NCCN Guidelines for Patients
Breast Cancer – Metastatic (STAGE IV), Version 2.2017
Hormone receptor–negative cancers
Hormone receptor–negative cancers
These cancers lack hormone receptors that trigger
cell growth. Thus, in general, endocrine therapy
does not help. Thus, chemotherapy and targeted
therapy are used to treat hormone receptor–negative
The information in this section also applies to
endocrine refractory cancers. These cancers didn’t
improve during 3 back-to-back endocrine regimens.
Chemotherapy is the next option.
The types of chemotherapy differ in the way they
treat cancer. Some kill cancer cells by damaging
their DNA or by disrupting the making of DNA. Others
interfere with cell parts that are needed for making
new cells. Thus, no new cells are made to replace
dying cells. The four types of chemotherapy used to
treat metastatic breast cancer are listed in
Some chemotherapies work when cells are in an
active growth phase.
See Figure 10.
active growth phase, cells grow and divide to form
a new cell. Chemotherapy drugs that disrupt the
growth phase work well for cancer cells that are
growing and dividing quickly. Other chemotherapy
drugs work in any growth or resting phase.
What to expect
. Before starting chemotherapy,
your doctor may ask you to stop taking some of
your medicines, vitamins, or both. Some of these
treatments can cause chemotherapy to not work
as well or may cause health problems while on
chemotherapy. You may also have to change what
you drink and eat. If you smoke, it’s important that
Most chemotherapy for metastatic breast cancers are
liquids that are injected into a vein. Some are made
as pills to be swallowed. The injection may be one
fast shot of drugs into a vein or may be a slow drip
called an infusion. Chemotherapy can also be given
through a needle surgically placed in the chest or the
Chemotherapy is given in cycles of treatment
days followed by days of rest. The cycles vary in
length depending on which drugs are used. Giving
chemotherapy in cycles gives your body a chance to
recover after receiving chemotherapy.
You will need to go to a chemotherapy center
to receive the drugs. How long your visit will be
depends on which drugs you will get. It can take
a few minutes or a few hours to finish a dose of
chemotherapy. You may be given drugs to fight
nausea and vomiting. To learn more, read theNCCN Guidelines for Patients ® : Nausea and Vomiting.
may also get a shot of (peg-)filgrastim under your
skin. This medicine increases the number of white
blood cells to normal levels.
The reactions to chemotherapy differ among women.
Some women have many side effects. Other women
have few. Some side effects can be very serious
while others can be unpleasant but not serious.
Side effects of chemotherapy depend on the drug
type, amount taken, length of treatment, and the
person. In general, side effects are caused by the
death of fast-growing cells. These cells are found
in the hair follicles, gut, mouth, and blood. Thus,
common side effects of chemotherapy include
low blood cell counts, not feeling hungry, nausea,
vomiting, diarrhea, hair loss, and mouth sores.
Other side effects of chemotherapy may include
anxiety, fatigue, and peripheral neuropathy.
Peripheral neuropathy is numbness or tingling
of nerves in the hands and feet. Some types of
chemotherapy, such as anthracyclines, can cause
damage to the heart.