Treatment options for different stages of breast cancer

by Specialist

Early, limited or operable breast cancer

For stage I, stage II, and operable stage IIIA  breast cancers, possible treatments include the following.

Surgery

  • Breast-conserving surgery and sentinel lymph node biopsy. If a lymph node biopsy reveals cancer cells, lymph node dissection may be required.

  • Modified radical surgery for breast cancer and possibly breast reconstruction.

Postoperative radiotherapy

For patients who undergo breast-conserving surgery, whole-breast radiotherapy should be administered to reduce the risk of cancer recurrence. For those who have undergone modified radical breast cancer surgery, radiotherapy should be given to reduce the risk of cancer recurrence if any of the following are present.

  • Cancer cells were found in no fewer than 4 lymph nodes.
  • Tumor has metastasized to the lymph nodes.
  • Tumor has metastasized to the tissue surrounding the lymph nodes.
  • The tumor is large.
  • The tumor is large.
  • The tumor is large.
  • There are still cancer cells in or around the tissue near the margin of tumor resection.

Postoperative systemic therapy

The need for postoperative systemic therapy depends on the following factors:

  • Whether the tumor is hormone receptor negative or positive.

  • Tumor is HER2 (human epidermal growth factor receptor 2) negative or positive.

  • Whether the tumor is negative for both hormone receptors and HER2 (triple negative).
  • The size of the tumor.
  • The size of the tumor.

For patients with hormone receptor-positive premenopausal breast cancer, no additional treatment may be needed after surgery or the following treatment may be given:

  • Tamoxifen in combination with or without chemotherapy.

  • Tamoxifen in combination with treatment that inhibits or reduces estrogen production by the ovaries, the latter including drugs, oophorectomy, or ovarian radiation therapy.

  • Aromatase inhibitors in combination with treatment to inhibit or reduce ovarian secretion of estrogen, which includes drugs, oophorectomy, or ovarian radiation therapy.

For postmenopausal patients who are hormone receptor positive, no additional treatment may be given after surgery or the following may be given:

  • Aromatase inhibitors in combination with or without chemotherapy.

  • Tamoxifen treatment followed by an aromatase inhibitor in combination with or without chemotherapy.

For female patients who are hormone receptor negative, it may not be necessary to give more treatment or to give chemotherapy after surgery.

For HER2-negative female patients, chemotherapy may be given postoperatively.

For women who are HER2-positive with no lymph node metastases and small tumors, no more treatment is needed. If there are lymph node metastases or the tumor is large, postoperative treatment may include:

  • Chemotherapy and targeted therapy (trastuzumab, or Trastuzumab).

  • Endocrine therapy, such as tamoxifen or an aromatase inhibitor, for hormone receptor-positive individuals.

For patients with hormone receptor-negative and HER2-negative triple-negative breast cancer with no lymph node metastases and small tumors, no more treatment may be needed after surgery. If there are lymph node metastases or the tumor is large, postoperative treatment may include:

  • Chemotherapy.

  • Radiotherapy.

  • Clinical trials of new chemotherapy regimens.

  • Clinical trials of polyadenosine diphosphate ribose polymerase (PARP) inhibitors.

Preoperative systemic therapy

For hormone receptor-positive postmenopausal patients, preoperative therapy may include:

  • Chemotherapy.

  • Endocrine therapy, such as tamoxifen or an aromatase inhibitor, for women who cannot receive chemotherapy.

For premenopausal patients who are hormone receptor positive, preoperative therapy can be enrolled in clinical trials of endocrine therapy, such as tamoxifen or aromatase inhibitors.

For patients who are HER2-positive, preoperative therapy may include:

  • Chemotherapy and targeted therapy (trastuzumab).

  • Targeted therapy (pertuzumab, or pertuzumab)

For patients with HER2-negative or triple-negative breast cancer, preoperative treatment can be chemotherapy.

See a list of clinical trials that have accepted patients with stage I, II, IIIA, and IIIC breast cancer. For more specific information, use the criteria to filter, such as the region where the trial is being conducted, the type of treatment, or the name of the drug. You can ask your doctor about clinical trials that may be appropriate for you.

Advanced, metastatic, and inoperable breast cancer

Including treatment for stage IIIB, inoperable stage IIIC, stage IV, and metastatic breast cancer.

Stage IIIB, inoperable stage IIIC breast cancer

For stage IIIB, inoperable stage IIIC breast cancer, treatment may include the following:

  • Chemotherapy.
  • Chemotherapy followed by chemotherapy.
  • Chemotherapy followed by surgery (breast-conserving surgery or total mastectomy) with lymph node dissection followed by radiation therapy. Other treatments (chemotherapy, endocrine therapy, or a combination of both) may also be given.

  • Clinical trials of new anti-cancer drugs, new combinations of drugs, and new therapies.

Stage IV and metastatic breast cancer

For locally recurrent breast cancer (breast or chest wall recurrent breast cancer), treatment may include the following:

  • Surgery (modified radical mastectomy for breast cancer), chemotherapy, or a combination of the two.

  • Chemotherapy or endocrine therapy.

  • Antibody-drug combination therapy, namely trastuzumab-emtansine couples (Ado-trastuzumab emtansine, T-DM1).

  • Clinical trials of trastuzumab in combination with chemotherapy.

    For stage IV or metastatic breast cancer, treatment may include the following:

  • Endocrine therapy and/or chemotherapy, in combination or not with trastuzumab.

  • Monoclonal antibody trastuzumab and pertuzumab in combination with chemotherapy.

  • Antibody-drug combination therapy, i.e., trastuzumab-metanephrine couples.

  • Tyrosine kinase inhibitor (TKI) lapatinib in combination with capecitabine.

  •  Trastuzumab and lapatinib combination therapy.

  • The cell cycle protein-dependent kinase inhibitor pabocinib (Palbociclib) in combination with letrozole (Letrozole).

  • Radiotherapy and/or surgery to relieve pain or other symptoms.

  • Bisphosphonates may be used to reduce bone disease and pain when the tumor has metastasized to the bone.

  • Clinical trials of new chemotherapeutic agents and/or endocrine therapy.

  • Clinical trials including targeted therapies, endocrine therapies, and new therapeutic combinations for chemotherapy.

  • Clinical trial testing of other therapies, including high-dose chemotherapy combined with stem cell transplantation.

See a list of clinical trials accepting patients with stage IIIB, inoperable stage IIIC, and stage IV breast cancer. For more specific information, filter using search criteria, such as the region where the trial is being conducted, the type of treatment, or the name of the drug. You can ask your doctor about clinical trials that may be right for you.

Inflammatory breast cancer

Treatment for inflammatory breast cancer may include the following:

  • Chemotherapy.

  • Chemotherapy followed by surgery (breast-conserving surgery or total mastectomy) with lymph node dissection followed by radiation therapy. Other treatments (chemotherapy, endocrine therapy, or a combination of both) may also be given.

  • Clinical trials of new anti-cancer drugs, new combinations of drugs, and new therapies.

View a list of clinical trials receiving patients with inflammatory breast cancer. For more specific information, filter using search criteria, such as the region where the trial is being conducted, the type of treatment, or the name of the drug. You can ask your doctor about clinical trials that may be right for you.