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Standard Treatments for MBC
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We are grateful to input from breast cancer advocate Musa Mayer and www.advancedBC.org for this section on treatment options.
Types of Standard Treatments:
- Cytotoxic chemotherapy - Cytotoxic (cell killing) chemotherapy drugs are poisons that disrupt cancer cell functions, usually while a cell is dividing.
- Hormonal treatments target breast cancers that grow in the presence of estrogen (and sometimes progesterone), and are used only for tumors that are ER+ and/or PR+
- Targeted therapies or biologics target specific genes that make proteins that stimulate cell growth (oncogenes) and may only work if the tumor overexpresses certain proteins.
- Other common medications include intravenous bisphosphonates for bone metastases and biological response modifiers that offer growth-factor support for patients undergoing chemotherapy.
CHART OF DRUGS USED IN TREATMENT OF MBC
©Musa Mayer, 2011
| Brand Name | Generic Name | Drug Type and Administration |
| Abraxane™ |
paclitaxel albumin-bound |
Cytotoxic chemotherapy: Plant alkyloid, microtubule agent, Taxol™ dissolved in albumin, less toxic IV infusion, lessens allergic response |
|
Adriamycin™ |
doxorubicin | Cytotoxic chemotherapy: Antibiotic anthracycline - IV injection or infusion |
| Adrucil™ | 5-fluorouracil [5-FU] | Cytotoxic chemotherapy: Alkylating agent, antimetabolite - IV injection or infusion |
| Aranesp™ | darbepoeitin alfa | Biologic response modifier: Erythropoieses stimulating agent (treats anemia caused by chemotherapy) SubQ injection or IV infusion, 3 weekly |
| Aredia™ | pamidronate | Bisphosphonate: decreases hypercalcemia, fractures, pain in patients with bone mets. Standard of care for bone metastases - IV infusion, monthly or less frequently |
| Arimidex™ | anastrozole | Hormone therapy: anti-estrogen aromatase inhibitor - Oral, daily |
| Aromasin™ | exemestane | Hormone therapy: anti-estrogen aromatase inhibitor - Oral, daily |
| Avastin™ | bevacizumab | Monoclonal antibody: targets VEG-F Anti-angiogenesis, targets tumor blood supply - IV infusion, 3 weekly |
| Camptosar™ | irinotecan | Cytotoxic chemotherapy: plant alkaloid, topoisomerase I inhibitor - IV infection (investigational) |
| Cytoxan™ | cyclophosphamide | Cytotoxic chemotherapy: Alkylating agent IV infusion or injection or oral. Off patent. |
| Doxil™ | doxorubicin liposomal | Cytotoxic chemotherapy: Anthracycline bound to liposomes, alternative to Adriamycin™, epirubicin - IV infusion |
| Ellence™ | epirubicin | Cytotoxic chemotherapy: Anthracycline, similar to Adriamycin™, Doxil™ - IV infusion |
| Evista™ | raloxifene | Hormonal treatment: Selective estrogen receptor modulator (SERM) - Oral daily (not used yet in mbc) |
| Faslodex™ | fulvestrant | Hormonal therapy: SERD (selective estrogen receptor down-regulator) - Monthly injection |
| Femara™ | letrozole | Hormonal therapy: Aromatase inhibitor - Oral daily |
| Gemzar™ | gemcitabine | Cytotoxic chemotherapy: Antimetabolite - IV infusion, 3 weekly |
| Halaven™ | eribulin mesylate | Cytotoxic chemotherapy: Non-taxane microtubule inhibitor, IV injection |
| Halotestin™ | fluoxymesterone | Hormone therapy: Androgen, male hormone - Oral (older threatment, rarely used now) |
| Herceptin™ | trastuzumab | Monoclonal antibody: inhibitor of HER2. Targeted for HER2+ breast cancer only - IV infusion, 1 or 3 weekly |
| Ixempra™ | ixabepilone | Cytotoxic chemotherapy: Microtubule inhibiotr - IV infusion, 3 weekly |
| Lupron™ | leuprolide | Hormonal therapy: LHRH agonist, stops ovarian function. SubQ injection (similar to Zoladex™) Off patent |
| Megace™ | megestrol acetate |
Hormone therapy: Progesterone - Oral, daily (older treatment, rarely used). Off patent |
| methotrexate | methotrexate | Cytotoxic chemotherapy: Antimetabolite - IV infusion, injection, intrathecal |
| Mutamycin™ | mitomycin-C | Cytotoxic chemotherapy: Anti-tumor antibiotic - IV injection or infusion (investigational) |
| Navelbine™ | vinorelbine tartrate | Cytotoxic chemotherapy: Vinca alkaloid - IV injection |
| Neulasta™ | pegfilgrastim | Biologic response modifier: Boosts white blood cell production to avoid febrile neutropenia (Like Neupogen™ longer-lasting) - SubQ or IV injection, as needed |
| Neupogen™ | filgrastim | Biologic response modifier: Stimulates white-blood cell production, helps chemotherapy patients avoid infection - SubQ or IV injection, as needed |
| Nolvadex™ | tamoxifen | Hormone therapy: anti-estrogen selective estrogen receptor modulator (SERM) - Oral, daily |
| Novantrone™ | mitoxantrone | Cytotoxic chemotherapy: Anti-tumor antibiotic - IV injection |
| Paraplatin™ | carboplatin | Cytotoxic chemotherapy: Alkylating agent, Platinum chemotherapy - IV infusion |
| Platinol™ | cisplatin | Cytotoxic chemotherapy: Alkylating agent, Platinum chemotherapy - IV infusion (less common than carboplatin) |
| Procrit™ | epoetin alfa | Colony stimulating factor: Treatment for anemia caused by chemotherapy. Injection, daily as needed |
| Taxol™ | paclitaxel | Cytotoxic chemotherapy: Plant alkyloid, microtubule agent, taxane - IV infusion |
| Taxotere™ | docetaxel | Cytotoxic chemotherapy: Taxane - IV infusion |
| Temodar™ | temozolomide | Cytotoxic chemotherapy: alkylating agent - Oral (only used for brain metastases) |
| Toremifine™ | fareston | Hormonal treatment: Selective estrogen receptor modlator (SERM) - Oral, daily (similar to tamoxifen, rarely used) |
| Tykerb™ | lapatinib | Tyrosine kinase inhibitor of HER2 and EGFR: for HER2+ breast cancer only - Oral daily |
| Xeloda™ | capecitabine | Cytotoxic chemotherapy: Oral antimetabolite (a form of 5-fluorouracil) - Oral daily, intermittent schedule |
| Xgeva™ | denosumab | RankL (ligand) inhibitor: decreases hypercalcemia, fractures and pain in patients with bone metastases. Denosumab or IV bisphosphonate are standard of care for bone metastases |
| Zoladex™ | goserelin | Hormone therapy: LHRH afonist, stops ovarian function - SubQ injection, monthly (similar to Lupron) |
| Zometa™ | zolendronic acid | Bisphosphanate: decreases hypercalcemia, fractures, pain in patients with bone mets. Standard of care for bone metastases - IV, monthly or less frequently |
| ©Musa Mayer, 2011 See http://www.AdvancedBC.org for treatment links and resources |
PLEASE NOTE on CHART of DRUGS USED IN TREATMENT OF MBC:
* It does not include supportive medications to treat symptoms of the cancer or side effects of treatment.
* Some drugs are approved for use in other cancers and other diseases.
* Doctors may use drugs to treat metastatic breast cancer even though they are not FDA approved for this particular use. If there is high-quality research supporting the treatment, insurance and Medicare will usually reimburse. This is known as "off-label" use. Many treatments for MBC are used off-label.
*New research is constantly being presented at conferences or published in peer-reviewed oncology journals looking at whether these and other drugs, used singly or in combination, will benefit mbc patients.
