NCCN Guidelines for Patients
Breast Cancer – Metastatic (STAGE IV), Version 2.2017
Hormone receptor–positive cancers
This book focuses on cancer treatment. However,
supportive care is important, too. Supportive care
doesn’t aim to treat cancer but aims to improve
quality of life. It can address many needs.
One example of supportive care is treatment for
physical and emotional symptoms. Read the next
Breast cancer in bone
, for an example.
Supportive care can also help with treatment
decisions as you may have more than one option.
It can also help with coordination of care between
health providers. Talk with your treatment team to
plan the best supportive care for you.
Breast cancer in bone
A bone metastasis is the spread of cancer to the
bone. It is not the same as bone cancer, which starts
in bone. Your bones are at risk for injury and disease
when cancer spreads to them. Such health problems
include bone fractures, bone pain, and squeezing
(compression) of the spinal cord. High levels of
calcium in the blood, called hypercalcemia, may also
There is supportive care to prevent bone problems
caused by bone metastases. Your doctor may
prescribe denosumab (Xgeva™), zoledronic acid
), or pamidronate (Aredia
). Your treatment
team may advise you to take these drugs with
calcium and vitamin D.
Denosumab, zoledronic acid, or pamidronate
may damage your jawbone. This condition is
called osteonecrosis of the jaw. Your chances for
osteonecrosis of the jaw are higher if taking certain
medications such as chemotherapy. Poor dental
health and dental work during cancer treatment will
increase your chances, too. Get a dental exam and
treatment for any dental problems before starting
Most breast cancers are hormone receptor–positive.
Female hormones help hormone receptor–positive
cancers grow. Endocrine therapy is a standard
treatment for these cancers. It can work just as well
as chemotherapy and its side effects are less severe.
For some women, targeted therapy with endocrine
therapy may be an option.
Some people refer to endocrine therapy as hormone
therapy. However, hormone therapy can then be
confused with hormone replacement therapy. The
former treats breast cancer whereas the latter treats
Endocrine therapy affects female hormones by one
of two methods. Some therapies block hormones
from working. Others lower hormone levels in the
body. The main types of endocrine therapy are
described next. The section,
which ones may be an option for you.
lower estrogen levels in the
body. These drugs block a protein that changes
a hormone (androgen) into estrogen. They do
not affect estrogen made in the ovaries. See
for a complete list of drugs for hormone-
stop the effect of estrogen on
cell growth. SERMs (
odulators) attach to estrogen receptors and block
estrogen from attaching. SERDs (
egraders) block and destroy estrogen
See Figure 7.
may treat breast cancer when taken
in high doses. It is not known how hormones stop
breast cancer cells with hormone receptors from
growing. Hormones are not often used for treatment.