NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
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
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
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.