Targeted and immunotherapy drugs for breast cancer
You might have targeted or immunotherapy drugs as part of your treatment. It depends if your breast cancer cells have certain receptors. Drugs include trastuzumab, pertuzumab and pembrolizumab.
What are immunotherapy and targeted cancer drugs?
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the to attack cancer. They are called immunotherapies.
Some drugs work in more than one way. So they are targeted as well as working with the immune system.
When you might have targeted and immunotherapy drugs
This depends on:
what your breast cancer has
the of your cancer
The most common time to have this treatment is before and after breast cancer surgery.
Before surgery
Treatment before surgery is called neo adjuvant therapy. You may have it to try to shrink a large cancer. This might mean that your surgeon can remove just the cancer (a lumpectomy) instead of the whole breast (a
After surgery
This is called adjuvant treatment. The aim of this treatment is to lower the risk of the cancer coming back. You may also have targeted and immunotherapy drugs instead of surgery, if surgery is not an option for you.
For secondary breast cancer
Breast cancer can spread to other parts of the body such as the lungs and bones. This is secondary breast cancer. Targeted and immunotherapy drugs are possible treatments for secondary breast cancer. They can:
relieve symptoms
reduce the size of the cancer
improve your
There is a lot of research looking at targeted drugs for breast cancer. You may hear about new drugs as they become available. Do ask your doctor or nurse if you have any questions, they will explain if any new treatment is suitable for you.
Not all targeted and immunotherapy drugs are suitable for everyone. It depends if your breast cancer cells have certain receptors. You have tests on the cancer cells to find this out.
HER2
Some breast cancers have a change which means that they produce large amounts of a protein called human epidermal growth factor receptor 2 (HER2). These are called HER2 positive breast cancers.
You usually have treatment that targets HER2 receptors if you have HER2 positive breast cancer. For example trastuzumab.
PD-L1
Your doctor may check for a protein called PD-L1 on the surface of cancer cells if:
you have
it has spread to another part of your body - this is called secondary triple negative breast cancer
To test your cancer cells, doctors need a sample of your cancer. They may be able to use a sample from a biopsy or operation you have already had.
Alpelisib is a type of targeted drug called a cancer growth blocker. It blocks a protein called phosphatidylinositol 3 kinase (PI3K). It is also called a PI3K inhibitor.
Who is it for?
Alpelisib is for breast cancer that:
is
is
has changes (mutation) in the gene known as PIK3CA
It is a treatment option for:
To have alpelisib your cancer must have come back after treatment with both:
an such as anastrozole, exemestane or letrozole
a type of cancer growth blocker called a cyclin dependant kinases (CDK) inhibitor (abemaciclib, palbociclib or ribociclib)
Other treatments you have
You have alpelisib with a hormone therapy called fulvestrant. Your doctor will tell you more about this treatment and if it’s available to you.
Atezolizumab is a type of immunotherapy called a checkpoint inhibitor. It works by blocking a protein called PD-L1 that stops the from working properly.
Who is it for?
Atezolizumab is for people with breast cancer that:
is
has high levels of a protein called PD-L1
It is a treatment option for:
You might be able to have atezolizumab if:
it is not possible to remove your cancer with surgery
you haven't already had chemotherapy for breast cancer that has spread
Other treatments you have
You have atezolizumab with a type of chemotherapy drug called nab-paclitaxel.
When cancer spreads to the bones it can cause pain and weaken them. Your doctor may suggest you have denosumab. It can strengthen the bones, lower the risk of fractures and help to control pain.
Neratinib is a type of targeted drug. It targets a protein called human epidermal growth factor receptor 2 (HER2).
Who is it for?
Neratinib is for breast cancer that is:
It is a treatment option for:
To have neratinib you must have:
already had treatment with trastuzumab within the last year
Other treatments you have
You take neratinib after you have surgery, when you have finished treatment with trastuzumab. You start neratinib within 1 year of finishing trastuzumab.
Palbociclib is a type of cancer growth blocker. It targets the proteins cyclin dependant kinase 4 and 6 (CDK4 and CDK6) on cancer cells. It aims to slow or stop the growth of the cancer.
Who is it for?
Palbociclib is a treatment for breast cancer that is:
It is a treatment option for:
Other treatments you have
You usually have palbociclib together with hormone therapy such as:
anastrozole if you have not had hormone therapy before
fulvestrant if you have already had hormone therapy
Ribociclib is a type of targeted cancer drug called a . It targets proteins called cyclin dependant kinase 4 and cyclin dependant 6 (CDK 4 and CDK 6) on breast cancer cells.
Who has it?
Ribociclib is a treatment for breast cancer that is:
It is a treatment option for:
that has a high risk of coming back
Other treatments you have
You usually have ribociclib together with hormone therapy.
Sacituzumab govitecan is also called Trodelvy. It's a type of targeted cancer drug called an antibody drug conjugate (ADC). This means it is made up of 2 drugs:
sacituzumab – a type of targeted drug
govitecan or SN-38 – a chemotherapy drug
Who is it for?
It is for people with breast cancer that is:
It is a treatment option for:
You might be able to have sacituzumab govitecan if:
surgery is not a suitable option for you
you have had two or more drug treatments before - this must include treatment for secondary breast cancer
Trastuzumab is a type of also known by its brand name Herceptin, Herzuma and Ontruzant. It works by locking onto HER2 on the cancer cells. The aim is to stop the cells from growing and kills them.
Who can have it?
Trastuzumab is for breast cancer that is:
It is a treatment option for:
Other treatments you have
You might have trastuzumab:
on its own
with other drug treatments such as chemotherapy, hormone therapy or another type of targeted drug
Some people with breast cancer have low levels of HER2. This is called HER2 low breast cancer.
In Scotland, trastuzumab deruxtecan is available for for some people with HER2 low breast cancer. It is available on the NHS in Scotland if you have HER2 low breast cancer and:
you cannot have surgery or your cancer has spread
you have already had chemotherapy
your cancer has come back during chemotherapy, or within 6 months of finishing it
In England, Wales and Northern Ireland, trastuzumab deruxtecan is not available on the NHS for HER2 low breast cancer. The National Institute for Health and Care Excellence (NICE) have not approved it for use.
Trastuzumab emtansine (Kadcyla) is a combination of 2 drugs:
trastuzumab
a chemotherapy drug called emsatine
It works by finding and attaching itself to the HER2 protein on the surface of the cancer cell. The emtansine then goes inside the cancer cell to destroy it.
Who is it for?
Trastuzumab emtansine is for breast cancer that is:
It is a treatment option after surgery for if:
you had drug treatment before surgery and
when you had surgery, your surgeon found cancer cells nearby either in the breast or lymph nodes
It is a treatment option for or if:
the surgeon cannot remove your cancer
you have already had trastuzumab and chemotherapy drugs, either together or separately
Having targeted cancer drugs and immunotherapy treatment
You have your treatment as tablets or capsules or as a dip into your bloodstream. This depends on the type of drug you have.
Taking your tablets or capsules
You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Drip into your bloodstream
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.
Side effects
Everyone is different and the side effects vary from person to person. The side effects you have depend on:
which drug you have
whether you have it alone or with other drugs
the amount of drug you have (the dose)
your general health
A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.
It can be difficult to cope with the side effects of targeted and immunotherapy treatment. There are things you can do to help you cope with the side effects of cancer treatment.
Researchers are looking at new and different types of targeted and immunotherapy drugs for breast cancer.
They are also looking into different combinations. This includes combining them with chemotherapy or other types of drugs. They want to find out if they improve how well they work.
Treatment with immunotherapy or targeted cancer drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.
Contact your advice line if you have side effects or any concerns.
Early and locally advanced breast cancer: diagnosis and management
National Institute for Health and Care Excellence (NICE), 2018 (updated April 2025)
Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
S Loibl and others
Annals of Oncology, 2024. Volume 35, Issue 2, Pages 159 – 182
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.
