Chemotherapy and Other Systemic Therapies for Breast Cancer

MSK is a leader in developing new systemic therapies for treating breast cancer.
A clinical nurse with a patient at the David H. Koch Center for Cancer Care
Clinical nurse Jodie Pindulic with a patient at the David H. Koch Center for Cancer Care.
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Overview

Breast cancer chemotherapy (chemo), breast cancer hormone therapy, and breast cancer targeted therapy are types of systemic therapies. They travel through the bloodstream to treat breast cancer.

Breast cancer treatment most often starts with surgery. Your care team may recommend systemic therapies to help treat the cancer.

You may have neoadjuvant (NEE-oh-A-joo-vant) therapy, which is treatment you get before breast cancer surgery. Neoadjuvant therapy shrinks tumors so they’re easier to remove during surgery. This type of therapy also helps your team with your treatments after surgery.

You may have adjuvant (A-joo-vunt) therapy, which is treatment you get after breast cancer surgery. It’s used to kill any cancer cells that may be left in your breast or the rest of your body. Adjuvant therapy can lower the risk of breast cancer coming back or spreading.

Your treatment plan is based on things such as the cancer’s stage, size, and hormone status.

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Chemotherapy for breast cancer

What is chemotherapy (chemo)?

Chemotherapy (chemo) is a treatment that uses strong medicine to stop or slow cancer cells from growing. Chemo puts medicine that targets cancer cells into your vein. The medicines travel in your bloodstream to kill cancer cells in the body. 

There are many kinds of chemo medicines for breast cancer. Your care team will talk with you about the best options.

These medicines in general fight breast cancer by affecting how cancer cells grow and spread.

There are many types of chemotherapy medicines, and they do not work in the same way. They have different doses and schedules. Some are used alone, others along with other medicines. There also are differences in how well chemo medicines work. 

Chemotherapy medicines and regimens

If chemotherapy is a part of your treatment, your medical oncologist (cancer doctor) will recommend a chemotherapy plan. It’s also called a chemotherapy regimen (REH-jih-men). 

This treatment plan tells you important details, including:

  • Which medicines you’ll get.
  • The order in which you’ll get them.
  • The dose (amount) of each drug.
  • How often and how long you will need chemotherapy.
Your care team will make a treatment plan. It’s based on the type of cancer you have and how far the cancer has spread:
Chemotherapy for early-stage breast cancer
Your care team may recommend chemotherapy before breast surgery (neoadjuvant chemotherapy) or after breast surgery (adjuvant chemotherapy).
Chemotherapy for early-stage breast cancer
Chemotherapy for early-stage breast cancer

Your care team may recommend chemotherapy before breast surgery (neoadjuvant chemotherapy) or after breast surgery (adjuvant chemotherapy.

Here are some reasons we may recommend chemotherapy for early-stage breast cancer:

  • Chemo raises the chance your surgeon will remove all of the cancer.
  • Chemo shrinks the tumor so it’s easier to remove during surgery.
  • Chemo kills cancer cells in the lymph nodes, so there’s not need to remove your lymph nodes.
  • Chemo kills breast cancer cells that remain after surgery, so there’s less chance the cancer will come back.
Here’s more information about treatment for early-stage breast cancer:
Chemotherapy regimens

Most people with early-stage breast cancer have chemotherapy for about 3 to 6 months. 

Some people may have a dose-dense chemotherapy regimen. You will have chemo drugs with less time between treatments than regular chemo. Research shows dose-dense chemotherapy can improve survival. It also lowers the risk breast cancer will come back. Dose-dense chemotherapy does not cause more side effects. 

Combination drug therapy

Combination drug therapy means you get more than 1 type of drug at a time.

A tumor can become resistant to a drug, which means the drug stops working as well as before. With combination therapy, the tumor still responds to the second or third drug that’s part of your treatment.

You can have combination therapy before or after breast surgery. Most often, you will get 2 or 3 drugs together. 

Some of these drugs are breast cancer targeted therapies. They work by targeting certain molecules that make breast cancer grow. 

Up Next
Chemotherapy for metastatic breast cancer
Chemotherapy for early-stage breast cancer
Chemotherapy for early-stage breast cancer

Your care team may recommend chemotherapy before breast surgery (neoadjuvant chemotherapy) or after breast surgery (adjuvant chemotherapy.

Here are some reasons we may recommend chemotherapy for early-stage breast cancer:

  • Chemo raises the chance your surgeon will remove all of the cancer.
  • Chemo shrinks the tumor so it’s easier to remove during surgery.
  • Chemo kills cancer cells in the lymph nodes, so there’s not need to remove your lymph nodes.
  • Chemo kills breast cancer cells that remain after surgery, so there’s less chance the cancer will come back.
Here’s more information about treatment for early-stage breast cancer:
Chemotherapy regimens

Most people with early-stage breast cancer have chemotherapy for about 3 to 6 months. 

Some people may have a dose-dense chemotherapy regimen. You will have chemo drugs with less time between treatments than regular chemo. Research shows dose-dense chemotherapy can improve survival. It also lowers the risk breast cancer will come back. Dose-dense chemotherapy does not cause more side effects. 

Combination drug therapy

Combination drug therapy means you get more than 1 type of drug at a time.

A tumor can become resistant to a drug, which means the drug stops working as well as before. With combination therapy, the tumor still responds to the second or third drug that’s part of your treatment.

You can have combination therapy before or after breast surgery. Most often, you will get 2 or 3 drugs together. 

Some of these drugs are breast cancer targeted therapies. They work by targeting certain molecules that make breast cancer grow. 

Up Next
Chemotherapy for metastatic breast cancer
Chemotherapy for metastatic breast cancer
New chemotherapy methods make it possible to live for many years even if cancer has spread. New drug therapies can slow down or stop a tumor’s growth and help with symptoms. 
Chemotherapy for metastatic breast cancer
Chemotherapy for metastatic breast cancer

New chemotherapy methods make it possible to live for many years even if cancer spread to other parts. New drug therapies can slow down or stop a tumor’s growth, and help with symptoms. 

Your treatment plan is based on your health history, age, breast cancer type, and other things.

If you have early-stage breast cancer, most often you will have a few drugs together. 

If you have advanced breast cancer, most often you will have only 1 drug at a time. 

Treatment for metastatic breast cancer at MSK

Genomic testing can help us match treatment to the exact kind of tumor you have. It’s an important tool for treating breast cancer that has spread.

Changes in the molecular sequence of DNA are called mutations or variants. 

MSK offers tumor sequencing, also called molecular profiling, to all our patients with metastatic breast cancer. These tests look at the cancer cells for any changes in the genes that could be linked to the kind of breast cancer you have.

Our experts use a very advanced test developed by MSK researchers. MSK-IMPACT® looks for mutations in 505 genes. 

This information guides treatment. We can rule out drug therapies that may not work for you. We may suggest you join a research study, known as a clinical trial, that targets the exact mutation in your tumor. 
Chemotherapy for metastatic breast cancer
Chemotherapy for metastatic breast cancer

New chemotherapy methods make it possible to live for many years even if cancer spread to other parts. New drug therapies can slow down or stop a tumor’s growth, and help with symptoms. 

Your treatment plan is based on your health history, age, breast cancer type, and other things.

If you have early-stage breast cancer, most often you will have a few drugs together. 

If you have advanced breast cancer, most often you will have only 1 drug at a time. 

Treatment for metastatic breast cancer at MSK

Genomic testing can help us match treatment to the exact kind of tumor you have. It’s an important tool for treating breast cancer that has spread.

Changes in the molecular sequence of DNA are called mutations or variants. 

MSK offers tumor sequencing, also called molecular profiling, to all our patients with metastatic breast cancer. These tests look at the cancer cells for any changes in the genes that could be linked to the kind of breast cancer you have.

Our experts use a very advanced test developed by MSK researchers. MSK-IMPACT® looks for mutations in 505 genes. 

This information guides treatment. We can rule out drug therapies that may not work for you. We may suggest you join a research study, known as a clinical trial, that targets the exact mutation in your tumor. 

The MSK Difference

MSK developed a cancer drug that’s giving people with stage 4 breast cancer new hope. The drug, T-DXd, was approved in 2022. T-DXd is now being tested on other cancers and is changing the way doctors treat cancer.

Are there side effects to breast cancer chemotherapy?

Chemotherapy most often works by attacking cells that divide very fast. It can harm cancer cells. But it also means it harms healthy cells that divide fast. That includes the cells that make your hair grow.

Hair loss can be a side effect of chemotherapy. MSK offers scalp cooling as a way to help with hair loss. Scalp cooling involves wearing a cold cap on your head before, during, and after getting chemo.

Whether you have side effects from breast cancer chemotherapy depends on your treatment plan.

We have more information on managing the side effects of chemo.

We have ways to help manage nausea during chemotherapy. We have a team of experts who manage the symptoms and side effects of cancer treatment.

Michelle Villagomez was treated by experts in the Rare Breast Cancer Program 
Chemotherapy was a shock to my system. But I knew at any time when I didn’t feel well, I could call and someone would help me.
Michelle says MSK’s Rare Breast Cancer team helped her through her treatment for breast cancer.
Read her story

Hormone therapy for breast cancer

What is hormone therapy?

Some breast cancer cells need estrogen and other hormones to fuel their growth. Hormone therapy is a treatment for breast cancers that need hormones to grow. 

These medicines stop or slow the growth of cancer by blocking the hormones cancer cells need to grow. 

Your doctor can tell you if hormone therapy is right for you. The type of hormone therapy treatment may depend on whether you have gone through menopause. Menopause (MEH-nuh-pawz) is a permanent end of your monthly periods. 

  • Pre-menopause hormonal therapy. You have not yet gone through menopause. We may recommend an estrogen receptor blocker. We may add medicines that keep your ovaries from working. Another treatment is surgery to remove the ovaries.
  • Post-menopause hormonal therapy. You already have gone through menopause. We may recommend an aromatase inhibitor. This drug blocks your body from making estrogen. This starves cancer cells because they do not have hormones they need to grow. 
Are there side effects of hormone therapy?

There can be side effects. Your menstrual cycle (period) can be stopped. You can have hot flashes, a dry vagina, aching bones, and less interest in having sex. 

Your care team will talk with you about side effects from hormonal therapy, and how to manage them.

The MSK Difference

Our Integrative Medicine Service (also called complementary therapies) offers acupuncture, meditation, massage therapy, yoga, and exercise. Without using prescription drugs, integrative therapies can help manage the side effects of breast cancer treatment. 

Targeted therapies for breast cancer

Targeted therapies are cancer treatments that target a tumor’s gene changes (mutations or variants). It’s a personal treatment plan just for the type of cancer you have.

Targeted therapies are often called precision medicine or precision oncology.

Breast cancer research is exploring drugs that work by targeting certain molecules that make breast cancer cells grow. Targeted drugs attack the mutated proteins in cancer cells. Most healthy cells are not affected.

Chemotherapy instead attacks all cells that grow and divide quickly. Many targeted therapies may not cause hair loss or other common side effects of chemotherapy, such as low blood counts.

Targeted therapy drugs can treat the most common breast cancer gene mutations, such as:

  • BRCA1 and BRCA2
  • HER2
  • PIK3CA 
Innovations at MSK

Our experts are constantly uncovering new methods of treating breast cancer and managing side effects. Explore breast cancer news from MSK. 

MSK medical oncologist and breast cancer specialist Sarat Chandarlapaty
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