Hormone Receptor-Positive Breast Cancer
About 80% of all breast cancers are “ER-positive.” That means the cancer cells grow in response to the hormone estrogen. About 65% of these are also “PR-positive.” They grow in response to another hormone, progesterone.
If your breast cancer has a significant number of receptors for either estrogen or progesterone, it’s considered hormone-receptor positive.
Tumors that are ER/PR-positive are much more likely to respond to hormone therapy than tumors that are ER/PR-negative.
You may have hormone therapy after surgery, chemotherapy, and radiation are finished. These treatments can help prevent a return of the disease by blocking the effects of estrogen. They do this in one of several ways.
- The medications tamoxifen (Nolvadex) and toremifene (Fareston) are a class of drug called selective ER modulators (SERMs). They help stop cancer from coming back by blocking hormone receptors, preventing hormones from binding to them. It’s sometimes taken for up to 5 years after initial treatment for breast cancer.
- Elacestrant (Orserdu) and fulvestrant (Faslodex) are selective estrogen receptor degraders (SERDs). These medications work by blocking and damaging estrogen receptors and are sometimes used in the treatment of metastatic breast cancer.
- A class of medicines called aromatase inhibitors actually stops estrogen production. These include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara).
- Luteinizing hormone-releasing hormone (LHRH) agonists shut down the ovaries' production of estrogen leading to temporary menopause. These medications include goserelin (Zoladex) and leuprolide (Lupron).
- CDK 4/6 inhibitors abemaciclib (Verzenio), palbociclib (Ibrance) and ribociclib (Kisqali) are sometimes used with aromatase inhibitors or the hormone therapy fulvestrant (Faslodex).
- Everolimus (Afinitor) is an mTOR inhibitor that improves the success of hormone therapy drugs. It is used for women who have gone through menopause.
- Alpelisib (Piqray) is a P13K inhibitor in pill form that can be used with fulvestrant in women with advanced HR+, HER2-negative breast cancer with a PIK3CA gene mutation.
- Sacituzumab govitecan (Trodelvy) is a monoclonal antibody with an attached chemotherapy drug. It is used to treat some advanced HR+, HER2-negative breast cancer.
Learn more about hormone therapy to treat breast cancer.
HER2-Positive Breast Cancer
In about 20% of breast cancers, the cells make too much of a protein known as HER2. These cancers tend to be aggressive and fast-growing.
For women with HER2-positive breast cancers, the targeted drug trastuzumab (Herceptin) has been shown to dramatically reduce the risk of the cancer coming back. It‘s standard treatment to give this medication along with chemotherapy after surgery to people with breast cancer that’s spread to other areas. It can also be used for early-stage breast cancer. But there is a small but real risk of heart damage and possible lung damage.
There are several other targeted therapies sometimes used in the treatment of HER2-positive breast cancer. These include:
- Abemaciclib (Verzenio)
- Ado-trastuzumab emtansine (Kadcyla)
- Fam-trastuzumab deruxtecan-nxki (Enhertu)
- Lapatinib (Tykerb)
- Margetuximab (Margenza)
- Neratinib (Nerlynx)
- Pertuzumab (Perjeta)
- Tucatinib (Tukysa)
- Trastuzumab, pertuzumab, and hyaluronidase injection (Phesgo)
Read more on HER2-positive breast cancer causes, symptoms, and treatment.
Triple-Negative Breast Cancer
Some breast cancers -- between 10% and 20% -- are known as “triple negative” because they don’t have estrogen and progesterone receptors and don’t overexpress the HER2 protein. Many breast cancers associated with the gene BRCA1 are triple negative. They are often treated with surgery, chemotherapy, and radiation.
- Olaparib (Lynparza) and talazoparib (Talzenna) are targeted therapy medicines that can be used to treat women with a BRCA mutation who have metastatic HER2-negative breast cancer. These drugs block a protein called PARP.
- Atezolizumab (Tecentriq) is an immunotherapy drug used in combination with the chemotherapy nab-paclitaxel (Abraxane) to block a protein called PD-L1 in certain breast cancers that are triple negative.
- In the case of advanced disease where two other drugs have been tried, the antibody-drug conjugate sacituzumab govitecan (Trodelvy) may be tried.
Get an overview on triple-negative breast cancer symptoms and treatment.
