Types of metastatic breast cancer treatments
Metastatic breast cancer treatment includes a range of therapies used to control cancer growth, reduce symptoms, and help people live as long and as well as possible.
- Medical Review: Maryam Lustberg, MD, MPH
At LBBC, we know how overwhelming a metastatic breast cancer diagnosis can be. Coming to terms with being in some form of treatment for the rest of your life is an ongoing process. There’s no right way to feel, and feelings will change and evolve over time.
Metastatic breast cancer treatment has three main goals:
- Helping you live as long as possible while controlling the cancer
- Reducing symptoms caused by the cancer
- Keeping treatment side effects to a minimum
The cancer’s characteristics and location in your body, and whether you’ve had treatment for breast cancer before, can all affect your treatment plan. We know it’s complicated. We’re here for you with information and support as you make decisions with your healthcare team.
As you’re planning treatment, let your healthcare team know what’s most important in your life. Maybe it’s family connections, maintaining a fulfilling career, or going on mountain hikes. Maybe it’s playing with grandkids, making art, or all of the above. Talking with your team about what you want can help in creating a treatment plan that works for your life.
Below, we’ll talk about the different types of medicines and therapies used to treat metastatic breast cancer and when they might be prescribed.
Your treatment team
No matter which treatments you need, a number of experts will be involved in your care. Your healthcare team will work together and meet regularly to discuss your treatment.
Your treatment team may include:
- A radiologist, who looks at images of your body tissues for signs of cancer
- An interventional radiologist, who can perform image-guided biopsies and can also treat areas of metastasis
- A pathologist, who looks at biopsied tissue samples to figure out what kind of breast cancer it is
- A medical oncologist, who diagnoses the cancer and treats it with medicine
- A radiation oncologist, who can treat certain areas and types of breast cancer spread with radiation therapy
- A surgeon, who can perform surgery to treat metastasis-related fractures, spinal cord compression, or to remove areas of brain metastasis
- Nurses, patient navigators, social workers, and therapists, who are all available to help you with treatment, emotional, and practical needs
- Palliative care specialists, who can help you manage pain, symptoms, and significant stress
There are many other experts you may meet along the way. For example, most metastatic breast cancer does not require surgery, but if you need surgery, a surgical oncologist will perform it. If you have a strong family history of breast cancer, you might meet with a genetic counselor to consider genetic testing.
Understanding why your healthcare team may be recommending a particular treatment can help reduce feelings of uncertainty. Here are some questions to get you started:
- What are the benefits of the treatment?
- Why do you believe this treatment is the best option for me?
- What are the short and long-term side effects?
- How is the treatment given?
- Which medicines will I get at which times?
- Will this treatment’s side effects prevent me from enjoying daily activities?
- What side effects mean I should call you immediately?
- If this treatment doesn’t work or has too many side effects, what are my other options?
- Am I eligible for any clinical trials?
Learn more about your treatment team.
Diagnosis and treatment planning
A metastatic breast cancer diagnosis means living with breast cancer in the long term.
If you were treated for early-stage breast cancer in the past, treatments for metastatic breast cancer sometimes may not seem as aggressive as those you had in the past. This is because early-stage treatment is short-term, and the goal is to reduce the risk of a metastatic recurrence.
If the disease does recur, the goal of treatment for metastatic breast cancer is to manage the disease over the long term while helping you live with as few treatment side effects as possible. Two things that can help you get the most out of treatment: Confirming the diagnosis is accurate and creating a treatment plan that may change over time.
Confirming the subtype of breast cancer
Sometimes, metastatic breast cancer has different characteristics than the type found in a past diagnosis. For example, an early-stage breast cancer that was hormone receptor-positive may now be hormone receptor-negative.
Whether you’ve had breast cancer before or this is your first diagnosis, talk with your medical oncologist about having a biopsy of one or more of the cancer sites to remove a small piece of tissue for examination.
After the tissue is taken to the lab, testing can confirm whether the cancer is:
- Hormone receptor-positive: the hormones estrogen and/or progesterone help the cancer to grow
- HER2-positive, HER2-low, or HER2-ultralow: there are too many copies of the HER2 gene that send growth signals to the cancer
- Triple-negative: the cancer cells test negative for estrogen, progesterone, and HER2 receptors
Hormone and HER2 receptors are proteins on breast cancer cells that play a role in the cancer’s growth. Protein receptors and other substances on cancer cells are known as biomarkers. Biomarker and other testing can help you and your care team choose effective treatments for you unique diagnosis.
Even if the cancer is the same subtype as a past diagnosis, you may need different treatments than you did before. Cancer cells sometimes stop responding to past treatments. Or, a past treatment may be too toxic to have more than once. Still, there are many effective treatment options for metastatic breast cancer.
Testing for additional biomarkers
Hormone and HER2 receptors are two of several different kinds of breast cancer biomarkers. Other examples include cancer characteristics such as gene mutations, including AKT1, ESR1, and PIK3CA, and proteins such as PD-L1.
Testing the blood or biopsy tissue for these and other biomarkers can help match the cancer to a specific treatment that targets the biomarker.
- Tests that use next-generation sequencing technology can check tissue or blood for hundreds of mutations at a time.
- ctDNA tests, called liquid biopsy, use next-generation sequencing or other technologies to find mutations in the blood.
It’s important to ask your care team about biomarker testing at the time of a metastatic breast cancer diagnosis and any time you are considering a new treatment.
Creating a flexible treatment plan
Treatment for metastatic breast cancer changes over time as the cancer adapts and builds resistance to medicines. Usually, a treatment is used until the cancer grows or spreads, or the side effects become too much to manage.
Then, you and your care team will decide on a new treatment. It’s hard to predict how long a specific treatment will work against a certain breast cancer. For some people, a single treatment type will manage the cancer for many years, while others may need to change treatments more often.
Treatment plans are highly individual depending on your specific diagnosis and medical history. There are many options, and if side effects are difficult, it is possible to switch treatments. In some cases, it is also possible to adjust the dose to reduce side effects.
Below, you can learn about the FDA-approved treatments for metastatic breast cancer.
Hormonal therapy
Hormonal therapy is one approach used in metastatic breast cancer treatment when the cancer grows in response to hormones such as estrogen or progesterone.
Hormonal therapy interferes with hormones’ ability to help hormone receptor-positive breast cancer grow. Hormonal therapy is sometimes called endocrine therapy. This treatment may be given at the same time as other breast cancer treatments, such as chemotherapy and targeted therapy.
Side effects can include menopausal symptoms such as hot flashes, vaginal dryness or discharge, joint pain, weight changes, bone loss, and changes in sexual desire.
It’s important to know that hormonal therapy is not the same as hormone replacement therapy. Hormonal therapy lowers or blocks hormones that help hormone receptor-positive breast cancer to grow. Hormone replacement therapy involves taking hormones after menopause to replace hormones no longer made by the ovaries. Learn more on the Menopausal symptoms page.
Here are the hormonal therapies approved to treat hormone receptor-positive metastatic breast cancer:
Aromatase inhibitors
Aromatase inhibitors stop an enzyme called aromatase from changing other hormones into estrogen, reducing the amount of estrogen in the body.
Aromatase inhibitors are available in pill form, and include:
In pre- and perimenopausal women and men, aromatase inhibitors are typically given with medicines called gonadotropin-releasing hormone (GnRH) agonists to lower hormone levels even more. These medicines are given by injection.
In women, GnRH agonists shut down the ovaries (ovarian suppression). This causes temporary menopause for as long as the GnRH agonist is taken. You can learn more about GnRH agonists below.
Selective estrogen receptor modulators (SERMs)
SERMs block estrogen receptors on breast cancer cells. This prevents estrogen from being able to attach to the receptors, slowing the cancer’s growth.
Tamoxifen is a SERM commonly used to treat breast cancer. It is available in pill or liquid form.
Injectable medicines called gonadotropin-releasing hormone (GnRH) agonists are often added to tamoxifen in pre- and perimenopausal women and men to lower hormone levels in the body.
Toremifene (Fareston), given as a pill, is an older SERM that is not used as often as tamoxifen. GnRH agonists may be recommended for premenopausal women taking toremifene.
Selective estrogen receptor degraders (SERDs)
SERDs break down estrogen receptors on breast cancer cells, interfering with estrogen’s ability to help the cancer grow.
Two SERDs, elacestrant (Orserdu) and imlunestrant (Inluriyo), are approved to treat hormone receptor-positive metastatic breast cancer that tests positive for an ESR1 gene mutation. These medicines are available in pill form.
An older SERD, fulvestrant (Faslodex), is given by injection.
In pre- and perimenopausal women and men, these medicines can also be given with injectable gonadotropin-releasing hormone (GnRH) agonists to lower hormone levels and slow cancer growth. Below, you can learn more about GnRH agonists.
Gonadotropin-releasing hormone (GnRH) agonists
Gonadotropin-releasing hormone agonists (GnRH), also called luteinizing hormone-releasing hormone agonists (LHRH), given as injections, temporarily shut down the ovaries in pre- and perimenopausal women. This temporarily stops the ovaries from producing estrogen. This is called ovarian suppression.
Men can also take GnRH agonists with other hormonal therapies.
These medicines work differently in women and men to lower hormone levels in the body:
- In women, GnRH agonists stop the ovaries from producing estrogen, causing temporary menopause as long as the drugs are taken.
- In men, GnRH agonists lower testosterone. Some testosterone naturally converts into estrogen in men. GnRH agonists reduce the amount of testosterone available to convert into estrogen.
GnRH agonists include:
- Goserelin (Zoladex)
- Leuprolide (Lupron)
- Triptorelin (Trelstar)
GnRH agonists are often given with tamoxifen, aromatase inhibitors, certain SERDs, and some targeted therapies. For example, a premenopausal woman with hormone receptor-positive metastatic breast cancer may be given a combination of the targeted therapy abemaciclib (Verzenio), an aromatase inhibitor such as anastrozole, and a GnRH agonist such as leuprolide.
You and your care team will decide on the right treatment combination for you.
Targeted therapy
Targeted therapy is a type of cancer treatment that targets specific cell characteristics or processes in the body that help breast cancer to grow. These can include proteins, gene mutations, and enzymes. Due to a more focused approach, these therapies are generally more effective than some older treatments.
Different targeted therapies can cause different side effects. These can include nausea, diarrhea, anemia, low blood cell counts, and fatigue. You can learn more about these side effects and ways to manage them on the Targeted therapy page.
Below, we’ll talk about the targeted therapies approved to treat the different subtypes of metastatic breast cancer.
For hormone receptor-positive, HER2-negative metastatic breast cancer
There are several targeted therapies FDA approved for metastatic breast cancers that are hormone receptor-positive and HER2-negative:
AKT inhibitors target the AKT protein, which helps regulate cell growth. AKT inhibitors stop the AKT protein from working. This interferes with the cancer cells’ ability to grow and divide.
Capivasertib (Truqap) is an AKT inhibitor approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer that tests positive for AKT1, PIK3CA, or PTEN gene mutations. It is taken orally as a pill. It must be taken with the hormonal therapy fulvestrant.
CDK 4/6 inhibitors block enzymes from sending growth signals to metastatic breast cancer cells. If you’ve been diagnosed with hormone receptor-positive, HER2-negative metastatic breast cancer, CDK 4/6 inhibitors may be the first treatment recommended for you.
CDK 4/6 inhibitors are taken orally in pill form along with a hormonal therapy such as an aromatase inhibitor or fulvestrant. In certain situations, CDK 4/6 inhibitors may be taken alone. Approved CDK 4/6 inhibitors for metastatic breast cancer include:
Antibody-drug conjugates (ADCs) pair a chemotherapy with an antibody. The antibody delivers the chemotherapy directly to the cancer cells. ADCs are given by vein through an intravenous (IV) line.
ADCs approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer are:
Trastuzumab deruxtecan (Enhertu) is an ADC option for hormone receptor-positive metastatic breast cancer that tests positive for low levels of HER2 (HER2-low or HER2-ultralow).
mTOR (mammalian target of rapamycin) inhibitors stop cancer cells from dividing and may block the growth of blood vessels that tumors need to grow.
- Everolimus (Afinitor) is the only mTOR inhibitor approved to treat metastatic breast cancer. It is given as a pill along with the hormonal therapy exemestane.
PI3K (phosphatidylinositol 3-kinase) inhibitors block PI3K enzymes from supporting the growth of metastatic breast cancer with a PIK3CA gene mutation.
There are two FDA-approved PI3K inhibitors approved to treat hormone receptor-positive, HER2-negative metastatic breast cancer:
- Alpelisib (Piqray) is a pill taken with the hormonal therapy fulvestrant.
- Inavolisib (Itovebi) is a pill taken with the targeted therapy palbociclib and the hormonal therapy fulvestrant.
Visit Targeted therapy for hormone receptor-positive breast cancer to learn more about all of the above treatments.
or HER2-positive, HER2-low, or HER2-ultralow breast cancer
For metastatic breast cancers that are HER2-positive, HER2-low, or HER2-ultralow, there are many FDA-approved targeted therapies available.
Monoclonal antibodies work by attaching to HER2 proteins and blocking signals that help cancer cells grow. In metastatic breast cancer treatment, these include:
- Trastuzumab (Herceptin) is an intravenous (IV) treatment that can be given alone or with chemotherapy and the targeted therapy pertuzumab (Perjeta).
- Trastuzumab biosimilars are similar, but not identical to, trastuzumab. These medicines, like generic drugs, have been proven to be just as effective as the brand name drug Herceptin, and they may be more affordable.
- Pertuzumab (Perjeta) is an IV treatment used with trastuzumab and the chemotherapy docetaxel.
- Pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo) is a different way to receive two drugs mentioned above: as a combination of pertuzumab, trastuzumab, and a protein that allows it to be given as an injection. The injection is given at the same time as chemotherapy.
- Margetuximab (Margenza) is an IV medicine given with chemotherapy.
Tyrosine kinase inhibitors interfere with HER2’s ability to help cancer to grow. There are three tyrosine kinase inhibitors approved to treat HER2-positive metastatic breast cancer:
- Lapatinib (Tykerb) is a pill given with the chemotherapy pill capecitabine (Xeloda) In people with hormone receptor-positive, HER2-positive breast cancer, lapatinib is given with the hormonal therapy letrozole.
- Neratinib (Nerlynx) is a pill given with the chemotherapy pill capecitabine.
- Tucatinib (Tukysa) is a pill given with trastuzumab and the chemotherapy pill capecitabine.
Antibody-drug conjugates (ADCs) deliver chemotherapy directly to cancer cells. There are two antibody-drug conjugates approved to treat metastatic breast cancer that tests positive for HER2 receptors:
- Ado-trastuzumab emtansine (Kadcyla) is an IV treatment given by vein.
- Trastuzumab deruxtecan (Enhertu) is an IV treatment FDA approved to treat several subtypes of metastatic breast cancer. For HER2-positive metastatic breast cancer, trastuzumab deruxtecan is approved to be taken with pertuzumab as a first treatment. Trastuzumab deruxtecan is also approved to treat HER2-low metastatic breast cancer and hormone receptor-positive, HER2-low or HER2-ultralow metastatic breast cancer.
Learn more about targeted therapies for HER2-positive breast cancer.
For triple-negative metastatic breast cancer
There are three antibody-drug conjugate medicines available to treat triple-negative metastatic breast cancer. These medicines deliver chemotherapy directly to cancer cells. All are given by vein through an intravenous line:
- Sacituzumab govitecan (Trodelvy) can be given with the immunotherapy pembrolizumab (Keytruda) as a first treatment if the cancer tests positive for a protein called PD-L1.
- Trastuzumab deruxtecan (Enhertu) may be an option for metastatic breast cancers that have very low levels of HER2 (HER2-low or HER2-ultralow). Breast cancer that was originally diagnosed as triple-negative is sometimes found to have low levels of HER2 after repeat testing. In this case, a person may be eligible to take trastuzumab deruxtecan. If you were diagnosed with triple-negative metastatic breast cancer, ask your care team about follow-up testing to confirm HER2 status.
- Datopotamab deruxtecan (Datroway) may soon be FDA approved to treat triple-negative metastatic breast cancer. The National Comprehensive Cancer Network clinical breast cancer guidelines list datopotamab deruxtecan as another recommended first treatment option for triple-negative metastatic breast cancer that tests negative for the PD-L1 protein.
For people who test positive for a BRCA mutation
There are two targeted therapies called PARP inhibitors approved to treat hormone receptor-positive, HER2-negative or triple-negative metastatic breast cancer in people who also test positive for an inherited BRCA mutation.
PARP inhibitors stop an enzyme in the body known as poly (ADP-ribose) polymerase, or PARP, from repairing cancer cell DNA. Cancer cells in people with BRCA mutations already have a hard time repairing their own DNA. PARP inhibitors make it even harder, and can cause the cancer cells to die. The two approved PARP inhibitors, given in pill form, are:
Immunotherapy
Immunotherapy helps the body’s own immune system to destroy cancer cells.
There is one immunotherapy, approved to treat metastatic breast cancer that is triple-negative: Pembrolizumab (Keytruda).
Pembrolizumab is an IV immunotherapy approved to treat triple-negative breast cancer that tests positive for a protein called PD-L1. This medicine blocks PD-L1 from interfering with the immune system’s ability to kill cancer cells.
Pembrolizumab is given with chemotherapy or with medicines called antibody-drug conjugates. Antibody-drug conjugates are targeted therapies that deliver chemotherapy directly to cancer cells.
Learn more about pembrolizumab.
Chemotherapy
Chemotherapy kills rapidly dividing cells in order to slow or stop the growth of cancer. Chemo is often given intravenously (by injection into a vein). Some chemotherapies are available in pill form.
Whether you get chemotherapy depends on many factors, such as:
- The specific type of cancer cells
- Your age
- The presence or absence of estrogen and progesterone receptors
- The amount of HER2 protein on the surface of the cancer cells
- Which treatments you had in the past
- Where the cancer is in your body, and how much there is
If you’re receiving chemotherapy intravenously (IV chemotherapy), you will be treated at regularly scheduled appointments at your cancer center. There are different ways you can receive IV chemotherapy:
- Through a vein in your arm
- Through an access port, sometimes called a port-a-cath, placed under the skin in the upper part of the chest, connecting to a major vein; ports are for treatment that is given for a long time (months to years)
- Through a PICC (peripherally inserted central catheter) line: a long, flexible tube inserted into an arm vein that gives access to larger veins; PICC lines are for treatments that are given for a shorter time (weeks to months)
A port or PICC line allows a person to avoid repeated needlesticks in the arm, and can reduce the risk of IV medicines irritating the blood vessels.
There are many possible side effects of chemotherapy, and there’s no way to know who will experience each one. Some common side effects include:
Your healthcare team can recommend effective ways to manage some side effects with lifestyle changes or medicine. Visit the chemotherapy section to learn more.
Radiation therapy
Radiation therapy focuses the power of high-energy x-rays on specific areas of cancer. It’s a local treatment, which means it impacts only cells at or near the location receiving treatment. Radiation is thought to cause breaks in strands of DNA, which can keep the cancer cells from dividing and growing.
Most often, radiation for metastatic breast cancer is used to:
- Shrink tumors
- Manage pain from tumors in the bone
- Treat or prevent symptoms caused by breast cancer in the brain or lungs
- Lessen pain and prevent injury to nerves by treating tumors of the spine that are pushing on the spinal cord
The side effects of radiation therapy are very specific to the part of the body being treated. If you receive radiation to the liver, for example, nausea or vomiting may be side effects. If the breast cancer has spread to the brain, radiation therapy can cause changes in thinking and memory. If your healthcare team recommends radiation therapy, you and your radiation oncologist will talk before and during treatment about possible side effects and how to manage them. Visit the radiation therapy page for more information.
Surgery
Surgery is rarely done for metastatic breast cancer, but there are a few reasons your doctor may recommend it:
- If you have pain or bleeding, removing the original tumor can help ease symptoms.
- If there are tumors in places outside the breast that are causing you pain or other symptoms, removing them can help reduce symptoms.
- If you have metastatic breast cancer that has spread to the bones, orthopedic surgery can be done to reduce the risk of bone breaks and to ease pain. Specific situations can include:
- Surgery to insert metal rods within bone to provide stability
- Kyphoplasty, a surgery in which cement is inserted into a bone to ease pain
- If breast cancer has spread to the brain, a surgery called craniotomy is sometimes performed to remove a tumor. Craniotomy is performed by a neurosurgeon and involves removing a small piece of skull to get to the tumor and remove it. Other team members may include a neurologist or neuro-oncologist.
If there is cancer in your bones, lung, liver, or brain, and the cancer is not growing, or is in only one place, talk with your doctor about whether cancer-removing surgery may be an option.
If you’re premenopausal and the cancer is hormone receptor-positive, you may have the option of having your ovaries removed in a surgery called oophorectomy. Having the ovaries removed takes away most of the estrogen in the body, and can greatly reduce the risk of hormone receptor-positive cancer growth in premenopausal women. But it’s important to know that in these women, oophorectomy causes sudden menopause. Side effects include hot flashes, an increased risk for heart disease, bone loss or fractures, and decreased sexual desire.
Talk with your doctor about your individual situation and whether surgery is an option to consider.
Complementary & integrative medicine
Complementary therapies are physical, mental, and spiritual practices used in addition to standard cancer treatment. While complementary therapies do not treat cancer directly, research shows they can ease some side effects, such as nausea, fatigue, anxiety, and depression.
Standard medical care combined with complementary therapies is called integrative medicine. Integrative medicine works to control the cancer with standard-of-care treatment while using complementary therapies to support mental and spiritual well-being.
Complementary therapies include:
Reach & Raise
Kathy DiGiorgio leads an inspirational all-levels yoga class at LBBC’s 2018 Conference on Metastatic Breast Cancer. Whether you are just starting or ending your day, unravel your yoga mat and follow along to refresh and energize your body.
Clinical trials and new drug options
Breast cancer researchers are always working to develop new and better treatment options. Any time you’re considering a treatment is a good time to ask your doctor about opportunities to participate in a clinical trial.
Clinical trials are one way to access promising metastatic breast cancer treatments before they gain FDA approval. You can join a clinical trial at any point during your treatment — not just when other treatment options stop working.
Clinical trials play a key role in discovering new medicines. Some newer treatment types under study are:
- Genomically driven treatments are medicines that can target specific features of the cancer, such as gene mutations. If you are interested in trying a new genomically driven treatment through a clinical trial, it’s important to talk with your doctor about biomarker testing. Biomarker tests that include next-generation sequencing and other technologies can confirm whether you may be eligible for a trial.
- Antibody drug conjugates (ADCs) deliver chemotherapy directly into tumor cells. Several ADCs are approved now, and many more are under investigation.
- Immune-based therapies — including CAR T-cell therapy, cell-based therapies, and vaccines — are in development now.
It’s important to know that by the time clinical trials enroll human participants, researchers have spent many hours learning how safe and effective the medicine is.
Visit our clinical trials section to learn how participating in a trial can help, what the risks are, and more. We also have specific information on clinical trials for metastatic breast cancer and a Metastatic Trial Search tool.
Treatment breaks
Metastatic breast cancer means being in treatment for life. But treatment doesn’t have to be life. When you need it, it may be possible for you to take a break from treatment to allow for those significant, positive life experiences we all crave.
You and your doctor can schedule treatment breaks for special events, like vacations or weddings, if it will be hard to get treatment while you’re away or the side effects may prevent you from enjoying the event.
It’s also possible to take treatment breaks just to give your body a rest from treatment and side effects. If you think you may need or want a treatment break, talk with your healthcare team as soon as you can.
Stopping treatment
The goal of treating metastatic breast cancer is to manage the disease for as long as possible. It can be extremely challenging to have conversations with loved ones about stopping treatment. But it can also be a relief to just talk honestly about what you want and need.
Choosing to stop treatment is not giving up, and does not mean the end of all medical care. When you stop treating the cancer, your care team can still continue caring for you, through palliative care or hospice care, to ease symptoms and provide support.
Watch Talking about end of life with oncology psychotherapist Kelly Grosklags, LISCSW, BCD, to learn more about letting your loved ones and your healthcare team know what’s most important to you.
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Reviewed and updated: March 1, 2026
Reviewed by: Maryam Lustberg, MD, MPH
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Living Beyond Breast Cancer is a national nonprofit organization that seeks to create a world that understands there is more than one way to have breast cancer. To fulfill its mission of providing trusted information and a community of support to those impacted by the disease, Living Beyond Breast Cancer offers on-demand emotional, practical, and evidence-based content. For over 30 years, the organization has remained committed to creating a culture of acceptance — where sharing the diversity of the lived experience of breast cancer fosters self-advocacy and hope. For more information, learn more about our programs and services.