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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017


Chemotherapy and HER2 treatment Overview

The first treatment for many women

with stage III breast cancer will be

chemotherapy. HER2 treatment may

be added. Part 3 explains the role of

chemotherapy and lists which drugs are

options. It also presents some details on

what to expect during chemotherapy.


Almost all stage III breast cancers are treated with

chemotherapy. Read this section to learn when

chemotherapy and HER2 treatment are given and to

whom. This section also reviews how chemotherapy

and HER2 treatment work.

Timing of treatment

Chemotherapy is often given before surgery for

stage III cancers. It is given to shrink tumors as much

as possible. Shrinking tumors allows more normal

tissue to be saved at the time surgery. Cancer drugs

given for this purpose are called preoperative (or

neoadjuvant) treatment.

Instead of chemotherapy, endocrine therapy is

sometimes used for preoperative treatment. It is an

anti-hormone treatment. Thus, it is used for hormone

receptor–positive cancers. It may be an option

before surgery for slow-growing cancers or because

of health issues. Read Part 6 to learn more about

endocrine therapy.

Sometimes, chemotherapy is received after surgery.

More chemotherapy may be advised even if you had

it before surgery. If you received endocrine therapy

before surgery, you may receive chemotherapy

afterward. Some women who have surgery first

receive chemotherapy afterwards. Chemotherapy

given after surgery is called adjuvant treatment.

Not advised for

Do not receive chemotherapy if you’ve been

pregnant for fewer than 3 months. Chemotherapy

may harm your baby. Some types of chemotherapy

are safe in the second and third trimesters.

Chemotherapy if older

than 70 years

The use of chemotherapy for women older

than age 70 has been questioned. You may

not be given chemotherapy if you are older

than 70 years for the following reasons.



There is little research on older women

to help inform treatment decisions.



Chemotherapy may not be that helpful

because the return of breast cancer can

take a long time in older women. Thus,

the odds that chemotherapy will stop a

life-threatening recurrence are small.



Some women have reactions to

chemotherapy that threaten their health.



You may have health problems other

than cancer that are more serious.