Treatment

There are a range of different treatments and combinations of treatments available for women with secondary breast cancer. The variety of complicated drug names and the range of different ways they work to treat secondary breast cancer can be a lot to take in, especially if you are newly diagnosed or have recently changed to a new and unfamiliar treatment.

Here, we explain everything related to secondary breast cancer treatment, from what treatments are aiming to do and how treatment decisions are made, to the different drugs you may experience and what you can expect from these.

In this section

Aims of treatment

Although there is currently no cure for secondary breast cancer, there are lots of treatments available. The aims of these treatments are to control and slow the spread of disease whilst giving the best possible quality of life. This means trying to minimise any symptoms and side effects which would negatively impact your daily life or stop you from carrying out your usual activities. In other words, helping you to live well with your cancer for as long as possible.

Treatment decisions

As secondary breast cancer can vary so much from patient to patient, the treatment you receive will be tailored to you and your cancer.

Your healthcare team will consider many things when deciding on the best treatment for you. These will include:

  • Where in the body your secondary breast cancer is.
  • How large the cancer is and how many places it has spread to.
  • Characteristics of the cancer e.g. whether it will respond to hormone treatment.
  • Any symptoms the cancer is causing.
  • Any breast cancer treatments you’ve had in the past.
  • Your health and any other medical conditions you might have.

Lots of people are involved when making decisions about how to treat your secondary breast cancer. The multi-disciplinary team (MDT) is a team of healthcare professionals, each bringing different a sort of expertise to help make decisions about your care. This can include a specialist breast cancer nurse, a chemotherapy nurse, medical and clinical oncologists (cancer doctors specialising in different sorts of cancer treatment), a pathologist (a doctor specialising in tissues and cells) and a radiologist (a doctor specialising in the use of imaging tests to diagnose and treat patients), amongst others.

Treatment decisions are also very personal to you and your life. They will involve weighing up the benefits of treatment against the potential negatives. You may start a treatment and decide the side effects are too much for you to manage. It is important to share this with your doctor (and, if you have one, your breast cancer nurse), as they may be able to help you better manage these side effects or suggest an alternative treatment if appropriate.

Breast cancer receptors & their role in treatment decisions

Some breast cancer cells have special proteins stuck to their surface called ‘receptors’. Other proteins or hormones can attach to these receptors and stimulate the cancer cell to grow.

It is important to know whether these receptors are present on a woman’s breast cancer cells since this determines what sort of treatment the cancer is likely to respond to.

There are two main types of receptors in breast cancer. If you have been treated for primary breast cancer in the past, it is likely that you will have come across these terms.

Hormone receptors

Breast cancer cells with hormone receptors allow the hormone oestrogen to attach and stimulate cancer growth. This is referred to as ‘oestrogen receptor positive’, ‘ER positive’ (this stands for the American spelling of estrogen receptor) or ‘hormone positive’ breast cancer. Around 70% of breast cancers will have hormone receptors. This means that they will respond to a type of treatment known as hormone therapy.  There is also another type of hormone receptor which responds to the hormone progesterone, though the effect of hormone therapy on this receptor is less well understood.

HER2 receptors

Human Epidermal Receptor 2 (HER2) is the name of a protein which is ‘overexpressed’ on some breast cancer cells. This means that it is there is a much larger amount of this protein than normal. It is estimated that around 20% or 1 in 5 of all invasive breast cancers (i.e. breast cancer that has the potential to ‘metastasize’ or spread to other parts of the body) have this receptor. Breast cancers with this receptor present are known as ‘HER2 positive’ and, as a result, are able to respond to certain treatments known as targeted therapies, including trastuzumab (Herceptin), pertuzumab (Perjeta) and trastuzumab emtansine (Kadcyla).

Doctors are able to test for receptors by collecting a sample of cells using a procedure known as a biopsy. Please see our section on Diagnosis for further information on biopsies and other tests which may be used to diagnose and monitor secondary breast cancer in the body.

‘Triple negative breast cancer’ describes breast cancer cells which do not have any of these receptors (oestrogen, progesterone or HER2) present. This means that they will not respond to the sorts of treatments described above. However, they can be treated using chemotherapy. Recent advancements have also been made in the use of targeted and other newer therapies to treat triple negative secondary (metastatic) breast cancer.

Treatments for secondary breast cancer

As with all medications, those used in secondary breast cancer have what is called their ‘generic’ drug name as well as a brand name given to them by drugs companies. This can be very confusing, especially when you start or change to a new treatment. In this section, we will refer to all drugs using both names, putting their brand name in brackets.

Please bear in mind that we have not listed all of the possible side effects for all of the drugs detailed below. It is very important that you contact your hospital immediately if:

  • You experience severe side effects or side effects which are concerning you
  • Your side effects are getting worse
  • Your side effects are not getting any better

Your doctor (or, if you have one, your breast cancer nurse) will provide you with a contact number to ring for medical advice in these circumstances at any time, day or night.

Chemotherapy

There are lots of different varieties of chemotherapy. These are ‘anti-cancer’ drugs which destroy cancer cells. In general, they work by preventing cancer cells from growing and multiplying, though different chemotherapy drugs do this in different ways. They can also be toxic and damaging to normal body cells, which is why chemotherapy can cause side-effects. However, healthy cells are normally able to recover from this damage, whereas cancer cells are not.

In secondary breast cancer, chemotherapy can help to reduce the size of the cancer and to slow down its spread. It can also help to ease some of the symptoms caused by the cancer.

The choice of chemotherapy drug depends upon a number of things;

  • The characteristics of your cancer.
  • Whether you have been treated with chemotherapy previously. If so, which drug and how well it worked.
  • Your general health.
  • Your own personal priorities (e.g. whether you would prefer tablets, whether hair loss is a major concern for you).
  • Side-effects you have experienced in the past and how manageable they were for you.

What to expect

You may have had chemotherapy treatment in the past for primary breast cancer and know what to expect. However, for some women, this may be the first time they have had chemotherapy and it can be a daunting prospect.

Before starting your chemotherapy, your doctor or nurse will provide you with a contact number to use at any time, day or night, if you are feeling unwell during treatment. They will also explain any side effects that you might experience and how they can be managed. This can be a lot to take in at once so give yourself time to absorb the information and don’t be afraid to ask any questions or voice any concerns before starting treatment.

There are lots of different chemotherapy drugs. Depending on the drug, chemotherapy may either be given as tablets to swallow or as a ‘drip’ through a needle in your vein.

You will have a set amount of treatment followed by a break to allow your body to recover. This is known as a chemotherapy cycle.

The specific chemotherapy drug, combination of drugs, dose and the number of cycles you have is referred to as your chemotherapy regimen or regime.

Intravenous chemotherapy

There are lots of different chemotherapy drugs which are given via a needle into your vein. They are known as intravenous chemotherapy and examples include docetaxel (Taxotere), paclitaxel (Taxol) and eribulin (Halaven).

If you have your chemotherapy delivered intravenously (via a needle in the vein), you will come into hospital to receive your treatment. This may be in an outpatient department or a day-case unit. You can usually go home the same day, though be prepared to be there for a while. There may be delays, you may need tests before you can receive your treatment and it can take some time for nurses to receive, prepare and administer your treatment. It is a good idea to take some snacks and something to keep you occupied, such as books, newspapers or headphones to listen to music or podcasts. Some people also ask a friend or family member to come along with them to keep them company.

Most commonly, intravenous chemotherapy is given using a cannula. This is a small needle which is placed in a vein in your hand. The needle is removed and a little plastic tube sits in the vein (this can be easily taken out when you have had your treatment). The chemotherapy drugs are diluted and injected into the vein or administered via a drip (a bag of fluids into which the chemotherapy drug has been diluted). They pass into the vein through the little tube and around the body.

Oral chemotherapy

If you have chemotherapy as a tablet (e.g. Capecitabine), the drug is absorbed into your blood and carried around your body, just as with chemotherapy given as a ‘drip’. You will be able to take these tablets at home, rather than coming in to hospital to have your treatment. It is very important that you take these tablets as directed by your doctor and the pharmacist.

Breast Cancer Now and Macmillan have a range of further information on the different ways of delivering chemotherapy, both intravenously and via other routes.

Side effects of chemotherapy

Because chemotherapy drugs also affect the body’s normal cells, you may experience a range of side effects. These can differ depending on the drug you are treated with but common side-effects include;

  • Nausea and sickness
  • Hair loss
  • Sore mouth
  • Soreness of the skin on hands and feet
  • Pins & needles and pains in the hands and feet
  • Skin & nail changes
  • Forgetfulness and difficulty concentrating (‘chemo brain’)

Please see our Symptom monitoring section for a range of advice on how to self-manage side effects which may be experienced when undergoing chemotherapy and other secondary breast cancer treatments.

Hormone therapy

If your cancer is found to be ‘hormone receptor positive’ (i.e. the cancer cells have receptors on their surface which respond to the hormones oestrogen and progesterone), this means that it can be treated with hormone therapy.

Hormone therapies are a type of drug which block hormones from attaching to the surface of cancer cells. This prevents the hormones from stimulating the cancer cells to grow. It can therefore make more sense to consider them as ‘anti-hormone’ therapies.

In secondary breast cancer, they may be taken alone or alongside another type of treatment, such as targeted therapies.

Choice of hormone therapy will depend on whether you have been through the menopause and which (if any) hormonal therapies you have received in the past. This information allows your doctor to select the most suitable drug for you.

Types of hormone therapy

Hormone therapy works by either reducing the amount of oestrogen hormone which is in the body OR stopping oestrogen in the body from working.

Tamoxifen is a drug which works by blocking the hormone receptors on breast cancer cells, preventing oestrogen from attaching and stimulating the cancer cells to grow and divide. It is known as an ‘anti-oestrogen’ drug.

If you are taking Tamoxifen and have not been through the menopause, doctors may also give you treatment to stop your ovaries from producing hormones. This is known as ‘ovarian suppression’ and can be achieved through surgery (an operation to remove the ovaries, called an ‘oophorectomy’) or through another type of drug (stopping the ovaries from working). These drugs are known as ‘luteinising-hormone releasing hormone analogues’ (LHRH). One example is gosarelin (brand name Zoladex), which is given as a monthly injection.

Aromatase inhibitors are a group of drugs which work by stopping the body from producing oestrogen hormone. Examples include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).

Aromatase inhibitors are given to women who have been through the menopause. After the menopause, though oestrogen is not produced by the ovaries anymore, it is released from fatty tissues around the body. This happens when an enzyme (a protein which is involved in reactions in the body) turns other hormones into oestrogen. This enzyme is called aromatase, therefore the drugs which block it are known as aromatase inhibitors.

As Aromatase Inhibitors have the potential to cause thinning of the bones, your doctor may prescribe a bone protecting drug known as a bisphosphonate. Some of these drugs are given as a drip (via a small needle in your vein) every 3-4 weeks e.g. zoledronic acid (Zometa), whilst others are taken as a tablet e.g. ibandronate (Bondronat).

Fulvestrant (brand name Faslodex) is another type of hormone therapy known as an ‘oestrogen receptor down regulator‘ or oestrogen antagonist. This drug works by ‘down regulating’ the action of oestrogen on breast cancer cells. It does this by reducing the number of oestrogen receptors or by binding to the receptors and changing their shape, preventing them from working. It is given as two injections (one in each buttock), initially every 2 weeks. After 3 doses, the injections are given once a month.

What to expect

Most hormone therapy drugs are taken daily as tablets at home. Some are given as a monthly injection, e.g. Faslodex and Zoladex. You will usually come into clinic to have this, though it may be possible to arrange to have this treatment at your GP surgery.

Side effects of hormone therapy

Side-effects can differ depending on the drug you are taking. Below are some of the side effects which may be experienced when taking hormonal therapies. They can be very similar to those experienced when going through the menopause;

  • Hot flushes
  • Night sweats
  • Changes in mood
  • Changes in sex drive or ‘libido’
  • Vaginal dryness
  • Vaginal discharge and/or itching
  • Vaginal bleeding

Some other side effects which you may experience include;

  • Muscle/joint pains
  • Muscle/joint cramps
  • Feeling sick (nausea)
  • Thinning hair
  • Tiredness and fatigue
  • Pain around the injection site

Lots of women find that the side effects they experience begin to ease after a few months of treatment.

Explore our range of self-management advice for guidance on how to cope with these symptoms.

Macmillan and Cancer Research UK also have a range of further information on the different hormonal therapies which you may be prescribed in secondary breast cancer.

Targeted (biological) therapy

Targeted or ‘biological’ therapies are drugs which specifically target the processes and signals happening in and around cancer cells, stopping them from growing and dividing.

There are a number of different targeted therapies which work to treat cancer in different ways. In recent years, an increasing number of targeted therapies have become available for use in secondary breast cancer. 

Before starting treatment with any of the targeted therapies, your healthcare team will guide you on what you can expect, how to manage any side effects and when to seek medical advice. Before each treatment you will also usually have a blood sample taken to check that you are well enough and it is safe for you to be treated that day. As with any medication, there is a risk of allergic reaction when your body encounters a targeted therapy for the first time. You will be therefore be monitored closely during your first treatment.

Here, we provide a summary of the main targeted therapies which you may encounter as part of your treatment for secondary breast cancer.

Unfortunately, not all targeted therapies are suitable for all women with secondary breast cancer. Furthermore, not all targeted therapies are widely available on the NHS.

In some cases, the Cancer Drugs Fund is able to help patients access the drugs they need. Speak to your doctor (or, if you have one, your breast cancer nurse) about the treatment options relevant to you and whether it might be appropriate to apply for funding support.

The targeted (biological) therapies which may be prescribed in secondary breast cancer include:

We list all of the potential side effects for these drugs for reference but please remember that not everyone will experience these. If you have any concerns, please speak to your doctor.

Trastuzumab (Herceptin)

Trastuzumab (Herceptin) is a widely known targeted therapy, used to treat women whose breast cancer is HER2 positive (i.e. the breast cancer cells have HER2 receptors on their surface). It belongs to the ‘monoclonal antibody’ or MAB family of drugs. Herceptin works by blocking the HER2 receptor so that the cancer cell cannot receive signals to grow.

Side effects are usually mild and can include flu like symptoms, nausea and diarrhoea. As with all cancer treatment, there is the potential for more serious side effects. These may be due to infection (e.g. suddenly feeling unwell, temperature over 37.5°C, shivering, sore throat, cough, diarrhoea, needing to pass urine frequently) or an allergic reaction (e.g. breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face).

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you.

Your doctor or nurse will talk you through all of the potential side effects which you might experience before you begin your treatment and will advise you on when it is important to contact the hospital straight away. As Herceptin can have an effect on the heart, you will have tests to assess your heart health before beginning treatment and whilst on treatment.

Herceptin is given as either a drip, via a small needle in a vein, or injected under the skin. Either way, you will usually have your treatment in the day unit. Afterwards, you will be monitored for a short time to make sure that you are well enough to go home.

Herceptin is usually given once a week or every three weeks. Women with secondary breast continue to have this treatment for as long as it is working for them.

For further information on Herceptin, please see Cancer Research UK and Macmillan.

Trastuzumab Emtansine (Kadcyla)

This treatment is a combination of the targeted therapy trastuzumab (Herceptin) with the chemotherapy emtansine. The emtansine becomes active once the combined drug has targeted and entered the HER2 positive breast cancer cell. It is therefore specifically used to treat women with HER2 positive breast cancer.

There are some important side effects to be aware of, including symptoms of infection (e.g. fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), symptoms of allergic reaction (breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face) and unusual bruising or bleeding.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you.

Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment, as well as guiding you on how to manage less severe side effects such as;

  • Sickness
  • Constipation
  • Sore mouth
  • Dry mouth
  • Tiredness or fatigue  
  • Stomach pain
  • Skin changes
  • Muscle aches and pain

As with Herceptin, this treatment is given as a drip via a needle in a vein (this may be via a cannula or using another intravenous device such as a PICC line or a central line). The first treatment you have is usually given over longer period of time, around 90 minutes, to check for any reactions. If there are no problems, your next treatments will be given to you over a shorter period of time.

Kadcyla is given once every three weeks. This usually continues for as long as it is effective in treating your secondary breast cancer.

Cancer Research UK and Macmillan have a range of further information on trastuzumab emtansine.

Pertuzumab (Perjeta)

Pertuzumab (Perjeta) belongs to the same family of drugs as trastuzumab (Herceptin). In secondary breast cancer, these treatments are given alongside one another, together with a chemotherapy drug called Docetaxel. They are given as a drip, via a needle in a vein, delivered over 30-60 minutes in the day unit of your hospital.

This treatment is only effective for women whose secondary breast cancer is HER2 positive which hasn’t previously been treated with another targeted therapy (e.g. trastuzumab or Herceptin) or chemotherapy.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you.

Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment, as well as guiding you on how to manage less severe side effects such as;

  • Sickness
  • Constipation
  • Sore mouth
  • Dry mouth
  • Tiredness or fatigue  
  • Stomach pain
  • Skin changes
  • Muscle aches and pain

Other important side effects to be aware of include symptoms of infection (e.g. fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), symptoms of allergic reaction (breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face) and unusual bruising or bleeding.

You will usually have a set number of treatments of Docetaxel and continue to have Perjeta around once every 3 weeks for as long as it working for you, providing you are not suffering from any difficult to manage side effects.

Breast Cancer Now and Cancer Research UK have some further information on what you can expect with this treatment.

Denosumab (Xgeva)

This drug is another of the monoclonal antibody (MAB) family. Denosumab (of which there are several different brands, Xgeva and Prolia) works by targeting the cells which break down bone. These cells, called osteoclasts, break down older bone as part of normal, healthy bone growth. They are balanced out by another type of cell, osteoblasts, which helps to rebuild new bone. By stopping the osteoclasts from breaking down bone, denosumab helps to strengthen bone which has been weakened by secondary breast cancer.

Side effects can include muscle cramps or tingling (due to a low level of calcium in the blood), shortness of breath, diarrhoea and pain in the muscles or bones.

A more serious side effect can be damage to the jaw bone (osteonecrosis of the jaw), causing symptoms such as ongoing pain and swelling in the jaw, numb or heavy sensation in the jaw and loosening of the teeth.

Please contact your hospital straight away if you experience any of these symptoms, or if you are concerned about any other serious or ongoing side effects.

Densoumab is given as an injection, usually once every 4 weeks. You will have this treatment as an outpatient.

Cancer Research UK and Macmillan have a range of further information on what to expect when being treated with denosumab.

Evirolimus (Afinitor)

Evirolimus (brand name Afinitor) is a targeted therapy used to treat post-menopausal women (i.e. those who have been through the menopause) whose secondary breast cancer is HER2 receptor negative but oestrogen receptor positive and has returned following treatment with hormone therapies such as anastrozole or letrozole.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you when taking this treatment.

Severe side effects can include infection (with symptoms such as fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), allergic reaction (with symptoms such as breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face), shortness of breath, and unusual bruising and bleeding. Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment, as well as guiding you on how to manage other potential side effects such as;

  • Sickness
  • Diarrhoea
  • Constipation
  • Sore mouth
  • Changes in taste
  • Tiredness or fatigue  
  • Skin changes

Evirolimus is taken alongside the hormonal therapy, exemestane (Aromasin). It is prescribed to you as an outpatient and you take it as a tablet, once a day.

Women taking this treatment are recommended to avoid grapefruit or grapefruit juice, as this can prevent it from working.

Breast Cancer Now has a range of further information on evirolimus (Afinitor) and what to expect when taking this targeted therapy.

Laptinib (Tyverb)

Laptinib or Tyverb is another targeted therapy used to treat women whose secondary breast cancer is HER2 positive, though it isn’t routinely offered on the NHS. Your doctor (or, if you have one, your breast cancer nurse) will be able to advise you as to whether this could be a potential and appropriate option for you.

This treatment belongs to the ‘tyrosine kinase inhibitor’ family and works by switching off the HER2 receptor, causing the breast cancer cells to stop growing and die. It may be prescribed alongside another cancer treatment, such as the oral chemotherapy capecitabine, the targeted therapy trastuzumab (Herceptin) or a hormone therapy.

Women may be prescribed this treatment if they have HER2 positive secondary breast cancer and have already been treated with a chemotherapy (with or without trastuzumab).

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you when taking this treatment.

Severe side effects can include infection (with symptoms such as fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), allergic reaction (with symptoms such as breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face), shortness of breath, and unusual bruising and bleeding. Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment.

Common side effects can include;

  • Diarrhoea
  • Sickness
  • Sore mouth
  • Loss of appetite
  • Tiredness or fatigue
  • Skin changes
  • Redness or soreness of the hands and feet
  • Cough or shortness of breath
  • Pain in the muscles or joints
  • Unusual bruising or bleeding e.g. nosebleeds and bleeding gums.

Tyverb is taken as a tablet, once daily.

Cancer Research UK and Breast Cancer Now have a range further information on this treatment and what you can expect when taking it.

Abemaciclib (Verzenios)

Abemaciclib (brand name Verzenios) is one of the newer targeted therapies which belongs to the ‘CDK 4/6 inhibitors’ family of drugs. These work by blocking important processes which would normally allow breast cancer cells to grow and divide. It is prescribed in women whose secondary breast cancer is hormone receptor positive, HER2 receptor negative and is taken alongside a hormone therapy such as fulvestrant or an aromitase inhibitor (e.g. letrazole).

Severe side effects can include infection (with symptoms such as fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), allergic reaction (with symptoms such as breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face), shortness of breath, and unusual bruising and bleeding. Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you when taking this treatment.

Other side effects can include:

  • Diarrhoea
  • Sickness
  • Loss of appetite
  • Stomach pain
  • Changes in taste
  • Tiredness or fatigue
  • Low white cell count (which can lead to infection)
  • Bruising and bleeding
  • Hair loss or thinning
  • Rash
  • Dry skin
  • Watery eyes
  • Headache
  • Changes to the way the liver works (this will be checked for by having blood tests throughout treatment).

Abemociclib is taken as a tablet twice a day, once in the morning and once in the evening. It should be taken at around the same time everyday. You will have this treatment for as long as it continues to work for you.

Breast Cancer Now have a range of further information on what you can expect when being treated with abemociclib.

Palbociclib (Ibrance)

Palbociclib (brand name Ibrance) is another of the ‘CDK 4/6 inhibitors’ family of drugs, stopping breast cancer cells from growing and dividing by blocking important processes inside the cells. It is prescribed in women whose secondary breast cancer is hormone receptor positive and HER2 receptor negative. It is usually taken alongside a hormone therapy such as fulvestrant or letrozole.

Severe side effects can include infection (with symptoms such as fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), allergic reaction (with symptoms such as breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face), shortness of breath, and unusual bruising and bleeding. Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you when taking this treatment.

Other side effects can include:

  • Diarrhoea
  • Sickness
  • Loss of appetite
  • Sore mouth
  • Tiredness or fatigue
  • Skin changes
  • Bruising and bleeding
  • Hair loss or thinning
  • Dry or watery eyes
  • Changes to the way the liver works (this will be checked for by having blood tests throughout treatment).
  • Low white cell count (which can lead to infection)

Palbociclib is taken as a capsule once daily for 21 days, followed by a 7 day break. After this, women start taking Ibrance again for the next 21 days. Treatment carries on for as long as it continues to work.

Women taking Ibrance should avoid eating grapefruit or drinking grapefruit juice, as this interferes with the way this drug works.

Breast Cancer Now have a range of information on palbociclib, including details on its availability for patients across the UK. Macmillan also have lots of information on what to expect when taking this treatment.

Ribociclib (Kisqali)

Ribociclib (brand name Kisqali) is another of the newer targeted therapies which belongs to the ‘CDK 4/6 inhibitors’ family of drugs. These work by blocking important processes which would normally allow breast cancer cells to grow and divide. They are prescribed in women whose secondary breast cancer is hormone receptor positive and HER2 negative. It is usually taken alongside a hormone therapy such as fulvestrant or letrozole.

It is very important that you contact your hospital immediately if you are feeling unwell, have a temperature or are experiencing any side effects which are worrying you when taking this treatment.

Severe side effects can include infection (with symptoms such as fever, shivering, sore throat, cough, diarrhoea or needing to pass urine frequently), heart problems, allergic reaction (with symptoms such as breathlessness, itching, skin rash, feeling hot and flushed, swelling in the mouth or face), shortness of breath, and unusual bruising and bleeding. Your healthcare team will be able to advise you on which side effects will require more urgent review before you start your treatment.

Other side effects can include:

  • Diarrhoea
  • Constipation
  • Sickness
  • Loss of appetite
  • Tiredness or fatigue
  • Hair loss or hair thinning
  • Headaches
  • Stomach pain
  • Changes to the way the heart works (this can cause symptoms such as breathlessness, chest pain or tightness, palpitations or feeling as though your heart is beating quickly).

Ribociclib is taken as a tablet once daily for 21 days, followed by a 7 day break. After this, women start taking Kisqali again for the next 21 days. Treatment carries on for as long as it continues to work.

Women taking ribociclib should avoid having grapefruit or pomegranate (including juices) as these can interfere with the way this drug works.

Breast Cancer Now have a range of information on ribociclib, including details on its availability for patients across the UK. Macmillan also have lots of information on what to expect when taking this treatment.

Radiotherapy

In primary breast cancer, radiotherapy is usually used to destroy any cancer cells which may have been left behind in and around the breast, chest and lymph nodes following surgery to remove the cancer. In secondary breast cancer, radiotherapy is instead used to relieve symptoms such as pain when cancer has spread to the bones or brain. It works by shrinking the cancer in a particular area.    

If you have not had this treatment in the past, the prospect of having radiotherapy can be daunting or frightening. Your doctor or nurse will be able to talk you through what to expect before your first treatment and address any concerns which you might have.

Radiotherapy itself is not painful, though you may find the position you need to lie in during treatment uncomfortable. It may help to take a painkiller shortly before your treatment if this is bothering you.

You will usually attend the hospital every day for a week to receive radiotherapy treatment. This is called a radiotherapy session and you may have one or more sessions. You will be able to return home each day and there is no risk to you or those around you; the treatment does not cause you to be radioactive in any way.  

If you have had radiotherapy to treat your bones, it may take several weeks before you start to feel the positive effects and may need to continue with regular pain relief in the meantime. You may find that you feel particularly tired following your treatment.

If you have been treated in an area that is close to your stomach, you may feel nauseous or sick. Speak to your nurse or doctor if you are struggling with this as they will be able to prescribe you some anti-sickness medication.

If you are having radiotherapy to relieve symptoms of secondary breast cancer in the brain, treatment may be over a number of weeks. You may feel very tired during treatment and this can last for weeks afterwards. It is important to get plenty of rest whilst you are recovering and it may help to take some regular, gentle exercise.

In certain circumstances, some specialist centres are also able to offer special type of targeted radiotherapy known as stereotactic ablative radiotherapy, although this is not suitable for everyone. With this specialised treatment, very small tumours can be targeted by beams of radiation from different angles. This gives the cancer cells a high dose of radiation whilst protecting the healthy cells around them.

Macmillan have a range of further information on radiotherapy for secondary breast cancer.

Surgery

Though lots of women undergo surgery as part of their treatment for primary breast cancer, this is much less common in secondary breast cancer. At this stage, it is usually more difficult to try and remove the cancer since it may have spread to more than one area.

There are a few circumstances, however, where surgery may be used to help in the treatment of secondary breast cancer.

Where the cancer has spread to the bones, surgery may be used make a bone more stable if it has become weakened e.g. a leg or hip. Some women may undergo a hip replacement if the cancer has significantly weakened or caused damage to this bone or joint.

More rarely, surgery may be performed in women with secondary breast cancer of the liver or brain. This is usually only possible if there is a very small area or single tumour and must be carried out by a specialist liver or brain surgeon.

Macmillan have some further information on surgery in secondary breast cancer.

Other treatments

Asides from the main treatments used to treat your secondary breast cancer, you may also be prescribed some other treatments to help with side effects which you might experience as a result of treatment or the cancer itself.

Steroids

In secondary breast cancer, steroids are a type of medication which may be given in the short term to help relieve symptoms such as swelling (e.g. around the tumour in the liver or brain), pain and sickness. They may also be used to prevent an allergic reaction to certain treatments. As they are usually taken for a short amount of time, side effects are often mild and not too bothersome. They can include fatigue (tiredness), trouble with digestion, difficulty sleeping, increased appetite and weight gain.

Simple measures can help to overcome these side effects, e.g. taking your steroids in the morning and with food. Speak to your doctor or nurse if you are worried or struggling to manage these.

Some women may be prescribed a larger dose of steroid over a longer period of time following treatment with chemotherapy or radiotherapy. This may cause more significant side effects such as changes in mood, weight gain, swollen feet or legs and an increased risk of infection.

If you are worried about any side effects which you are experiencing, please speak to your doctor (or, if you have one, your breast cancer nurse).

Bisphosphonates

Bisphosphonates are a type of bone-strengthening drug. For women whose breast cancer has spread to their bones, they are used to ease bone pain and to strengthen and protect the bones from any further damage or fractures (breaking).

There are several different bisphosphonates which you may be prescribed, most of which are given as a drip via a needle in the vein every 3-4 weeks (e.g. zolendronic acid or ‘Zometa’, ibandronate or ‘Bondronat’).

Clondronate is a bisphosphonate (brand names ‘Loron’ and ‘Bonefos’) which is taken as a tablet once or twice a day.

These drugs are also used to treat high levels of calcium in the blood (hypercalcaemia), which can happen as a result of cancer spreading to and damaging bone. This causes symptoms such as thirstiness, tiredness and passing lots of urine. Some people may also be sick or feel tired or confused. It is very important for you to contact your hospital if you are having these symptoms as hypercalcaemia must be diagnosed quickly so that it can be treated.

Side effects of those drugs are usually mild and can include;

  • Headaches
  • Feeling sick (nausea)
  • Chills
  • Muscle aches

When taken as a tablet, bisphosphonates may also cause heartburn or indigestion, diarrhoea, and constipation.

More rarely, they can cause damage to the jaw bone. This is called osteonecrosis. If you are having pain or problems in your teeth or jaw, it is very important that you let your doctor know immediately. It is also important for your dentist to be aware if you are being treated with a bisphosphonate and for you to have a check up with them before starting this treatment.

Clinical trials

During your treatment, you may wish to find out if there are any clinical trials which you would be suitable to take part in. You may also be approached by your doctor or by a research nurse at your hospital to take part in a trial.

In secondary breast cancer, clinical trials are looking to find new and better treatments. They may also look at using current treatments in different ways.

This means that patients who take part in clinical trials may be able to access a treatment or a different way of receiving a treatment that may be beneficial to them and which they would not have otherwise been able to.

Speak to your doctor or nurse if you are interested in the possibility of taking part in a clinical trial. Macmillan provide a range of information which is helpful to consider when making this decision. Breast Cancer Now also provide information on clinical trials in secondary breast cancer, including details of where you can search for trials which might be relevant to you.

Further information

Macmillan, Cancer Research UK and Breast Cancer Now all have a wide range of information and guidance on the different targeted therapies used to treat secondary breast cancer.

Breast Cancer Now also discuss recent advances made in treatments for secondary breast cancer on their website.

If you have any questions or concerns about any of the treatments you have read about in this section, please don’t hesitate to speak to your healthcare team who will be able to provide you with advice which is relevant to you.  

If you are worried about the impact of the Coronavirus (COVID-19) outbreak on your cancer or treatment, please see Breast Cancer Now’s advice on Coronavirus for people living with cancer.

Page last updated: April 2020