Treatments for Metastatic Breast Cancer

Metastatic breast cancer (also called stage IV or advanced breast cancer) is not a specific type of breast cancer. It’s the most advanced stage of breast cancer.

Metastatic breast cancer is breast cancer that has spread beyond the breast and nearby lymph nodes to other parts of the body (most often the bones, lungs, liver or brain).

If you’ve been diagnosed with metastatic breast cancer, you’re not alone. It’s estimated there were more than 168,000 women in the U.S. living with metastatic breast cancer in 2020 (most recent estimate available) [1]. Men can also get metastatic breast cancer.

Although metastatic breast cancer has spread to another part of the body, it’s still breast cancer and treated as breast cancer.

For example, breast cancer that has spread to the bones is still breast cancer (not bone cancer). The breast cancer cells have invaded the bones. It’s not the same as cancer that starts in the bones. So, it’s treated with breast cancer drugs rather than treatments for cancer that began in the bones.

Some people have metastatic breast cancer (also called stage IV or advanced breast cancer) when they are first diagnosed with breast cancer (about 6% of diagnoses in women and about 9% of diagnoses in men in the U.S.) [3]. This is called de novo metastatic breast cancer.

Most often, metastatic breast cancer arises years after a person has completed treatment for early or locally advanced breast cancer. This may be called a distant recurrence or metastasis.

A diagnosis of metastatic breast cancer is not your fault. You did nothing to cause the cancer to spread.

Metastatic breast cancers come from breast cancer cells that remained in the body after treatment for early breast cancer. The breast cancer cells were always there but couldn’t be detected. For some unknown reason, the cancer cells began to grow again. This process is not well-understood.

The risk of metastasis

The risk of metastasis after breast cancer treatment varies from person to person. It depends on:

The biology of the tumor, including biomarkers (such as hormone receptor status and HER2 status)
The stage at the time of the original diagnosis
The treatments for the original cancer (trying to prevent breast cancer recurrence)

Modern treatments continue to improve survival for people with metastatic breast cancer. However, survival varies greatly from person to person.

About one-third of women diagnosed with metastatic breast cancer in the U.S. live at least 5 years after diagnosis [1]. Some women may live 10 or more years beyond diagnosis [2].

Your oncologist can give you some information about your prognosis, but they don’t know exactly how long you will live.

Metastatic breast cancer treatment

As hard as it is to hear, metastatic breast cancer cannot be cured today.

However, metastatic breast cancer can be treated. Treatment focuses on extending life and maintaining quality of life.

Your treatment plan is guided by many factors, including:

The biology of the tumor, including biomarkers (such as hormone receptor status and HER2 status)
Where the cancer has spread
Your symptoms
Your past breast cancer treatments
Whether you have a BRCA1 or BRCA2 inherited gene mutation
Your overall health, age, menopausal status and other medical issues
Your personal goals and preferences

It’s always OK to get a second opinion at any time during your treatment.

Learn about factors related to the biology of the tumor that affect treatment options.

Learn about emerging areas in treatment.

Learn more about getting a second opinion.

Susan G. Komen^® Metastatic Breast Cancer (MBC) Impact Series

Susan G. Komen’s MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, collaborative space to gather information related to metastatic breast cancer and discover practical resources to help make decisions for improved physical and emotional health.

During the free events, you can participate in sessions with leading experts, hear from individuals living with metastatic breast cancer and gather information from wellness experts. You’ll also have the opportunity to ask our speakers questions.

To learn more and register, visit www.komen.org/mbcseries.

The biology of the tumor

Many tests will be done on a sample of the metastatic tumor (from a biopsy of the metastases). The results of these tests give information on the biology of the tumor that help guide treatment.

Which tumors are tested?	What does the tumor test determine?	How do the test results guide treatment?
All tumors	Hormone receptor status (estrogen and progesterone receptor status)	If the cancer is hormone receptor-positive, the first treatment is usually hormone therapy, often paired with a CDK4/6 inhibitor.
All tumors	HER2 status	If the cancer is HER2-positive, HER2-targeted therapies, such as trastuzumab (Herceptin), are included in the treatment plan. If the cancer is HER2-low, trastuzumab deruxtecan (Enhertu) may be included in the treatment plan.
Tumors that are both hormone receptor-positive and HER2-negative	Whether the tumor has a PIK3CA gene mutation	If the tumor has a PIK3CA gene mutation, the cancer may be treated with the PI3 kinase inhibitor alpelisib (Piqray), in combination with the hormone therapy fulvestrant.
Tumors that are both hormone receptor-positive and HER2-negative	Whether the tumor has a ESR1 gene mutation	If the tumor has an ESR1 gene mutation, the cancer may be treated with the hormone therapy elacestrant (Orserdu).
Triple negative breast cancers (tumors that are both hormone receptor-negative and HER2-negative)	PD-L1 status	If the cancer is PD-L1-positive, the first treatment may be the immunotherapy drug pembrolizumab (Keytruda) in combination with chemotherapy.
Adapted from National Comprehensive Cancer Network (NCCN), 2023 [4]

Drug therapies for metastatic breast cancer

Many different drug therapies can be used to treat metastatic breast cancer. To learn about drug therapies that may be part of your treatment plan, click on any class of drugs or drug name below.

Class of drugs	Drug (brand name) in alphabetical order by class of drugs
Hormone therapy (endocrine therapy)
	Anastrozole (Arimidex)
	Elacestrant (Orserdu)
	Exemestane (Aromasin)
	Fulvestrant (Faslodex)
	Goserelin (Zoladex)
	Letrozole (Femara)
	Leuprolide (Lupron)
	Megestrol acetate (Megace)
	Tamoxifen (Nolvadex)
	Toremifene (Fareston)
CDK4/6 inhibitors
	Abemaciclib (Verzenio)
	Palbociclib (Ibrance)
	Ribociclib (Kisqali)
mTOR inhibitors	Everolimus (Afinitor)
PI3 kinase inhibitors	Alpelisib (Piqray)
HER2-targeted therapy
	Ado-trastuzumab emtansine, T-DM1 (Kadcyla)
	Lapatinib (Tykerb)
	Margetuximab (Margenza)
	Neratinib (Nerlynx)
	Pertuzumab (Perjeta)
	Trastuzumab (Herceptin)
	Trastuzumab deruxtecan (Enhertu)
	Tucatinib (Tukysa)
PARP inhibitors
	Olaparib (Lynparza)
	Talazoparib (Talzenna)
Immunotherapy with a checkpoint inhibitor
Immunotherapy with a checkpoint inhibitor	Pembrolizumab (Keytruda)
Trop-2 antibody-drug conjugates
Trop-2 antibody-drug conjugates	Sacituzumab govitecan (Trodelvy)
Chemotherapy
	Capecitabine (Xeloda)
	Carboplatin (Paraplatin)
	Cisplatin (Platinol)
	Cyclophosphamide (Cytoxan)
	Docetaxel (Taxotere)
	Doxorubicin (Adriamycin)
	Epirubicin (Ellence)
	Eribulin (Halaven)
	5-Fluorouracil (Adrucil)
	Gemcitabine (Gemzar)
	Ixabepilone (Ixempra)
	Liposomal doxorubicin (Doxil)
	Methotrexate (Maxtrex)
	Paclitaxel (Taxol)
	Paclitaxel, albumin bound, also called nab-paclitaxel (Abraxane)
	Vinorelbine (Navelbine)

Genetic testing for inherited gene mutations

The National Comprehensive Cancer Network (NCCN) recommends everyone diagnosed with metastatic breast cancer get genetic testing for BRCA1 and BRCA2 (BRCA1/2) inherited gene mutations [4]. This recommendation includes people with no family history of breast cancer [4].

If you have a BRCA1/2 inherited gene mutation, a PARP inhibitor may be included in your treatment plan.

Learn more about BRCA1/2 inherited gene mutations.

Learn more about genetic testing to guide treatment.

Metastatic breast cancer can respond to many different drug therapies. This means the drugs can shrink the tumors.

However, over time, tumors can become resistant (stop responding) to drugs that are used to treat metastatic breast cancer. So, you’ll be monitored (checked) regularly to see if the cancer is responding to treatment.

If a drug therapy is no longer working, or if the side effects are not manageable, your health care provider will change your treatment or discuss other options.

Learn more about how your metastatic breast cancer will be monitored, including scans and blood tests for tumor markers, and when drug therapies are likely to change. Also learn about scan anxiety (scanxiety).

Discuss quality of life issues with your health care team and your family. They can help you decide what treatments are best for you.

Keep in mind how each treatment option fits with your values and beliefs, your family situation, your finances and anything else that is important to you.

Joining a support group or talking with another person living with metastatic breast cancer through a peer mentoring program may also help you think through these issues. One-on-one counseling may also be helpful.

Learn about managing side effects and supportive care.

Learn about pain management.

Komen Financial Assistance Program

Susan G. Komen^®created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals.

Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage 4).

To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org.

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About my cancer

Where in my body has the breast cancer spread?
What is my prognosis with treatment? What is my prognosis without treatment?
Will you do a biopsy or other tests to learn more about the tumor in the new location(s)?
What are the hormone receptor status and HER2 status of my cancer? Are these different from my first breast cancer? How do these affect my treatment options?
Should my tumor be tested for a PIK3CA gene mutation (with a blood test or test of the tumor tissue)?
• Should my tumor be tested for an ESR1 gene mutation (with a blood test or test of the tumor tissue)?
Should my tumor be tested for PD-L1 status?
Should I get genetic testing for BRCA1 and BRCA2 inherited gene mutations to see if a PARP inhibitor may be used in my treatment plan?

Treatment

What are my treatment options? What are the pros and cons of each option? Which do you recommend for me and why?
How will treatment affect my quality of life?
Are there clinical trials I can join? If so, how do I learn more?
How long do I have to make a treatment decision?
Should I get a second opinion? How do I do that?
How will I know if treatment is working? What tests will I need and how often will I need them?

Side effects and supportive care

What side effects should I expect? How long will they last? Which should I report to you right away?
Will I have any pain? If so, how can I manage it? Will you refer me to a palliative care specialist or pain specialist?
Are there any limits on my activity?
Where can I find a counselor for one-on-one support or a support group? What support is available for my family?

For people with bone metastases

Should I be concerned about my bones? How can I protect them from fractures (breaks) or other problems? Will I get bone-strengthening medications?

For people with brain metastases

Are there any drugs that can pass through the blood to the brain that can be used in my treatment plan?

Stopping treatment for the cancer

How will I know if it’s time to stop treatment for the cancer?
Who will be in charge of my medical care after treatment for the cancer ends?
What kind of care will I get if I stop treatment for the cancer?
When will hospice care be considered?

Learn more about talking with your health care provider.

If you’ve been recently diagnosed with metastatic breast cancer or feel too overwhelmed to know where to begin to gather information, Susan G. Komen® has a Questions to Ask Your Doctor About Metastatic Breast Cancer resource that might help.

You can download and print it to bring with you to your next doctor’s appointment or you can save it on your computer, tablet or phone using an app such as Adobe. Plenty of space and a notes section are provided to write or type the answers to the questions.

There are other Questions to Ask Your Doctor resources on many different breast cancer topics you may wish to download.

The National Comprehensive Cancer Network (NCCN) has an animated video on how to talk with your doctor about metastatic breast cancer.

Treatment guidelines for metastatic breast cancer

Although the exact treatment for metastatic breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care team about which treatment guidelines they use.

After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment option has risks and benefits to consider along with your own values and lifestyle.

The Centers for Disease Control and Prevention (CDC) recommends people with cancer and their caregivers get the seasonal flu shot.

Find more information from the CDC about the seasonal flu.

The NCCN recommends people with cancer, their caregivers, household family members and the general public get the COVID-19 vaccine and stay up to date on COVID-19 vaccines. This includes booster shots (when you’re eligible) and additional doses (for those with weakened immune systems).

Find more information about COVID-19 and breast cancer.

Clinical trials

Clinical trials offer the chance to try new treatments and possibly benefit from them.

Many clinical trials are available. Some are for the first treatment a person might get for their metastatic breast cancer, and others are for treatments later in the disease course. Consider joining a clinical trial when you’re newly diagnosed, when your oncologist is considering changing treatments or when there are limited treatment options.

Susan G. Komen^® Breast Care Helpline

If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

The helpline offers metastatic breast cancer clinical trial education and support, such as:

Knowing when to consider a trial
How to find a trial
How to decide which trial is best for you
What to expect during a trial
Information about clinical trial resources

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Metastatic Trial Search

The Metastatic Trial Search is a web-based clinical trial matching tool that can help you find clinical trials that fit your needs.

Learn more about clinical trials for people with metastatic breast cancer.

Learn what Komen is doing to help people find and participate in breast cancer clinical trials, including trials supported by Komen.

You’re not alone

Many women and men have been where you are today. It’s estimated there were more than 168,000 women living with metastatic breast cancer in the U.S. in 2020 (most recent estimate) [1].

It may be helpful to talk with others. You might consider a cancer support group. Or you may prefer talking one-on-one with another person living with metastatic breast cancer through a peer mentoring program. You could consider meeting with a counselor as well. Your health care provider may be able to help you find a local support group, counselor or other resources.

Learn more about support groups, counseling and other types of support for people with metastatic breast cancer.

Learn about social support for loved ones.

SUSAN G. KOMEN^® METASTATIC BREAST CANCER SUPPORT RESOURCES

If you or a loved one needs more information about metastatic breast cancer, contact the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org. All calls are answered by a trained specialist or oncology social worker, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. Se habla español.
Komen Patient Navigators can help guide you through the health care system as you go through a metastatic breast cancer diagnosis and treatment. They can help to remove barriers to high-quality breast care. For example, they can help you with insurance, local resources, communication with health care providers and more. Call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org to learn more about our Patient Navigator program, including eligibility.
We offer an online support community through our closed Komen Metastatic Breast Cancer (Stage IV) Group. The Facebook group provides a place where those living with metastatic breast cancer, and those who love them, can find support, friendship and information. Click the link above or visit Facebook and search for Komen Metastatic Breast Cancer (Stage IV) Group and request to join.
Our free MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, collaborative space to gather information related to metastatic breast cancer and discover practical resources to help make decisions for improved physical and emotional health. To learn more and register visit www.komen.org/mbcseries.
Our Real Pink podcast series covers many relevant topics for people living with metastatic breast cancer and caregivers.
Our fact sheets, booklets and other education materials offer additional information.

Financial assistance

Costs related to metastatic breast cancer care can quickly become a financial burden. Dealing with finances and insurance can be overwhelming.

Many cancer centers have patient financial counselors who can discuss insurance and cost coverage with you.

Learn more about insurance plans and prescription drug assistance programs.

Learn more about other financial assistance programs.

Komen Financial Assistance Program

Susan G. Komen^®created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals.

Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage 4).

To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org.

Se habla español.

Updated 06/25/23