If diagnosed with advanced human epidermal growth factor receptor-2 (HER-2)-negative breast cancer, patients still have some treatment options. Exploring these treatment options can also help to understand what it really means to have HER-2 negative advanced breast cancer.
Advanced breast cancer, or stage III or IV breast cancer, is a large tumor that has invaded beyond the initial site of the breast, may have invaded some lymph nodes or other parts of the body, and has recurred after treatment, and previous treatments are no longer effective. HER-2 negative breast cancer means that there is no specific protein called HER-2 on the surface of the cancer cells. This is important because for this group of patients, drugs that target HER-2 as a cancer treatment will not work.
However, there are still many treatments that can be tried in this group of patients. The physician will discuss the best treatment options with the patient, and treatment choices are related to the type of treatment the patient has received, the site of the cancer, the genes, proteins, and other characteristics of the cancer cells, the patient’s overall health status, and the patient’s expectations for treatment. Patients should make sure they understand the purpose of treatment and the likely outcomes.
Chemotherapy
For most patients with advanced breast cancer, chemotherapy remains the primary treatment. Chemotherapy drugs kill cancer cells in the body as well as cells that are growing vigorously elsewhere in the body and are usually given orally or by intravenous infusion.
There are several chemotherapy drugs, and patients may be treated with one at a time. The duration of treatment will depend on how well the drug works and how well the patient tolerates the side effects. If the currently used drug is no longer effective, it may be replaced with another drug. Chemotherapy may be given in conjunction with other treatments, and some stage III breast cancers may also receive surgery or radiation therapy.
Endocrine therapy
The body produces hormones (eg, estrogen, progesterone) that can stimulate the growth of some kinds of breast cancer cells, and these are called estrogen receptor (ER)-positive or progesterone receptor (PR)-positive breast cancers. If a patient has this type of breast cancer, endocrine therapy may be a treatment option.
Many drugs can block hormone pathways in the body or lower hormone levels so that cancer cells cannot grow in response to hormones. These drugs can be given by mouth or by injection. For many patients, one endocrine therapy drug may gradually lose its effectiveness, at which point another drug may be tried. Endocrine therapy drugs include:
- tamoxifen and toremifene
- Anastrozole, exemestane, and letrozole
- Fulvestrant
- Goserelin and leuprolide
- Goserelin and leuprolide
.
Targeted therapy
Doctors test cancer cells for the presence or absence of HER-2 protein, in addition to other proteins that help them grow. Targeted therapy drugs can block these proteins from working to inhibit the growth of cancer cells. Depending on the protein that acts on the tumor, targeted therapeutics can include:
- Everolimus, which targets a protein called mTOR
- Abemaciclib, palbociclib, and ribociclib, which target the CDK 4/6 protein
Only patients with HER-2 negative cancer and positive hormone receptors can take these drugs, and targeted therapy is most effective when combined with endocrine therapy.
Clinical trials
There is no single best way to treat cancer, so doctors are constantly working to find better ways. Clinical trials help doctors discover new treatments.
Clinical trials are designed to explore how to make better use of existing treatments, how to better combine them, and to find drugs that work better than current drugs. Participation in clinical trials can lead to new therapies before they are widely used.
In any clinical trial, patients will always have access to at least the best treatment available to all patients. Before a patient agrees to participate in a clinical trial, he or she is clearly informed of the pros and cons of participating in the trial. Patients can ask their doctor if there is a clinical trial that is appropriate for them to participate in.
Palliative supportive care
Patients have the right to receive treatment that makes them feel as well as possible, no matter what. Supportive care focuses on relieving symptoms or alleviating the side effects of the treatment the patient is receiving. Regardless of the stage or type of cancer, every person with cancer can receive supportive care, such as analgesia, nausea relief, nutritional support, and oxygen.
Delaying or stopping cancer progression is also part of palliative supportive care. For example, patients may receive radiation therapy to kill cancer cells in bone metastases, followed by surgery to implant a support rod to provide support for the bone, and radiation therapy to shrink tumors that are pressing on nerves and causing pain. If the cancer invades the bone, the doctor may also recommend medications to strengthen the bone and reduce pain.
Supportive therapy will not “fight” the cancer, but can be used in conjunction with other anti-cancer treatments. If you have any questions or concerns, you can contact your doctor. Comfort is an important part of good cancer care.