy may be offered.

  • Aromatase inhibitors (AIs, all available as generic drugs) include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). AIs decrease the amount of estrogen made by the body. This type of treatment is effective in treating all stages of breast cancer in postmenopausal women, but there is not much information on AI use for men with breast cancer. Caution is urged in using AIs in men who still have their testicles (testes), as these treatments could cause androgen levels to increase. If an AI is used, an additional injection medication to decrease androgen production may be offered as well.

  • Fulvestrant (Faslodex) is a drug that is given by injection once a month. It is used to treat metastatic breast cancer. It stops estrogen from helping a cancer grow in a way that is different from tamoxifen. Like AIs, there is not much information on its use for men, but research has shown that it may be effective.

Side effects of hormonal therapy can include hot flashes, decreased sexual desire or ability, leg cramps, mood swings, bone loss, and blood clots.

Men with breast cancer should not receive testosterone or androgen supplementation.

This information is based on ASCO recommendations for Management of Male Breast Cancer. Please note that this link takes you to another ASCO website.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These treatments are very focused and work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

The first approved targeted therapies for breast cancer were hormonal therapies. Then, HER2-targeted therapies were approved to treat HER2-positive breast cancer. Targeted therapies are also used to treat metastatic breast cancer.

HER2-targeted therapy
  • Trastuzumab (Herceptin, Herzuma, Ogivri, Ontruzant, Hylecta). This drug is approved as an adjuvant therapy for non-metastatic HER2-positive breast cancer and for treatment of metastatic HER2-positive breast cancer. Currently, most patients with stage I to stage III breast cancer (see Stages) should receive a trastuzumab-based regimen, often including a combination of trastuzumab with chemotherapy, followed by 1 year of adjuvant trastuzumab. For patients with metastatic breast cancer, trastuzumab is often combined with chemotherapy or other targeted drugs. Patients receiving trastuzumab have a small (2% to 5%) risk of heart problems. This risk is increased if a patient has other risk factors for heart disease or receives chemotherapy that also increases the risk of heart problems at the same time. These heart problems may go away and can be treatable with medication. This drug is given by vein every 1 to 3 weeks or by injection (Hylecta) every 3 weeks.

  • Pertuzumab (Perjeta). This drug is approved for stage II and stage III breast cancer and for metastatic breast cancer in combination with trastuzumab and chemotherapy. This drug can cause diarrhea and skin rash. This drug is given by vein every 3 weeks.

  • Pertuzumab, trastuzumab, and hyaluronidase–zzxf (Phesgo). This combination drug, which contains pertuzumab, trastuzumab, and hyaluronidase-zzxf in a single dose, is approved for people with early-stage HER2-positive breast cancer. It may be given in combination with chemotherapy. It is given by injection under the skin and can be administered either at a treatment center or at home by a health care professional.

  • Ado-trastuzumab emtansine or T-DM1 (Kadcyla). This is approved for the treatment of patients with early-stage breast cancer who have had treatment with trastuzumab and chemotherapy with either paclitaxel or docetaxel followed by surgery, and who had cancer remaining (or present) at the time of surgery. It is also approved for treatment of metastatic HER2 positive breast cancer. T-DM1 is a combination of trastuzumab linked to a very small amount of a strong chemotherapy. This allows the drug to deliver chemotherapy into the cancer cell while lessening the chemotherapy received by healthy cells. T-DM1 is given by vein every 3 weeks.

  • Trastuzumab deruxtecan (Enhertu). Trastuzumab deruxtecan is approved for treatment of patients with metastatic HER2-positive breast cancer who have already received 2 or more HER2-targeted therapies. This HER2-targeted treatment is a combination of a drug that is similar to trastuzumab, called a biosimilar, linked to a small amount of a strong chemotherapy. The trastuzumab biosimilar carries the chemotherapy to the HER2-positive cancer cells, so it can kill the cancer cells and limit damage to healthy cells. It is given by vein every 3 weeks. The treatment has a low risk of interstitial lung disease (ILD), which causes scarring of the lungs and can make it difficult to breathe or cause coughing.

  • Tucatinib (Tukysa). Tucatinib, when added to capecitabine chemotherapy and trastuzumab, is approved for the treatment of advanced unresectable or metastatic HER2-positive breast cancer, including cancer that has spread to the brain, in those who have already received 1 or more HER2-targeted therapy. Unresectable means surgery is not an option. Tucatinib is a tyrosine kinase inhibitor designed to turn off HER2. It is an oral medication that is given twice daily. This drug can cause diarrhea and affect the liver.

  • Neratinib (Nerlynx). Neratinib, in combination with capecitabine chemotherapy, is approved for the treatment of higher-risk HER2-positive, early-stage breast cancer. It is taken for a year, starting after patients have finished 1 year of trastuzumab. It is also approved for treatment of advanced or metastatic HER2-positive breast cancer in patients who have already received 2 or more HER2-targeted therapies. Neratinib is a tyrosine kinase inhibitor. It is an oral medication that is given every day for 3 weeks. This drug can cause diarrhea and can also affect the liver.

  • Lapatinib (Tykerb). Men with HER2-positive metastatic breast cancer may benefit from lapatinib when other medications are no longer effective at controlling the cancer’s growth. The combination of lapatinib and the chemotherapy capecitabine is approved to treat metastatic HER2-positive breast cancer when a patient has already received chemotherapy and trastuzumab. The combination of lapatinib and letrozole is also approved for metastatic HER2-positive and ER-positive cancer. Lapatinib is also used in combination with trastuzumab for patients whose cancer is growing while receiving trastuzumab. Lapatinib may be able to enter into the brain, and could be an option for HER2-positive breast cancer that has spread to the brain. This drug can affect the liver and can also cause diarrhea.

Combination regimens for stages I to III, HER2-positive breast cancer may include:

  • AC-TH (doxorubicin, cyclophosphamide, paclitaxel, trastuzumab)

  • AC-THP (doxorubicin, cyclophosphamide, paclitaxel, trastuzumab, pertuzumab)

  • TCHP (docetaxel or paclitaxel, carboplatin, trastuzumab, pertuzumab)

  • TCH (docetaxel or paclitaxel, carboplatin, trastuzumab)

  • TH (paclitaxel, trastuzumab)

Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Bone modifying drugs

Bone modifying drugs block bone destruction and help strengthen bone. They are mainly used to treat cancer that has spread to the bone. In people whose cancer has not spread, bone modifying drugs may be used to help keep the cancer from recurring. Certain types are also used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones. ASCO recommends that men with early-stage breast cancer that has not spread to the bone should not be treated with bone modifying drugs to prevent recurrence, but they could receive these drugs to prevent or treat osteoporosis.

There are 2 types of drugs that block bone destruction:

  • Bisphosphonates. These block the cells that destroy bone, called osteoclasts. Bisphosphonates include the medicines zoledronic acid (Reclast), alendronate (Binosto, Fosamax), and ibandronate (Boniva).

  • Denosumab (Prolia). An osteoclast-targeted therapy called a RANK ligand inhibitor.

Other types of targeted therapy for breast cancer

You may have other targeted therapy options for breast cancer treatment, depending on several factors. Many of the following drugs are used for advanced or metastatic breast cancer.

  • Alpelisib (Piqray). Alpelisib is an option along with the hormonal therapy fulvestrant for men and women with hormone receptor-positive, HER2-negative metastatic breast cancer that has a PIK3CA gene mutation and has worsened during or after hormonal therapy.

  • Drugs that target the CDK4/6 protein in breast cancer cells, which may stimulate cancer cell growth. These drugs include abemaciclib (Verzenio), palbociclib (Ibrance), and ribociclib (Kisqali). They are approved for ER-positive, HER2-negative advanced or metastatic breast cancer and may be combined with some types of hormonal therapy.

  • Larotrectinib (Vitrakvi). Larotrectinib is for breast cancer with an NTRK fusion that is metastatic or cannot be removed with surgery and has worsened with other treatments.

  • Olaparib (Lynparza). This oral drug may be used for patients with metastatic HER2-negative breast cancer and a BRCA1 or BRCA2 gene mutation who have previously received chemotherapy. It is a type of drug called a PARP inhibitor, which destroys cancer cells by preventing them from fixing damage.

  • Talazoparib (Talzenna). Talazoparib is an oral drug that may be used for treating patients with locally advanced or metastatic HER2-negative breast cancer who have a BRCA1 or BRCA2 gene mutation.

  • Sacituzumab govitecan-hziy (Trodelvy). In 2020, the U.S. Food and Drug Administration (FDA) approved the use of sacituzumab govitecan-hziy for the treatment of people with metastatic triple-negative breast cancer who have already received at least 2 treatments. Sacituzumab govitecan-hziy is an antibody-drug conjugate, which means the antibody attaches to a cancer cell and then delivers the anticancer drug it carries to start destroying the cancer cell.

Immunotherapy (updated 09/2021)

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. The following drugs, which are a type of immunotherapy called immune checkpoint inhibitors, are used for recurrent and advanced or metastatic breast cancer. Pembrolizumab is also used for high-risk, early-stage disease.

  • Pembrolizumab (Keytruda). This is a type of immunotherapy that is approved by the FDA to treat both high-risk, early-stage triple-negative breast cancer and metastatic cancer or cancer that cannot be treated with surgery. Pembrolizumab is approved to treat people with high-risk, early-stage, triple-negative breast cancer in combination with chemotherapy before surgery. It could then continue to be given alone following surgery. For people with metastatic breast cancer, pembrolizumab is approved in combination with a few different chemotherapy drugs to treat metastatic or locally recurrent triple-negative breast cancer that cannot be treated with surgery and that tests positive for PD-L1. In addition, pembrolizumab can be used to treat people with metastatic breast cancer whose tumors have a molecular alteration called microsatellite instability-high (MSI-H) or DNA mismatch repair deficiency (dMMR) (see Diagnosis).

  • Dostarlimab (Jemperli). This type of immunotherapy is approved by the FDA to treat recurrent or metastatic breast cancers that have dMMR and have progressed during or after previous treatment.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Recurrent breast cancer

If the cancer returns after treatment for early-stage disease, it is called recurrent cancer. When breast cancer recurs, it may come back in the following parts of the body:

  • The same place as the original cancer, which is called a local recurrence.

  • The chest wall or lymph nodes under the arm or in the chest, which is called a locoregional recurrence.

  • A location distant from the breast, including organs such as the bones, lungs, liver, and brain. This is called a distant recurrence or a metastatic recurrence.

When breast cancer recurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. Testing may include imaging tests, such as those discussed in the Diagnosis section. In addition, a biopsy may be needed to confirm the breast cancer recurrence and learn about the features of the cancer.

After this testing is done, you and your doctor will talk about the treatment options. The treatment plan may include some of the treatments described above, such as surgery, radiation therapy, chemotherapy, targeted therapy, and hormonal therapy, but they may be used in a different combination or at a different pace. The treatment options for recurrent breast cancer depend on the following factors:

  • Previous treatment(s) for the original cancer

  • Time since the original diagnosis

  • Location of the recurrence

  • Characteristics of the tumor, such as ER, PR, and HER2 status

A local recurrence may be considered curable with further treatment. A metastatic (distant) recurrence is generally considered incurable, but it is treatable. Some patients live for years after a metastatic recurrence of breast cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent breast cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the focus of care may switch to trying to help a person live as well as possible with the cancer.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable and preferable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.