Chemotherapy for Breast Cancer Treatment

What is chemotherapy?

Chemotherapy is the use of anti-cancer drugs to treat cancerous cells. Chemotherapy reaches all parts of the body, not just the cancer cells. The oncologist will recommend a treatment plan for each individual. Specific treatment will be based on:

• Your overall health and medical history

• Your age and whether you are menstruating

• The type and stage of the cancer

• Your tolerance for specific medications and procedures

• Expectations for the course of the disease

• Your opinion or preference

The oncologist will also determine how long and how often you will have chemotherapy treatments. Chemotherapy can be administered intravenously (in the vein) or by pill, and is usually a combination of drugs. Chemotherapy treatments are often given in cycles; a treatment for a period of time, followed by a recovery period, then another treatment. Chemotherapy may be given in a variety of settings including your home, a hospital outpatient facility, a physician's office or clinic, or in a hospital.

Chemotherapy can be given before surgery to shrink the tumor and sometimes make breast conserving surgery possible rather than a mastectomy. Many times it is given after surgery and may be given every three weeks or every two weeks in a “dose dense” fashion.

What are the different types of chemotherapy drugs used for breast cancer treatment and their potential side effects?

As each person's individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins. Most side effects disappear once treatment is stopped.

• Doxorubicin (Adriamycin®). Doxorubicin (Adriamycin) is an intravenous medication. Doxorubicin is red in color, and it turns urine red for several hours following treatment. Women who receive doxorubicin often experience mouth sores and hair loss. This drug is most often given with cyclophosphamide. This drug combination is referred to as “AC.” Four to six cycles of treatment over three to six months are commonly administered for breast cancer.

• Cyclophosphamide (Cytoxan®). Cyclophosphamide (Cytoxan) is an anticancer drug that can be given either intravenously or orally in tablet form. The intravenous drug is clear. Cyclophosphamide can cause irritation of the lining of the urinary bladder and often nausea and vomiting. This drug is most often given with doxorubicin. This drug combination is referred to as “AC.” Four to six cycles of treatment over three to six months are commonly administered for breast cancer.

• Methotrexate (Folex®, Mexate®, Amethopterin®). Methotrexate is an anticancer drug that is usually given intravenously for women with breast cancer. The drug is yellow in color. Some women who receive methotrexate experience mouth sores following treatment. This drug is most often given with both cyclophosphamide and fluorouracil. This drug combination is referred to as “CMF.” Four to six cycles of treatment over three to six months are commonly given for breast cancer.

• Fluorouracil.  Fluorouracil (5FU) is an anticancer drug that is given intravenously. The intravenous drug is clear. For some women, fluorouracil can cause mouth sores and diarrhea. This drug is most often given with both cyclophosphamide and methotrexate. This drug combination is referred to as “CMF.” Four to six cycles of treatment over three to six months are commonly given for breast cancer.

• Epirubicin (Ellence®). Ellence is a new drug similar to doxorubicin and is given intravenously. Its side effects are much the same as those caused by doxorubicin.

• Paclitaxel (Taxol®), docetaxel (Taxotere®), paclitaxel (Abraxane™). These drugs belong to a group of drugs called taxanes. Taxol has been approved for treating early and advanced breast cancer. Taxotere has been approved for treatment of locally advanced or metastatic breast cancer. Abraxane is approved for use in advanced or recurrent breast cancer. Abraxane is a new formulation of paclitaxel that can be given over thirty minutes as opposed to three hours for Taxol and there is less likelihood of an adverse reaction to the drug. These drugs can cause mild allergic reactions (like fever, flushing, hives, and itching), peripheral neuropathy - which is numbness and tingling in the hands and feet; diarrhea, nausea and vomiting.

• Capecitabine (Xeloda®). Xeloda is an oral chemotherapy that is converted into fluorouracil at the cellular level and is sometimes used for advanced cancer. It can cause diarrhea, nausea, mouth sores, and hand-foot syndrome (tingling, numbness, rain, redness or swelling of the hands or feet.).

• Gemcitabine (Gemzar®). An antimetabolite used in treating advanced breast cancer. For some women, gemcitabine can cause loss of appetite, hair thinning, diarrhea, and nausea.

• Vinorelbine (Navelbine®). Navelbine is sometimes used to treat advanced breast cancer. It can cause nausea, vomiting, mouth sores, and hair loss.

• Ixabepilone (Ixempra®). Ixabepilone is a new drug shown to reduce tumor size or slow tumor growth in some patients with advanced or metastatic breast cancer. This drug belongs to a class of drugs called epothilone analogs, that work by binding to and interfering with structures called microtubules. Microtubules play a major role in cell division. Thus, cancer cell growth is slowed in the body. The drug is given by intravenous infusion once every three weeks. It can cause low white counts, low platelet counts, numbness or tingling in the hands or feet, constipation, nausea, and muscle and joint pain.

All of these drugs can cause changes in your blood counts that can make you feel very tired and make it harder for you to fight infections. Again, talk to your health care team about what side effects you should watch for and which, if any, need to be reported to the doctor right away. In most cases, there are things that can be done to help control or even prevent chemotherapy side effects.