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Biological therapy for secondary breast cancer

Biological therapies are treatments that stop signals that tell cancer cells to grow. Some types of biological therapy can shrink secondary breast cancer or stop it from growing to keep it under control for some time. Treatments used in the UK for secondary breast cancer include Herceptin (trastuzumab), lapatinib (Tyverb), pertuzumab (Perjeta), everolimus (Afinitor) and denosumab (Prolia, Xgeva).

Herceptin (trastuzumab)

Trastuzumab is the most commonly used biological therapy for secondary breast cancer. It is a monoclonal antibody that targets cells that make too much of a growth stimulating protein called HER2. Up to 3 out of 10 secondary breast cancers that have spread (30%) make too much of this protein. You have Herceptin by drip or as an injection under the skin. You usually have it every week or every 3 weeks for as long as it keeps the cancer under control. It may be combined with chemotherapy or you may have it in trials with other biological therapy drugs. 

Lapatinib (Tyverb)

Lapatinib is sometimes used with a chemotherapy drug called capecitabine (Xeloda) for advanced breast cancers that have receptors for HER2 on their cells. You have it as daily tablets. 

Pertuzumab (Perjeta)

Pertuzumab is sometimes used to treat breast cancer that has spread or that has come back in the breast. You have it into a vein. It is given with herceptin and a chemotherapy drug called docetaxel. 

Everolimus (Afinitor)

Everolimus is a type of cancer growth blocker called an mtor inhibitor. It can help to treat advanced breast cancer. You take it as daily tablets. It is given alongside the hormone therapy drug exemestane (Aromasin).

Denosumab (Prolia, Xgeva)

Denosumab (pronounced den-oh-sue-mab) is a type of monoclonal antibody. When cancer spreads to the bones it can weaken them and cause pain. Denosumab helps to strengthen the bones, which lowers the risk of fractures and helps to control pain. You have it as an injection just under your skin (subcutaneously) every 4 weeks or every 6 months.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Secondary breast cancer section.

 

 

Types of biological therapy

Biological therapy is treatment that stops signals that tell cancer cells to grow. Herceptin (trastuzumab) is the main type of biological therapy used to treat secondary breast cancer. Other drugs include lapatinib (Tyverb), pertuzumab (Perjeta), and everolimus (Afinitor). A drug called denosumab (Prolia, Xgeva) can help to strengthen bones and reduce pain in women whose cancer has spread to the bone.

 

Trastuzumab (Herceptin)

Herceptin (trastuzumab) is a type of monoclonal antibody that attaches to breast cancer cells that have a large amount of a protein called HER2. It is also called trastuzumab. Up to 3 out of 10 breast cancers that have spread (30%) are likely to respond to treatment with Herceptin. 

HER2 protein is a growth factor receptor. It transmits signals from outside the cell to the inside, which make the cells grow. The Herceptin antibody attaches itself to this protein receptor and blocks it. So the receptor can no longer tell the cancer cells to grow. Herceptin also increases the effect of chemotherapy drugs on breast cancer cells.

You usually have Herceptin in combination with the chemotherapy drug paclitaxel (Taxol) if you have not had chemotherapy before for secondary breast cancer. 

If you have already had chemotherapy treatments for advanced breast cancer you may have Herceptin alone or in combination with other treatments such as chemotherapy or hormone therapy.

You have Herceptin into a vein, through a drip or central line. The first dose takes about an hour and a half. But after that you have it over 30 to 60 minutes each time. You have Herceptin every week, or every 3 weeks, for as long as it keeps your cancer under control. Doctors usually stop or change the treatment if the cancer starts to grow or spread again, unless it has only spread within the brain and spinal cord (the central nervous system). 

Some research seems to suggest that Herceptin may help some people to live longer even if the cancer continues to grow during treatment but we need more research to be sure. Research studies are looking at different ways of giving Herceptin. 

We have detailed information about the side effects of trastuzumab (Herceptin).

 

Lapatinib (Tyverb)

Lapatinib (Tyverb) stops cancer cells growing by blocking the activity of 2 receptors – epidermal growth factor receptor 1 and HER2. You take it as a daily tablet. It is most commonly used with a chemotherapy drug called capecitabine (Xeloda) for secondary or locally advanced HER2 positive breast cancer if other treatments, including Herceptin, are not working. Lapatinib and capecitabine are both taken as tablets so you can usually have this treatment at home after the first dose.

Lapatinib is sometimes used in combination with hormone therapy drugs called aromatase inhibitors in women who have hormone receptor positive and HER2 positive breast cancer. It is also used in combination with Herceptin for patients with hormone receptor negative advanced breast cancer that has continued to grow while having Herceptin in combination with chemotherapy.

You take it for as long as it controls the cancer.

You can find out more about the side effects of lapatinib (Tyverb).

 

Pertuzumab (Perjeta)

Pertuzumab is sometimes used to treat breast cancer that has spread or that has come back in the breast. It targets the HER2 protein but blocks a different part of the protein to herceptin. You have pertuzumab in combination with herceptin (trastuzumab) and a chemotherapy drug called docetaxel (Taxotere)

You have pertuzumab by drip into your vein. We have information about pertuzumab and its side effects.

 

Everolimus (Afinitor)

Everolimus is pronounced ever-oh-lih-mus. It is also known by its brand name Afinitor. It is a type of cancer growth blocker called an mtor inhibitor. It stops some cancer cells from dividing and growing. The National Institute for Health and Care Excellence (NICE) has looked at whether it should be available with the hormone therapy exemestane (Aromasin) for women whose breast cancer is advanced, HER2 negative and has grown with other treatments. NICE does not recommend it as a treatment on the NHS because it says that it is not cost effective. But doctors can apply to use it under the Cancer Drugs Fund.

Trials in the UK are looking at using everolimus with chemotherapy, hormone therapy or other types of biological therapy, for HER2 positive breast cancer that has spread outside the breast. 

 

Denosumab (Prolia, Xgeva)

Denosumab (pronounced den-oh-sue-mab) is a type of monoclonal antibody. There are 2 brands – Prolia and Xgeva (pronounced ex-jeev-ah). When cancer spreads to the bones it can cause pain and weaken them. When the bones are weaker they break more easily. If your cancer has spread to your bones your doctor may suggest that you have denosumab. It can strengthen the bones to lower the risk of fractures and help to control pain. You have it as an injection just under your skin (subcutaneously).  

We have detailed information about denosumab and its side effects. You can also find out more about controlling bone pain and weakened bones.

 

Biological therapies for men with breast cancer

Because breast cancer is very rare in men, research trials into biological therapies for breast cancer have only been carried out in women. So we don't know how well biological therapies will work in men. But you may still be able to have biological therapy treatment. We have general information about breast cancer treatment in men.

 

Side effects of biological therapy for breast cancer

The side effects vary depending on which biological therapy drug you have. But the possible side effects of biological therapies for breast cancer include

Tell your doctor or chemotherapy nurse if you have any of these effects as you can have medicines to help to control them. There is information about the side effects of individual biological therapies in our cancer drugs section.

 

Research into biological therapies

Other biological therapies being researched in breast cancer trials include 

In some trials particular drugs are combined with chemotherapy to see if they improve the results of treatment. 

You can find details of these trials on our clinical trials database.

 

More about biological therapies

If you want to know more about biological therapy, you can talk to your doctor or the nurses involved in your treatment. There is general information in our biological therapy section

You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. They will be happy to answer any questions that you have.

Our breast cancer organisations page gives details of other people who can provide information about breast cancer and its treatment. Some organisations can put you in touch with a cancer support group. There are books and booklets about biological therapy, some of which are free. Look at our breast cancer reading list.  

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 11 August 2014