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The National Comprehensive Cancer Network is "an alliance of leading cancer centers devoted to patient care, research, and education." Their published NCCN Guidelines for Patients is a great source to read on the latest recommended treatments for Stage IV disease. It is 68 pages long, but you can do not need to read the whole thing in one sitting and some sections will not apply to you, based on your breast cancer subtype. Here is a link to the latest NCCN GUIDELINES for STAGE IV.

We are grateful for input from breast cancer advocate Musa Mayer and www.advancedBC.org for the rest of this section on treatment options.

Types of Standard Treatments:

  1. Cytotoxic chemotherapy - Cytotoxic (cell killing) chemotherapy drugs are poisons that disrupt cancer cell functions, usually while a cell is dividing.
  2. 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+
  3. 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.
  4. Other common medications include intravenous bisphosphonates for bone metastases and biological response modifiers that offer growth-factor support for patients undergoing chemotherapy.
You will note there are 3 helpful links in the chart which offer additional useful information:
1. Each brand name drug has its own website, sponsored by the Pharmaceutical company which explains the prescribing information and also usually has information on financial assistance programs offered by the company, if you qualify. The website is always in this format: brandname.com e.g. www.kadcyla.com or www.perjeta.com or www.arimidex.com
2. Rx List.com provides the full prescribing information (or package insert) required by the FDA which includes: drug description, indications, dosage, side effects and drug interactions, warnings and precautions, overdosage and contraindications, clinical pharmacology, medication guide. For most drugs there are also patient reviews from a link to webmd.com.
3. Chemocare.com  is patient friendly and written less technically than Rx list. It also groups side effects by most common and less common.
Another useful site is the National Cancer Institute (NCI) Drugs Approved for Breast Cancer. Unique to this site is:
  • the drug pronunciation applet for the scientific name. (Impress your oncologist!)
  • history of FDA approval of the drug
  • available clinical trials still investigating different uses of the drug
You will notice that some drugs used for breast cancer such as carboplatin, cisplatin, or navelbine are not on the list. The reason is that they were never specifically approved for breast cancer, but can be prescribed by your oncologist as "off-label use," which is not an uncommon practice with cancer drugs.





* 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.




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