Early Breast Cancer Treatments: 5 Common Options to Explore

Lumpectomy

A lumpectomy removes the tumor and a small margin of surrounding tissue, but it preserves most of the breast. It's also called breast-conserving surgery. It's usually followed by radiation therapy.

Mastectomy

A mastectomy removes the entire breast. It may be recommended when the tumor is large, when there are multiple tumors, or when a person carries a BRCA (breast cancer) gene mutation. Breast reconstruction may be an option afterward.

Lymph node evaluation

Breast cancer can spread to nearby lymph nodes under the arm. Your surgeon may remove one or more lymph nodes during surgery to check for cancer spread. This helps determine the stage of your cancer and guide next steps.

Chemotherapy for early breast cancer

Chemotherapy for early breast cancer kills rapidly dividing cancer cells. Depending on your situation, it can be given before or after breast surgery. But if your breast cancer is considered slower growing, it might not be effective.

Chemotherapy is typically given in cycles, or phases, over 3 to 6 months. It’s often given intravenously (IV) — as an injection into a vein. But some chemotherapy treatment can also be taken as an oral pill. These are some common chemotherapies used for early breast cancer management:

• Doxorubicin (Adriamycin)

• Cyclophosphamide (Cytoxan)

• Carboplatin (Paraplatin)

• Epirubicin (Ellence)

• Capecitabine (Xeloda)

• Docetaxel (Taxotere)

• Paclitaxel (Taxol)

• Fluorouracil

• Methotrexate

Oftentimes, 2 to 3 chemotherapies are combined to achieve a greater effect. One common chemotherapy regimen that may be used for early breast cancer is cyclophosphamide and docetaxel.

Hormone therapy for early breast cancer

When breast cancer cells use estrogen or progesterone as fuel to grow, it’s considered hormone receptor-positive (HR+) breast cancer. Hormone (endocrine) therapy medications treat early, HR+ breast cancer by blocking or lowering the levels of estrogen and progesterone in the body. Hormone therapy lowers the risk of breast cancer coming back.

Aromatase inhibitors

Aromatase inhibitors (AIs) are common hormone therapies for women with early breast cancer. Top AIs are:

• Anastrozole (Arimidex)

• Letrozole (Femara)

• Exemestane (Aromasin)

These are all available as oral pills that are taken daily for 5 to 10 years at a time.

For women who haven’t gone through menopause, AIs are used in combination with a medication for ovarian suppression, such as leuprolide (Lupron Depot) or goserelin (Zoladex). 

For women who have experienced menopause, ovarian suppression isn’t necessary.

SERMs

Selective estrogen receptor modulators (SERMs), such as tamoxifen (Soltamox), can be used as hormone therapy for women and men with early breast cancer. SERMs are available as pills taken by mouth daily for 5 to 10 years.

Immunotherapy for early breast cancer

Immunotherapy medications work by enhancing your body’s immune system. They aim to help it identify and kill cancer cells more effectively.

Pembrolizumab (Keytruda) is the main immunotherapy used to treat early breast cancer. It works by targeting programmed cell death protein 1 (PD-1) receptors on T cells of the immune system. Blocking PD-1 helps unleash the immune system on breast cancer cells, but it’s not equally effective for all forms of breast cancer.

Pembrolizumab is FDA approved to treat early breast cancer in people whose breast cancer is considered “triple negative.” Triple-negative breast cancer cells don't have any estrogen, progesterone, or HER2 receptors on them. Only certain treatments can effectively treat this form of breast cancer.

Pembrolizumab is given in combination with chemotherapy before breast surgery and can be continued by itself after surgery. It's typically given as an IV infusion every 3 to 6 weeks. It helps lower the risk of cancer coming back.

Trastuzumab

Trastuzumab (Herceptin) works by blocking HER2 proteins on HER2-positive breast cancer cells. This helps slow down breast cancer growth. It’s typically given as an IV infusion every 3 weeks, and it can be given before or after surgery.

Other equally effective versions of trastuzumab are available too. Your cancer specialist may opt to prescribe a trastuzumab biosimilar in place of trastuzumab to save on cost. Or, they may prescribe an under-the-skin equivalent called trastuzumab / hyaluronidase (Herceptin Hylecta).

Pertuzumab

Pertuzumab (Perjeta) also works by blocking HER2 proteins on HER2-positive breast cancer cells. But it works differently than trastuzumab.

Pertuzumab is always given in combination with trastuzumab to treat HER2-positive early breast cancer. These medications block HER2 in different ways, so they work better together. Pertuzumab is typically injected into the vein every 3 weeks and can be given before or after surgery.

Good to know: A combination product that contains trastuzumab, pertuzumab, and hyaluronidase (Phesgo) is also available. If covered by your insurance, it’s a convenient option that's given as an under-the-skin injection.

Ado-trastuzumab emtansine

Ado-trastuzumab emtansine (Kadcyla) is an antibody-drug conjugate. It combines trastuzumab and a chemotherapy medication into a single treatment. This combination allows for a more targeted delivery of chemotherapy to HER2-positive breast cancer cells.

For HER2-positive, early breast cancer, ado-trastuzumab emtansine can be given to people who have already received cancer treatment before surgery but still have cancer remaining in their breast or lymph nodes at the time of surgery.

Neratinib

Neratinib (Nerlynx) is a tyrosine kinase inhibitor that blocks certain enzymes (proteins) that contribute to cancer growth. It works inside cancer cells to block signaling to HER2 receptors, which stops cancer growth. It's given in some circumstances to people with early breast cancer who have already been treated with trastuzumab and still need additional treatment.

Neratinib is a once-daily pill that's taken by mouth for 1 year at a time. It helps prevent breast cancer from coming back in some people with HER2-positive, early breast cancer.

Abemaciclib

Abemaciclib (Verzenio) is a CDK 4/6 inhibitor that’s approved to treat early breast cancer that’s spread to the lymph nodes and is considered HR+, HER2-negative. It works by blocking cyclin-dependent kinases (CDKs), which are proteins found inside HR+ breast cancer cells. By blocking CDKs, breast cancer cells stop dividing and are pushed into a state of “permanent sleep,” called senescence.

Abemaciclib is an oral pill that’s typically taken twice daily for 2 years in combination with hormone therapy. It’s usually given after surgery.

Olaparib

Olaparib (Lynparza) is a PARP inhibitor approved to treat early breast cancer that’s HER2-negative. PARP inhibitors block PARP proteins. (The term “PARP” stands for poly (ADP-ribose) polymerase). PARP proteins normally help repair DNA in cells. By blocking these proteins, cancer cell DNA isn't able to be repaired and the cancer cells die off.

But olaparib has some prerequisites. It can only be given to people with a BRCA mutation who are at a higher risk of their breast cancer coming back. BRCA mutations are a type of inherited gene mutation that can raise your risk of developing breast cancer. What’s more, it's only an option for people who have already received surgery and chemotherapy.

Olaparib is an oral pill that's typically taken as 2 tablets twice daily for a year. It's usually taken after completing chemotherapy and can be taken at the same time as hormone therapy.

References