Targeted and immunotherapy drugs for breast cancer
You might have targeted or immunotherapy drugs as part of your treatment for breast cancer.
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
quality of life
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.
Tests on your cancer cells
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.
Types of targeted and immunotherapy drugs for breast cancer
There are many different types of targeted and immunotherapy drugs. We describe some of the drugs used for breast cancer below.
Your doctor can tell you whether any of these treatments are suitable for you.
Your doctor might recommend you have a drug called abemaciclib. You might have it with:
- an aromatase inhibitor ( such as anastrozole, exemestane or letrozole)
- fulvestrant
This treatment is usually for people whose breast cancer has spread to in the armpit and has a high risk of coming back (recurrence). Your breast cancer must also be and .
Alpelisib is a type of targeted drug. It’s for people who have or secondary breast cancer and the cancer:
- is
hormone receptor positive - is
HER2 negative - has changes (mutation) in the gene known as PIK3CA
- has come back (recurred) after having a type of drug called a CDK4/6 inhibitor (for example abemaciclib, palbociclib, or ribociclib) with hormone therapy treatment
You may 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. You may have atezolizumab with a type of chemotherapy drug called nab-paclitaxel if you have .
It is for people with breast cancer that:
- cannot be removed by surgery
- has spread to surrounding tissue (locally advanced breast cancer)
- has spread to other parts of the body (secondary breast cancer)
Denosumab is a type of targeted drug called a .
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.
Everolimus is a type of cancer growth blocker. It stops some cancer cells from dividing and growing.
You might have everolimus if you have secondary breast cancer that is and . You have this drug if you are past the menopause (post menopausal). You take it with a hormone therapy drug called exemestane.
Neratinib belongs to a group of drugs called cancer growth blockers. They work by blocking the signalling processes that cancer cells use to divide.
You have neratinib treatment for if it is:
hormone receptor positive HER2 positive - and you have already had treatment with trastuzumab within the last year
Olaparib is a type of targeted drug called a . You might have this if you have a change in the or genes.
It is for people with breast cancer who have already had chemotherapy.
Your doctor might suggest palbociclib if you have locally advanced breast cancer. This means that the cancer has spread into the surrounding area such as the .
It is for people who have and breast cancer.
You usually have palbociclib in combination with hormone therapy such as anastrozole.
Pembrolizumab is a type of immunotherapy. It is a possible treatment for people with
You usually have pembrolizumab with chemotherapy before surgery (neo adjuvant treatment). This is to reduce the size of the cancer before surgery. You then continue to have it on its own after your surgery (adjuvant treatment).
Pertuzumab is also called Perjeta. It is a type of . You might have it if you have breast cancer.
You usually have pertuzumab alongside other drug treatments such as trastuzumab and chemotherapy if you have:
- early breast cancer that is at high risk of coming back
- breast cancer that has spread to surrounding tissue (locally advanced breast cancer)
- a rare type of breast cancer called inflammatory breast cancer
- cancer spread in the
lymph nodes
Ribociclib is a type of targeted cancer drug called a . You might have it if you have and breast cancer.
You usually have ribociclib in combination with hormone therapy such as anastrozole.
Sacituzumab govitecan is a type of targeted drug. It’s for people with breast cancer that has spread to surrounding tissue (locally advanced). Or for people whose cancer has spread to other parts of the body (secondary breast cancer) and is:
- a type called triple negative breast cancer and
- not suitable for surgery
You must have had two or more drug treatments beforehand. This must include treatment for secondary breast cancer.
Talazoparib is a type of targeted drug called a .
It’s for people with breast cancer who have an abnormal change (mutation) in the or genes.
You might have this if your breast cancer has spread to surrounding tissue (locally advanced). Or if it has spread to other parts of the body (secondary breast cancer).
To have talazoparib you usually must already have had:
- hormone therapy for
hormone receptor positive breast cancer - a type of chemotherapy called an
anthracycline or taxane or both
You might be able to have talazoparib if you were unable to have the treatments above.
Trastuzumab is a type of also known by its brand name Herceptin, Herzuma and Ontruzant. It is a treatment for breast cancer.
You might have trastuzumab:
- on its own
- in combination with other drug treatments such as chemotherapy, hormone therapy or another type of targeted drug
- with other treatments, such as radiotherapy
You might have it before or after surgery.
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.
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.
Tucatinib is a type of targeted drug called a . You usually have tucatinib in combination with:
You might have these drugs if you have breast cancer that has spread to:
- surrounding tissue (locally advanced) or
- other parts of the body (secondary breast cancer)
You must have already had 2 or more treatments for HER2 positive breast cancer before having this treatment.
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.
Research
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.
When you go home
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.
