NCCN Guidelines for Patients
Breast Cancer – Metastatic (STAGE IV), Version 2.2017
Hormone receptor–negative cancers
If you’re still premenopausal, chemotherapy may
cause menopause. However, don’t depend on
chemotherapy for birth control. You may become
pregnant while on chemotherapy, which can cause
birth defects. If you had menstrual periods before
chemotherapy, use birth control but not birth control
with hormones (eg, “the pill”).
Not all the side effects of chemotherapy are listed
here. Please ask your treatment team for a complete
list. If a side effect bothers you, tell your treatment
team. There may be ways to help you feel better.
There are five targeted therapies for hormone
receptor–negative breast cancer. All but one involves
HER2. As explained on page 19, some breast
cancers have many HER2s. HER2 targeted therapy
uses the HER2s to treat HER2-positive cancer.
Cancer cells need the food and oxygen in blood to
grow. Cancer cells get blood from blood vessels
that have grown into the tumor. VEGF (
actor) is one of the molecules
that triggers the growth of these blood vessels.
Targeted therapies involving HER2 or VEGF are
stop the action of HER2.
Antibodies work outside of the cell. HER2 antibodies
attach to HER2 and prevent growth signals from
See Figure 11.
Trastuzumab and pertuzumab are given by infusion.
It takes about 90 minutes to get the first dose of
trastuzumab and about 30 minutes for later doses.
For pertuzumab, it takes about 60 minutes to get the
first dose and about 30 to 60 minutes for later doses.
You may have a mild flu-like response to the first
dose of trastuzumab that includes fever, chills,
headache, muscle aches, and nausea. This response
is less common with the second and third doses.
Other side effects may include damage to the heart
and rarely to the lungs.
Common side effects of pertuzumab are diarrhea,
nausea, and feeling tired and weak. Less common
side effects include skin rash, low white blood
cell counts, and mouth sores. It is not yet clear
if pertuzumab damages the heart, although
trastuzumab may do so.
chemotherapy. As a targeted therapy, HER2
conjugates attach to HER2s then enter the cell. Once
inside, chemotherapy is released.
Ado-trastuzumab emtansine is given by infusion. It
takes about 90 minutes to get the first dose and 30
minutes for later doses. It is given every three weeks.
Common side effects include headache, nausea,
tiredness, diarrhea or constipation, nosebleeds, and
pain in your muscles, joints, or bones. Other side
effects may include damage to the heart, liver, or
stop the action of HER2. Inhibitors
work inside the cell. HER2 inhibitors attach to HER2
and stop growth signals.
See Figure 11.
Lapatinib is made as a pill that is taken every day
one hour before or after a meal. Common side
effects include diarrhea and skin rash. Your hands
and feet may become red, swollen, numb, and
painful. Less common side effects include fatigue,
vomiting, headaches, shortness of breath, and
heartburn. Other side effects include heart, liver, and
stop the action of VEGF. For
breast cancer, VEGF inhibitors attach to VEGF. Once
attached, VEGF cannot attach to endothelial cells
and start growth signals.