Treatments for locally advanced breast cancer

Locally advanced breast cancer is considered to be stage 2B (if the cancer has spread to the lymph nodes), 3A, 3B or 3C.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The treatments offered for locally advanced breast cancer depend on:

• the hormone receptor status of the cancer
• the HER2 status of the cancer
• your menopausal status
• your overall health
• any medical problems you may have
• your lifestyle and what you prefer or want

Chemotherapy may be offered for locally advanced breast cancer. It may be used before surgery (called neoadjuvant chemotherapy) or after surgery (called adjuvant chemotherapy). The following drugs may be combined for neoadjuvant or adjuvant treatment:

• anthracycline drugs such as doxorubicin or epirubicin
• taxane drugs such as paclitaxel or docetaxel
• cyclophosphamide
• fluorouracil (also called 5-fluorouracil or 5-FU)
• carboplatin

A targeted therapy drug will be added to some chemotherapy combinations to treat breast cancer that has too many copies of the HER2 gene (called HER2-positive breast cancer). The targeted therapy drug is commonly given with taxane chemotherapy drugs. There is a risk of heart problems if the targeted therapy drug is given with anthracycline chemotherapy drugs.

Find out more about chemotherapy for breast cancer.

Hormone therapy is offered to most people with locally advanced, hormone-receptor positive breast cancer. If you are having chemotherapy for locally advanced breast cancer, hormone therapy will be started after you have finished your chemotherapy treatments. Your healthcare team may also give you hormone therapy before surgery, to shrink the tumour, so you can have breast-conserving surgery.

Both premenopausal and post-menopausal people will have either tamoxifen or an aromatase inhibitor or both. Premenopausal people taking an aromatase inhibitor are also given a gonadotropin-releasing hormone (GnRH) agonist at the same time.

Adjuvant hormone therapy is given for a total of 5 to 10 years. You may be given:

• an aromatase inhibitor for 5 years
• tamoxifen for 2 to 3 years followed by an aromatase inhibitor for 3 to 4 years
• an aromatase inhibitor for 2 to 3 years followed by tamoxifen for 3 to 7 years
• tamoxifen for 5 to 10 years

Find out more about hormone therapy for breast cancer.

Targeted therapy is most often used for locally advanced breast cancer that is HER2-positive. It is often combined with chemotherapy.

The most common targeted therapy drugs include:

• trastuzumab (Herceptin and biosimilars)
• pertuzumab (Perjeta)
• trastuzumab and pertuzumab combined together in a single form (Phesgo)
• ribociclib (Kisqali)
• neratinib (Nerlynx)
• talazoparib (Talzenna)
• abemaciclib (Verzenio)
• tucatinib (Tukysa)

Locally advanced or metastatic breast cancer that is hormone-receptor positive and HER2 negative and has continued to progress while on letrozole (Femara) or anastrozole (Arimidex) may be treated with everolimus (Afinitor). Everolimus is combined with the hormone therapy drug exemestane (Aromasin).

Capivasertib (Truqap) is combined with the hormone therapy drug fulvestrant to treat hormone-receptor positive and HER2 negative breast cancer that has continued to progress on at least 1 hormone therapy or has recurred within 12 months of finishing hormone therapy. The breast cancer must have changes to the PIK3CA, AKT1 or PTEN gene. This combination is only given to people who were assigned female at birth.

Other targeted therapy drugs may be offered for HER2-negative breast cancer. Find out more about targeted therapy for breast cancer.

Surgery is done before or after chemotherapy for locally advanced breast cancer. The following types of surgeries may be done:

• breast-conserving surgery
• modified radical mastectomy
• axillary lymph node dissection (ALND)

Find out more about surgery for breast cancer.

External radiation therapy is given for locally advanced breast cancer after surgery to lower the risk that the cancer will come back.

The areas treated with external radiation therapy will depend on the type of surgery you had. Radiation therapy is usually given to the breast or chest wall and to the lymph nodes under your arm and near your collarbone.

Find out more about radiation for breast cancer.

Talk to your doctor about clinical trials open to people with breast cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they aren't likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.