What medications are available to treat breast cancer?

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The first-line treatment for breast cancer may depend on the stage and type of breast cancer people have. People may have medication before, or after, surgery or radiation therapy.

For people with hormone receptor-positive breast cancer, hormone therapy with tamoxifen (Nolvadex) or aromatase inhibitors may be the first-line treatment.

Tamoxifen can treat early, localized, or metastatic breast cancer. It blocks the activity of estrogen in breast cancer cells.

Aromatase inhibitors may be the first-line therapy for locally advanced or metastatic hormone receptor-positive breast cancer. Aromatase inhibitors block the enzyme called aromatase from turning other hormones into estrogen.

For hormone receptor-negative breast cancer, or triple-negative breast cancer, hormone therapy and targeted therapies are not effective, so chemotherapy is the main treatment option.

In August 2022, the Food and Drug Administration (FDA) approved Enhertu, a targeted therapy drug to help treat metastatic or inoperable HER2-low breast cancer. People take the drug as an intravenous infusion.

In 2022, the FDA also approved the combination of pembrolizumab (Keytruda), an immunotherapy drug, with chemotherapy. In some cases, this combination may help to improve survival for people with triple-negative breast cancer, compared to chemotherapy treatment alone.

Current research suggests that the addition of an AKT inhibitor called capivasertib to a hormone therapy drug called fulvestrant (Faslodex) may improve progression-free survival compared to fulvestrant alone.

The clinical trial is currently in phase 3, but researchers are hopeful this may be a promising new treatment for people with hormone receptor-positive breast cancer that is resistant to aromatase inhibitors.

Stage 0 breast cancer is also called ductal carcinoma in situ (DCIS).

Doctors treat DCIS with hormone therapy, such as tamoxifen, if the cancer is hormone-receptor-positive.

For those who are postmenopausal, doctors may recommend aromatase inhibitors, such as anastrozole (Arimidex) and exemestane (Aromasin).

Taking these medications for 5 years after surgery may help to reduce the risk of cancer returning.

People with stage 1–3 breast cancer may have drug therapies before or after surgery and radiation therapy.

Drug therapies may include:

• hormone therapy drugs, such as tamoxifen or aromatase inhibitors
• immunotherapy drugs, such as pembrolizumab
• targeted therapy drugs, such as:
  • trastuzumab (Herceptin)
  • pertuzumab (Perjeta)
  • abemaciclib (Verzenio)
  • olaparib (Lynparza)
• chemotherapy drugs, such as:
  • anthracyclines, including epirubicin (Ellence) and doxorubicin (Adriamycin)
  • 5-fluorouracil (5-FU)
  • capecitabine (Xeloda)
  • carboplatin (Paraplatin)
  • cyclophosphamide (Cytoxan)
  • taxanes, including docetaxel (Taxotere) and paclitaxel (Taxol)

Learn more about chemotherapy for breast cancer here.

The type of medications for treating stage 4 breast cancer will depend on the type of cancer, but may include the following:

Hormone receptor-positive

A doctor may prescribe:

• tamoxifen and aromatase inhibitors
• CDK4/6 inhibitors, including:
  • abemaciclib
  • palbociclib (Ibrance)
  • ribociclib (Kisqali)
• targeted therapy drugs, such as everolimus (Afinitor)
• PI3K inhibitors, such as alpelisib (Piqray)

Hormone receptor-negative

A doctor may prescribe chemotherapy drugs, including:

• eribulin (Halaven)
• capecitabine
• vinorelbine (Navelbine)
• gemcitabine (Gemzar)
• Ixabepilone (Ixempra)
• platinum agents, such as cisplatin (Platinol) and carboplatin
• taxanes, including:
  • docetaxel
  • paclitaxel
  • albumin-bound paclitaxel (Abraxane)
• anthracyclines, including:
  • doxorubicin
  • liposomal doxorubicin (Doxil)
  • epirubicin (Pharmorubicin)

HER2-positive

A doctor will prescribe chemotherapy alongside pertuzumab and trastuzumab.

Other options include an antibody-drug conjugate and a kinase inhibitor.

HER2-low

A doctor will prescribe an antibody-drug conjugate fam-trastuzumab deruxtecan (Enhertu).

HER2-negative in those with a BRCA gene mutation

A doctor will prescribe a PARP inhibitor, such as olaparib and talazoparib (Talzenna).

Chemotherapy medications and hormone drugs may also be beneficial.

HER2-negative in those with a PIK3CA gene mutation

A doctor will prescribe a PIK3 inhibitor, such as alpelisib.

Triple-negative breast cancer

A doctor will prescribe:

• an immunotherapy drug alongside chemotherapy to treat those with a PD-L1 protein
• PARP inhibitors to treat those with TNBC and BRCA gene mutations
• immunotherapy alongside pembrolizumab to treat those with gene changes called microsatellite instability
• antibody-drug conjugate sacituzumab govitecan (Trodelvy) to treat those with no specific protein or gene changes

People may take certain medications in remission to help prevent cancer from returning.

For people with hormone receptor-positive breast cancer, taking at least 5 years of hormone therapy may help lower the risk of the cancer returning.

For hormone receptor-negative cancer, people may have chemotherapy to lower the risk of the cancer returning.

Currently approved medications to prevent breast cancer include:

• raloxifene hydrochloride (Evista), for post-menopause only
• tamoxifen citrate (Soltamox), for before or after menopause

People who are at high risk of developing breast cancer may decide to take medications to help prevent breast cancer.

Both raloxifene and tamoxifen block estrogen in breast cells which may lower the risk of cancer developing by around 40%. People will usually take either of these drugs for 5 years to help prevent breast cancer.

Another option for people post-menopause with a high risk of breast cancer may be to take aromatase inhibitors.

What is the 5-year pill for breast cancer?

For people who have breast cancer that responds to hormonal treatment, taking hormone therapy for at least 5 years may help prevent the cancer from returning.

These include:

• letrozole (Femara), an aromatase inhibitor
• anastrozole, an aromatase inhibitor
• tamoxifen

If people do have healthcare insurance, they can ask the hospital or healthcare facility if they have any assistance programs to help cover out-of-pocket costs, or recommendations of nonprofit organizations that could help.

If people do not have healthcare insurance, they can ask a healthcare professional to refer them to a patient financial counselor or patient navigator to help them find coverage.

Other tips include:

• asking if the hospital can set up a payment plan to pay in installments
• considering taking part in a clinical trial, which may cover medical costs
• asking for generic medicines where possible, as these are less expensive than the brand-name equivalent
• checking if the pharmaceutical company of the drug offers a patient assistance program to help cover costs
• using a drug discount card
• looking into prescription assistance programs, such as the CancerCare Co-Payment Assistance Foundation

People may have medications to treat breast cancer as a stand-alone treatment, or before or after surgery or radiation therapy.

Medications include hormone therapy, chemotherapy, targeted therapy, and immunotherapy drugs. The type of medication may depend on the stage and type of cancer.

People at high risk of breast cancer may want to talk with a doctor about preventive medications.