How to treat stage 4 breast cancer? Is it curable? There is an answer

What Is Stage 4 Breast Cancer?

Stage 4 breast cancer is when cancer has spread beyond the breast and nearby lymph nodes to other parts of the body. Common sites of metastasis include the bones, liver, and lungs. It may also spread to the brain or other organs.

Treatment Approaches for Stage 4 Breast Cancer

For women diagnosed with stage 4 breast cancer, systemic drug therapy is the primary treatment. This may include:

Surgery or radiation may be helpful in certain situations. These treatments often shrink tumors, slow cancer growth, improve symptoms, and help extend survival. However, this stage is considered incurable.

Drug Treatments for Stage 4 Breast Cancer

Treatment continues until the cancer grows again or side effects become intolerable. If that happens, another medication may be considered.

The choice of drug depends on:

Hormone receptor status
HER2 status
Presence of specific gene mutations

Receptor-Based Treatment Options

1. Hormone Receptor Positive (HR+) Breast Cancer

Women with estrogen or progesterone receptor–positive breast cancer may receive hormone therapy first, such as:

Tamoxifen
Aromatase inhibitors
These are often combined with targeted agents like CDK4/6 inhibitors.

Premenopausal women may receive tamoxifen or ovarian suppression with other medications.

2. Hormone Receptor Negative Breast Cancer

Chemotherapy is the main treatment since hormone therapy is not effective.

3. HER2-Positive Breast Cancer

First-line treatments often include chemotherapy combined with HER2-targeted drugs:

Trastuzumab (Herceptin)
pertuzumab (Perjeta)

If the cancer is also hormone receptor–positive, hormone therapy may be added.

For HER2-low metastatic cases, fam-trastuzumab deruxtecan (Enhertu) may be considered.

4. Patients with BRCA Gene Mutations

Targeted PARP inhibitors are commonly used:

olaparib
talazoparib

Chemotherapy and hormone therapy may also be beneficial.

5. Triple-Negative Breast Cancer (TNBC)

Immunotherapy combined with chemotherapy may be used in tumors expressing PD-L1 (found in ~20% of TNBC cases).

For TNBC with BRCA mutations, PARP inhibitors such as olaparib or talazoparib may be used.

olaparib
talazoparib

If no specific mutations are found, treatment may include:

Chemotherapy alone
Sacituzumab govitecan (Trodelvy), an antibody-drug conjugate

6. Cancers With MSI-H or MMR Deficiency

Patients with these gene abnormalities (MLH1, MSH2, MSH6, PMS2) may be treated with:

Pembrolizumab, an immunotherapy drug.

Pembrolizumab may also be used for certain TNBC cases.

Localized Treatments for Stage 4 Breast Cancer

Radiation or surgery may be used when:

The breast tumor causes open wounds or pain
Treating a limited number of metastases, such as in the brain
Preventing or treating bone fractures
Cancer compresses the spinal cord
Treating blocked blood vessels in the liver
Relieving pain or other symptoms

Intrathecal Chemotherapy

This involves delivering chemotherapy directly into the fluid around the brain and spinal cord and may be useful in select cases.

Summary: Treatment Goals in Stage 4 Breast Cancer

Although stage 4 breast cancer cannot be cured, modern treatments help control symptoms, slow progression, and improve quality of life. Many patients live longer and better lives with personalized treatment tailored to their cancer type and drug response.