Targeted (biological) therapies for secondary breast cancer

Targeted therapy drugs interfere with the signals that tell cancer cells to grow. There are different types and they all work differently. You usually have them with or after chemotherapy, or some people have them with hormonal therapy. Targeted therapies are sometimes called biological therapies.

Trastuzumab (Herceptin®) is the main targeted therapy for women with HER2 positive breast cancer. It does not work for secondary breast cancer that has spread to the brain or spinal cord. But you may still be given it to treat any secondary cancer in other parts of the body. The side effects of trastuzumab are usually mild. Some women have flu-like symptoms, diarrhoea, headaches or an allergic reaction.

You may have other targeted therapy drugs, such as lapatinib (Tyverb®) or bevacizumab (Avastin®). They are not widely available on the NHS, but may be available in clinical trials or certain situations. Your cancer specialist will speak to you about whether any of these are suitable for you.

What are targeted therapies for secondary breast cancer?

Targeted therapy drugs interfere with signals that tell the cancer cells to grow. Some drugs also stop the cancer from developing new blood vessels. There are different types that work in slightly different ways. Targeted therapies are sometimes called biological therapies.

You usually have targeted therapy drugs with chemotherapy. They are also occasionally given with hormonal therapy.

Trastuzumab (Herceptin®) is the only targeted therapy drug widely available through the NHS to treat secondary breast cancer. Even if you have had treatment with trastuzumab previously, your cancer doctor may still recommend further treatment with it. This usually depends on how long ago you had it.

Trastuzumab and other targeted therapy drugs are sometimes given in clinical trials.

I asked my oncologist how long Herceptin worked. He explained it was different for everyone but he had a patient on it for several years, which was encouraging.

Karen


Trastuzumab (Herceptin)

You may be treated with trastuzumab if you have HER2-positive breast cancer. It locks on to the HER2 protein and blocks the receptor. This stops the cancer cells from dividing and growing.

You can have trastuzumab every three weeks as a drip (infusion) or as a small injection under the skin.

The side effects are often mild but some women may have:

  • flu-like symptoms
  • diarrhoea
  • headaches
  • an allergic reaction.

We can send you more information about trastuzumab.

Trastuzumab may cause damage to the heart. You have tests to check your heart before and during treatment. If it causes any heart problems, your doctor may prescribe drugs to treat these or stop trastuzumab for a while.

If trastuzumab is no longer controlling the cancer, your doctors will look at other treatments for you. But if you are having trastuzumab and the cancer spreads to the brain or spinal cord (central nervous system), you can usually continue taking it.

Your doctor will give you other treatments to control the cancer in the central nervous system (CNS).


Other targeted therapy drugs

The following drugs are not widely available on the NHS. You may be given them as part of a clinical trial or your cancer doctor may apply for a drug to be individually funded. If you live in England, certain drugs may be available through the Cancer Drugs Fund.

Pertuzumab

Pertuzumab is a monoclonal antibody drug that’s usually given with trastuzumab and the chemotherapy drug docetaxel. It is only used if you have HER2-positive breast cancer. You have it as a drip every three weeks.

Trastuzumab emtansine (Kadcyla®)

Trastuzumab emtansine is a combination of trastuzumab and a chemotherapy drug called emtansine. Trastuzumab delivers the chemotherapy to the cancer cells. You have it as a drip every three weeks. You need to have had previous treatment with trastuzumab and docetaxel or paclitaxel.

Lapatinib (Tyverb®)

Lapatinib is used in women with HER2-positive breast cancer. You take it as a tablet. It can be given in combination with the chemotherapy drug capecitabine (Xeloda®), or with an aromatase inhibitor.

Bevacizumab (Avastin®)

Bevacizumab is a monoclonal antibody drug that stops the cancer from developing new blood vessels. This may shrink the cancer or stop it from growing. It can be used to treat women when the cancer hasn’t got receptors for HER2 or for hormones. This is called triple negative breast cancer.

You have bevacizumab as a drip (infusion) every two to three weeks. It’s usually given with the chemotherapy drug paclitaxel.

Everolimus (Afinitor®)

Everolimus may be given to women with oestrogen receptor-positive breast cancer that is HER2-negative. You have it with the hormonal drug exemestane, but only if you have already had an aromatase inhibitor drug. You take everolimus as a tablet.