Maintenance therapy for advanced breast cancer is a long-term treatment option that aims to keep the cancer from growing or progressing. Maintenance therapy, which may include chemotherapy, immunotherapy or targeted treatments, can significantly improve overall and progression-free survival.
The type of maintenance therapy you are offered may depend on your tumor type, general health and response to previous treatments you may have received.
How does maintenance therapy differ from initial therapy?
After you undergo initial treatment for advanced breast cancer, your doctor may suggest maintenance therapy as a sustained treatment to help prolong your treatment response.
Maintenance therapy may be used regardless of whether you experienced a complete response to treatment. In some cases of advanced breast cancer that don’t fully respond to initial therapy, for example, maintenance therapy may help slow tumor growth and improve patient outcomes.
Depending on your specific treatment plan, the side effects from maintenance therapy can be different from those you experienced during initial treatment. For some, the symptoms can be milder.
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Maintenance therapy in HER2-positive breast cancer
Patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer may be eligible for treatments designed specifically to target this receptor. These include trastuzumab and pertuzumab.
Patients who are also hormone receptor (HR)-positive may receive endocrine therapy as part of their maintenance regimen.
Maintenance therapy in HR-positive, HER2-negative breast cancer
Patients with advanced HER2-negative cancer aren’t eligible for HER2-targeting drugs, as their cancer cells don’t carry the necessary receptors. If they have HR-positive cancer, though, they can take endocrine therapy.
Another class of drug called CDK4/6 inhibitors may form part of the long-term treatment plan in combination with endocrine therapy among those with HR-positive, HER2-negative cancer.
While evidence does suggest that endocrine therapy may be more effective in extending survival, some individuals with this type of cancer may be candidates for maintenance chemotherapy as well.
Maintenance therapy in triple-negative breast cancer
Patients with advanced or metastatic triple-negative breast cancer may receive low-dose maintenance chemotherapy, which can often be taken orally.
Recent evidence suggests that immunotherapies like pembrolizumab may also function well as maintenance therapy in people with advanced triple negative breast cancer whose tumors test positive for programmed death ligand-1 (PD-L1).
Managing side effects during long-term treatment
Unfortunately, maintenance therapy can cause side effects that range from mildly uncomfortable to severe and can impact nearly any body system. Some general tips for supporting your overall well-being throughout treatment include:
- Making sure to stay well-hydrated.
- Trying smaller meals if you experience nausea or abdominal discomfort.
- Opting for gentle physical activity.
- Staying well-rested and keeping a regular sleep schedule.
Even if your side effects are less intense than they were during your initial treatment, you should still reach out to your doctor to discuss adjusting your dose or switching medications if your symptoms are negatively impacting your quality of life.
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