Hormone Receptor-Positive Metastatic Breast Cancer: Treatment Options

Targeted medicines are drugs that home in on specific proteins on breast cancer cells that help them grow.

 They are often used in combination with hormone therapy. Your targeted treatment options might depend on your tumor’s features, including the cancer’s specific gene mutations.

CDK4/6 Inhibitors

These medicines are given in combination with tamoxifen or the aromatase inhibitors described above. They work by blocking the CDK 4/6 protein on breast cancer cells. This helps stop breast cancer cells from growing and dividing. CDK4/6 inhibitors are approved to treat HR-positive/HER2-negative breast cancers. They are taken as pills, usually once or twice a day. The most commonly used CDK4/6 inhibitors are palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). Common side effects of these medicines include fatigue and low blood cell counts. Nausea, vomiting, hair loss, diarrhea, mouth sores, and headache are less common.

Everolimus (Afinitor)

Everolimus works by blocking a protein called mTOR, which normally helps cells grow and divide, and may help hormone therapy medicines work better. Everolimus is used in patients with metastatic HR-positive/HER2-negative breast cancer who have already gone through menopause. It’s taken as a pill, usually once a day. Common side effects may include rash, mouth sores, diarrhea, nausea, weakness, tiredness, low blood cell counts, shortness of breath, and cough. It can also increase cholesterol levels, blood sugar levels, and your risk for infection.

Alpelisib (Piqray)

Alpelisib works by blocking a protein in cancer cells called PI3K, which can help stop the cancer cells from growing. Alpelisib can be used along with hormone therapy for metastatic HR-positive/HER2-negative breast cancer in patients who have a PIK3CA gene mutation. It’s taken by mouth, usually once daily. Side effects may include a skin rash; high blood sugar levels; diarrhea; low blood counts; nausea; vomiting; loss of appetite; fatigue; mouth sores; weight loss; low calcium levels; blood clotting issues; hair loss; and signs of kidney, liver, or pancreatic problems.

Capivasertib (Truqap)

Capivasertib blocks a form of the AKT protein, which helps cancer cells grow. It can be used in patients with HR-positive/HER2- negative metastatic breast cancer with mutations in the PIK3CA, AKT1, or PTEN genes. Capivasertib is taken by mouth, usually twice daily for four days, and then three days off each week. Side effects may include high blood sugar levels, diarrhea, skin rash and other skin reactions, nausea, vomiting, and mouth sores.

Sacituzumab Govitecan (Trodelvy)

Sacituzumab govitecan is an antibody-drug conjugate, which works by attaching to proteins on cancer cells and delivering chemotherapy directly to them. It can be used to treat patients with metastatic HR-positive/HER2-negative breast cancer who have already received hormone therapy and at least two types of chemotherapy. It’s given via an IV once a week for two weeks, followed by a week off, and then repeated. Common side effects of include nausea, vomiting, diarrhea, constipation, tiredness, rash, hair loss, loss of appetite, low red blood cell counts, and stomach pain.

PARP Inhibitors

These medicines work by blocking PARP proteins. They may be an option for a select group of patients with metastatic HR-positive/HER2-negative breast cancer that have BRCA gene mutations.

PARP inhibitors come as pills, which are taken once or twice daily. They can cause side effects such as nausea, diarrhea, vomiting, fatigue, loss of appetite, taste changes, insomnia, or dizziness.

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