Treatment of Metastatic Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include:

Hormone therapy

In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include:

• Tamoxifen therapy.
• Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, abemaciclib, or alpelisib) is also given.
• PARP inhibitor therapy for women with an inherited BRCA1 or BRCA2 mutation.

In premenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive, treatment may include:

• Tamoxifen, an LHRH agonist, or both.
• Cyclin-dependent kinase inhibitor therapy (ribociclib).

In women whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include:

• Aromatase inhibitor therapy.
• Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant or elacestrant.

Targeted therapy

In women with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as:

• Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors.
• Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib), which may be combined with hormone therapy.

In women with metastatic breast cancer that is HER2 positive, treatment may include:

• Targeted therapy such as trastuzumab, trastuzumab deruxtecan, pertuzumab, margetuximab, or lapatinib.
• Targeted therapy with tucatinib, a tyrosine kinase inhibitor used with trastuzumab and capecitabine.

In women with metastatic breast cancer that is HER2 negative, with mutations in the BRCA1 or BRCA2 genes, and who have been treated with chemotherapy, treatment may include targeted therapy with a PARP inhibitor (olaparib or talazoparib).

Chemotherapy

In women with metastatic breast cancer that has not responded to hormone therapy, has spread to other organs, or has caused symptoms, treatment may include chemotherapy with one or more drugs.

Chemotherapy and immunotherapy

In women with locally recurrent, inoperable, or metastatic triple-negative breast tumors which express PD-L1, treatment may include chemotherapy and immunotherapy (pembrolizumab).

Surgery

• Total mastectomy for women with open or painful breast lesions. Radiation therapy may be given after surgery.
• Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery.
• Surgery to remove cancer that has spread to the lung.
• Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery.
• Surgery to remove fluid that has collected around the lungs or heart.

Radiation therapy

• Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life.
• Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body.

Other treatment options

Other treatment options for metastatic breast cancer include:

• Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. For information about bisphosphonates, see Cancer Pain.
• Antibody-drug conjugate therapy with sacituzumab govitecan for certain patients with metastatic triple-negative breast cancer. Sacituzumab govitecan is also approved for certain patients with metastatic hormone receptor positive and HER2-negative breast cancer.
• A clinical trial of high-dose chemotherapy with stem cell transplant.
• Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.