If you had breast cancer in the past and it was hormone-receptor positive,  it is likely the metastasis will be hormone-receptor positive as well. Your medical oncologist may recommend you get a biopsy, or sample, of one or more of the sites of metastasis to check for hormone receptors. This helps confirm the hormone receptor status did not change from the original tumor.

In 2014, the American Society of Clinical Oncology released standard guidelines for women with hormone receptor-positive stage IV breast cancer. These guidelines recommend hormonal therapy be offered as the first treatment, when possible, for metastatic disease. Your doctors will likely offer hormonal therapy as long as it works at shrinking or controlling the cancer and does not cause you discomfort. There are several types of hormonal therapy, and you may be switched from one to another over time if one medicine stops working against the cancer.

The hormonal therapy or therapies you use will be based on your menopausal status. Therapies available for hormone-sensitive metastatic breast cancer are:

Premenopausal and Perimenopausal

• Tamoxifen
• Oophorectomy
• Goserelin (Zoladex)
• Leuprolide (Lupron)
• Triptorelin (Trelstar)
• Fulvestrant (Faslodex)
• Megestrol Acetate (Megace)
• Anastrozole (Arimidex and generic), Exemestane (Aromasin and generic) or Letrozole (Femara and generic) in combination with ovarian suppression

Postmenopausal

• Anastrozole (Arimidex and generic)
• Exemestane (Aromasin and generic), alone or with everolimus (Afinitor)
• Letrozole (Femara and generic), alone or with palbociclib (Ibrance)
• Tamoxifen
• Toremifene (Fareston)
• Fulvestrant (Faslodex)
• Megestrol Acetate (Megace)