Treatments for recurrent breast cancer

Breast cancer can come back (recur) after treatment. Sometimes it recurs years after it was first treated. There are different types of recurrence.

Local recurrence is when breast cancer comes back in the tissues or in the scar from surgery in the same breast where the cancer was originally found.

Regional recurrence is when breast cancer comes back in the lymph nodes around the breast (under the arms, around the collarbone or near the breastbone).

Distant recurrence is when breast cancer comes back in other areas of the body. Breast cancer most often spreads to the bone, liver, lungs or brain.

When deciding which treatments to offer for recurrent breast cancer, your healthcare team will consider:

• if it is a local, regional or distant recurrence
• the type and number of treatments you have had for breast cancer
• the hormone receptor status of the cancer
• the HER2 status of the cancer
• any other genetic changes to the cancer cells
• your overall health
• any medical problems you have
• your lifestyle and what you prefer or want

The following treatments may be offered for locally recurrent breast cancer.

Surgery is offered for a local recurrence of breast cancer. The type of surgery done will depend on the kind of surgery that you had to treat the original breast cancer.

If the first surgery you had was breast-conserving surgery, and the cancer has come back in the breast, a modified radical mastectomy may be offered.

If a mastectomy was used to remove the original tumour, your healthcare team may use surgery to remove a tumour that has recurred in the skin, muscles or lymph nodes in the area of the mastectomy.

If the cancer has come back in the muscles of the chest or in the chest wall, a radical mastectomy may be offered.

Find out more about surgery for breast cancer.

External radiation therapy may be given after surgery to remove a local recurrence if you weren't given radiation when the cancer was first treated or if the radiation was given many years ago. Radiation is directed at the area where the tumour was removed, the skin, the chest muscles, the lymph nodes under the arm and the lymph nodes around the collarbone.

Find out more about radiation therapy for breast cancer.

Hormone therapy is often offered for a local recurrence of hormone receptor–positive breast cancer.

Recurrent breast cancer cells sometimes have hormone receptors even if the cancer cells in the original tumour didn't have them. For this reason, hormone therapy may be offered when hormone receptor–negative breast cancer recurs in older people, when it recurs only in 1 or 2 places, or if there is a long period of time between when the cancer was first treated and when it recurred.

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 (GrRH) agonist at the same time.

If you were taking a hormone therapy drug when the cancer recurred, your healthcare team will offer you a different drug. You may be offered up to 3 different hormone therapy drugs for locally recurrent breast cancer. If the cancer stops responding to the third hormone therapy drug, your healthcare team may offer you chemotherapy.

Find out more about hormone therapy for breast cancer.

Chemotherapy may be offered for locally recurrent breast cancer to reduce the risk of the cancer coming back again. The type of chemotherapy offered by your healthcare team will depend on:

• the hormone receptor status of the cancer
• the HER2 status of the cancer
• which chemotherapy drugs you have been treated with before

The following chemotherapy drugs may be used for locally recurrent breast cancer to reduce the risk that the cancer will spread:

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

If breast cancer doesn't respond or stops responding to one chemotherapy drug or combination, your healthcare team will try another drug or combination. If the cancer does not respond to 3 different chemotherapy drugs or drug combinations given one after another, chemotherapy is stopped.

Chemotherapy for recurrent breast cancer may also be combined with targeted therapy or hormone therapy.

Find out more about chemotherapy for breast cancer.

Targeted therapy is often offered for a local recurrence of HER2-positive breast cancer. The targeted therapy treatment offered by your healthcare team will depend on any targeted therapy drugs you have been treated with before.

Trastuzumab (Herceptin and biosimilars) is the targeted therapy drug most commonly used to treat locally recurrent, HER2-positive breast cancer.

Capivasertib (Truqap) may be offered in combination with the hormone therapy drug fulvestrant in people who were assigned female at birth who have had a recurrence of breast cancer after hormone therapy was completed.

Other targeted therapy drugs may be offered for HER2-negative breast cancer, or if your cancer recurred after you were given trastuzumab. Find out more about targeted therapy for breast cancer and hormone therapy for breast cancer.

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

The following treatments may be offered for regionally recurrent breast cancer.

Surgery is offered for a regional recurrence of breast cancer to remove the lymph nodes where the cancer has recurred.

Find out more about surgery for breast cancer.

External radiation therapy may be given after surgery to remove a regional recurrence if you weren't given radiation when the cancer was first treated or if the radiation was given many years ago. Radiation is directed at the area where the lymph nodes were removed.

Find out more about radiation therapy for breast cancer.

Hormone therapy is often offered for a regional recurrence of hormone receptor–positive breast cancer.

Recurrent breast cancer cells sometimes have hormone receptors even if the cancer cells in the original tumour didn't have them. For this reason, hormone therapy may be offered when hormone receptor–negative breast cancer recurs in older people, when it recurs only in 1 or 2 places, or if there is a long period of time between when the cancer was first treated and when it recurred.

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. The aromatase inhibitors that may be offered are:

• letrozole (Armindex)
• anastrozole (Femera)
• exemestane (Aromasin)

If you can't take or don't want to take an aromatase inhibitor, you may be offered tamoxifen.

If you were taking a hormone therapy drug when the cancer recurred, your healthcare team will offer you a different drug. You may be offered up to 3 different hormone therapy drugs for regionally recurrent breast cancer. If the cancer stops responding to the third hormone therapy drug, your healthcare team may offer you chemotherapy.

Find out more about hormone therapy for breast cancer.

Chemotherapy may be offered for regionally recurrent breast cancer to reduce the risk of the cancer coming back again. The type of chemotherapy offered by your healthcare team will depend on:

• the hormone receptor status of the cancer
• the HER2 status of the cancer
• which chemotherapy drugs you have been treated with before

The following drugs may be combined for chemotherapy before or after surgery:

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

If breast cancer doesn't respond or stops responding to one chemotherapy drug or combination, your healthcare team will try another drug or combination. If the cancer does not respond to 3 different chemotherapy drugs or drug combinations given one after another, chemotherapy is stopped.

Chemotherapy for recurrent breast cancer may also be combined with targeted therapy or hormone therapy.

Find out more about chemotherapy for breast cancer.

The targeted therapy treatment offered by your healthcare team will depend on any targeted therapy drugs you have been treated with before.

The targeted therapy drugs that may be used to treat a regional recurrence of HER2-positive breast cancer include:

• trastuzumab (Herceptin and biosimilars)
• pertuzumab
• trastuzumab and pertuzumab (Phesgo)
• trastuzumab emtansine (Kadcyla or T-DM1)
• trastuzumab deruxtecan (Enhertu)
• palbociclib (Ibrance)

The targeted therapy drugs that may be used to treat a regional recurrence of HER2-negative breast cancer include:

• everolimus (Afinitor)
• alpelisib (Piqray)
• ribociclib (Kisqali)
• abemaciclib (Verzenio)

The targeted therapy drug that may be used to treat regionally recurrent breast cancer with BRCA gene mutations is talazoparib (Talzenna).

Targeted therapy may also be combined with hormone therapy or chemotherapy.

Find out more about targeted therapy for breast cancer.

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

Distant recurrence of breast cancer is treated like metastatic breast cancer.

Find out more about treatments for metastatic breast cancer.