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Treatments in Common Use for Metastatic Breast Cancer

Three fundamentally different kinds of drugs are used to treat metastatic breast cancer:
  • Cytotoxic chemotherapy: Cytotoxic (cell-killing) chemotherapy drugs are poisons that disrupt cancer cell functions, usually while a cell is dividing. Listed in yellow.
  • Hormonal treatments:Hormonal treatments target breast cancers that grow in the presence of estrogen (and sometimes progesterone), and are used only for tumors that are ER+ and/or PR+  Listed in blue.
  • Targeted therapies or biologics: Targeted therapies are biologics that target specific genes that make proteins that stimulate cell growth (oncogenes), and may only work if the tumor overexpresses certain proteins.  Listed in pink.
  •  Other common medications: Intravenous bisphosphonates for bone metastases, and biological response modifiers that offer growth- factor support for patients undergoing chemotherapy.  Listed in orange.

About this drug chart:

  • This chart does not include supportive medications to treat symptoms of the cancer or side-effects of treatment.
  • Each drug has three hyperlinks: 1) the manufacturer’s website (if there is one); 2) the FDA-approved prescribing information that appears on the drug label, from RxList.com, and 3) patient-friendly information at ChemoCare.com, developed by the Cleveland Clinic.
  • Some drugs are approved for use in other cancers and other diseases.
  • Doctors may use drugs to treat metastatic breast cancer even though they are not FDA approved for this use (called an "indication").  If there is high-quality research supporting this use, insurance and Medicare will usually reimburse. This is known as “off-label” use. Strictly speaking, much treatment for metastatic breast cancer is off-label.
  • New research is constantly being presented at conferences or published in peer-reviewed oncology journals looking at whether these and other drugs, used singly or in combination, will benefit metastatic breast cancer patients.  For recent updates, look in Research and Emerging Treatments.
  • Also, see NCCN Practice Guidelines for Chemotherapy and Endocrine therapy in the treatment of metastatic breast cancer.

    Brand Name    and Website Generic Name Drug Type and Administration

     Prescribing Information

    		Links to  Patient-Friendly info
    Abraxane®  paclitaxel abumin-bound Cytotoxic chemotherapy: Plant alkyloid, microtubule agent, Taxol dissolved in albumin, less toxic  IV infusion RxLabel Abraxane at ChemoCare
    Adriamycin® doxorubicin Cytotoxic chemotherapy: Antibiotic anthracycline  IV injection or infusion RxLabel Adriamycin at ChemoCare
    Adrucil® 5-fluorouracil [5-FU] Cytotoxic chemotherapy: Alkylating agent, antimetabolite  IV injection or infusion RxLabel 5-FU at ChemoCare
    Aranesp® darbopoeitin alfa Biologic response modifier: Erythropoeisis stimulating agent(treats anemia caused by chemotherapy)  SubQ injection, IV infusion, 3 weekly RxLabel Aranesp at ChemoCare
    Aredia® pamidronate  Bisphosphonate: decreases hypercalcemia, fractures, pain in patients with bone mets Standard of care for bone metastases  IV infusion, monthly or less frequently RxLabel Aredia at ChemoCare
    Arimidex® anastrozole Hormone therapy: anti-estrogen Aromatase inhibitor  Oral, daily RxLabel Arimidex at ChemoCare
    Aromasin® exemestane Hormone therapy: anti-estrogen Aromatase inhibitor  Oral, daily RxLabel Aromasin at ChemoCare
    Avastin® bevacizumab Monoclonal antibody: targets VEG-F Anti-angiogenesis, targets tumor blood supply  IV infusion, 3 weekly RxLabel Avastin at ChemoCare
    Camptosar® irinotecan Cytotoxic chemotherapy: plant alkaloid, topoisomerase I inhibitor   IV injection    (investigational)                                                          RxLabel Irinotecan at ChemoCare
      Cytoxan®  cyclophosphamide Cytotoxic chemotherapy: Alkylating agent  IV infusion or injection, oral RxLabel Cytoxan in ChemoCare
    Doxil® doxorubicin liposomal Cytotoxic chemotherapy: Anthracycline bound to liposomes, alternative to Adriamycin, epirubicin  IV infusion RxLabel Doxil in ChemoCare
    Ellence® epirubicin Cytotoxic chemotherapy: Anthracycline, similar to Adriamycin, Doxil  IV infusion RxLabel  Epirubicin in ChemoCare
    Evista® raloxifene Hormonal treatment: Selective estrogen receptor modulator (SERM)  Oral daily   (not used yet in MBC) RxLabel Raloxifene in ChemoCare
    Faslodex® fulvestrant Hormonal therapy: SERD (selective estrogen receptor down-regulator)  Monthly injection. RxLabel Faslodex in ChemoCare
    Femara® letrozole Hormonal therapy: Aromatase inhibitor  Oral daily. RxLabel Femara in ChemoCare
    Gemzar® gemcitabine Cytotoxic chemotherapy: Antimetabolite  IV infusion, 3 weekly RxLabel Gemzar in ChemoCare
    Halotestin® fluoxymesterone Hormone therapy: Androgen, male hormone  Oral (older treatment, rarely used now) RxLabel Halotestin in ChemoCare
    Herceptin® trastuzumab Monoclonal antibody: inhibitor of HER2 Targeted for HER2+ breast cancer only  IV infusion, 1or 3 weekly RxLabel Herceptin in ChemoCare
    Ixempra® ixabepilone Cytotoxic chemotherapy:  Microtubule inhibitor IV infusion, 3 weekly RxLabel Ixempra in ChemoCare
     Lupron® leuprolide Hormonal therapy: LHRH agonist, stops ovarian function SubQ injection   (similar to Zoladex) RxLabel Lupron in ChemoCare
    Megace® megestrol acetate Hormone therapy: Progesterone  Oral, daily   (older treatment, rarely used) RxLabel Megace in ChemoCare
    Methotrexate methotrexate Cytotoxic chemotherapy: Antimetabolite  IV infusion, injection, intrathecal           RxLabel Methotrexate in ChemoCare
    Mutamycin® mitomycin-C Cytotoxic chemotherapy: Anti-tumor antibiotic  IV injection or infusion  (investigational)                          RxLabel Mitomycin-C in ChemoCare
    Navelbine® vinorelbine tartrate Cytotoxic chemotherapy: Vinka alkaloid  IV injection RxLabel Navelbine in ChemoCare
    Neulasta® pegfilgrastim Biologic response modifier: Boosts white blood cell production to avoid febrile neutropenia  (Like Neupogen longer-lasting)  SubQ injection RxLabel Neulasta in ChemoCare
    Neupogen® G-CSF   granulocyte-colony  stimulating factor filgrastim Biologic response modifier: Stimulates white-blood cell production, helps chemotherapy patients avoid infection  SubQ or IV injection, as needed RxLabel Neopogen in ChemoCare
    Nolvadex® tamoxifen Hormone therapy: anti-estrogen Selective estrogen receptor modulator  Oral, daily RxLabel Tamoxifen in ChemoCare
    Novantrone® mitoxantrone Cytotoxic chemotherapy: Anti-tumor antibiotic  IV injection  (investigational)                             RxLabel Novantrone in ChemoCare
    Paraplatin® carboplatin Cytotoxic chemotherapy: Alkylating agent Platinum chemotherapy   IV infusion  Rx Label Carboplatin in ChemoCare
    Platinol® cisplatin Cytotoxic chemotherapy: Alkylating agent, Platinum chemotherapy  IV infusion   (less common than carboplatin) RxLabel Cisplatin in ChemoCare
    Procrit® epoetin alfa Colony stimulating factor: Treatment for anemia caused by chemotherapy  Injection, daily as needed RxLabel Procrit in ChemoCare
    Sutent® sunitinib malate Tyrosine kinase inhibitor: targets VEGF Anti-angiogenic (tumor blood vessel formation)  Oral RxLabel Sutent in ChemoCare
    Taxol® paclitaxel Cytotoxic chemotherapy: Plant alkyloid, microtubule agent, taxane  IV infusion RxLabel Taxol in ChemoCare
    Taxotere® docetaxel Cytotoxic chemotherapy: Taxane  IV infusion RxLabel Taxotere in ChemoCare
    Temodar® temozolomide Cytotoxic chemotherapy: Alkylating agent    Oral  (only used for brain metastases) RxLabel Temodar in ChemoCare
    Toremifine® fareston Hormonal treatment: Selective estrogen receptor modulator (SERM)  Oral, daily (similar to tamoxifen, rarely used) RxLabel Toremifine in ChemoCare
    Tykerb® lapatinib Tyrosine kinase inhibitor of HER2 and EGFR: for HER2+ breast cancer only  Oral, daily RxLabel Tykerb in ChemoCare
    Xeloda® capecitabine Cytotoxic chemotherapy: Oral antimetabolite (a form of 5-fluouracil)  Oral daily (intermittent schedule) Rx Label Xeloda at ChemoCare
    Zoladex® goserelin Hormone therapy: LHRH agonist, stops ovarian function  SubQ injection, monthly (similar to Lupron) RxLabel Zoladex in ChemoCare
    Zometa® zoledronic acid Bisphosphonate: decreases hypercalcemia, fractures, pain in patients with bone mets Standard of care for bone metastases  IV, monthly or less frequently RxLabel Zometa in ChemoCare

     © Musa Mayer 2008