Targeted and immunotherapy drugs for breast cancer
You might have immunotherapy or targeted cancer drugs as part of your treatment for breast cancer. The most common way to have it is before and after breast cancer surgery.
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.
Immunotherapy uses our to fight cancer. It works by helping the immune system recognise and attack cancer cells.
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
These drugs are used in different situations to treat breast cancer. The most common way to have it 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 you can have a smaller operation. For example, you might be able to have just the tumour removed (a lumpectomy) instead of 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 you. Some are only available if the breast cancer cells have certain receptors. Your doctor does various tests on the cancer cells to find this out.
For example, 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. So in this situation, you might have treatment that targets these HER2 receptors. An example of treatment that targets this receptor is such as trastuzumab.
You might have this type of treatment on its own, with other targeted or immunotherapy drugs, or with other treatments such as chemotherapy or hormone therapy.
Your doctor may also check for a protein called PD-L1 on the surface of cancer cells if you have 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 large amounts a substance 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:
You might be able to have neratinib if:
you 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 in combination 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
This treatment is made up of 2 drugs, trastuzumab and deruxtecan.
You might have this if you have breast cancer that:
cannot be removed by surgery (unresectable) or
has spread to other parts of the body (secondary breast cancer)
It's for people who have already had treatment for HER2 positive breast cancer.
Some people with breast cancer that has low levels of HER2 (HER2 low breast cancer) may have trastuzumab deruxtecan for unresectable or secondary breast cancer, if they have already had chemotherapy. Or if the cancer has come back during chemotherapy, or within 6 months of finishing it. This is available on the NHS in Scotland. But it hasn't been approved for use on the NHS in England, Wales and Northern Ireland.
Trastuzumab emtansine (Kadcyla) is a combination of 2 drugs:
trastuzumab
a chemotherapy drug called emsatine
It is a treatment for HER2 positive after surgery. It is only for people who had drug treatment before surgery. And when they had the operation the surgeon found cancer cells nearby either in the breast or lymph nodes.
It is also a treatment for HER2 positive locally advanced or secondary breast cancer. You might have it if:
the surgeon cannot remove your cancer
you have already had trastuzumab and chemotherapy drugs), either together or separately
Trastuzumab emtansine 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.
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
All treatments have side effects. These vary depending on the type of treatment you have. Side effects also vary from person to person. The side effects you have depend on:
whether you have it alone or with other treatments
the amount of drug you have (the dose)
how long you have had treatment for
your general health
Targeted therapy drugs and immunotherapy drugs can cause serious side effects. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you. Some of the common side effects include:
tiredness (fatigue)
loss of appetite
low levels of blood cells
feeling or being sick
skin changes such as red and sore skin or an itchy rash
flu-like symptoms such as chills, fever, dizziness
diarrhoea
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. Last updated June 2023
Early Breast Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
F Cardoso and others
Annals of Oncology, 2019. Vol 30, issue 8. Pages 1194-1220
Updated UK Recommendations for HER2 assessment in breast cancer
E A Radha and others
Journal of Clinical Pathology, 2015. Volume 68, PAges 93 -99
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.
