Sunday, February 18, 2024

Act Chemo For Breast Cancer

How Long Treatment Lasts

My Breast Cancer Taxol Chemotherapy Journey Round 4 – ACT red devil treatment & Symptoms

Youll usually have four to six cycles of AC chemotherapy, over three-four months. Both drugs are given on the same day, every three weeks.

The time between each cycle of treatment gives your body time to recover.

This may vary depending on whether the number of blood cells has returned to normal between each cycle.

When Is Chemotherapy Used

Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:

  • After surgery : Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but cant be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
  • Before surgery : Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed . Also, by giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesnt shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that have spread but cant be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.

For certain types of breast cancer, if there are tumor cells still found at the time of surgery , you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back .

Chemotherapy Regimens For Early

At some point, your medical oncologist will recommend a chemotherapy plan for you. Also called a chemotherapy regimen, the plan will have important details about your treatment, including:

  • which drugs youre receiving
  • the order in which you receive them
  • the amount of each drug
  • how often and how long you will need chemotherapy

Most women with early-stage breast cancer receive chemotherapy for approximately three to six months. Theres time in between treatments to allow your body to recover. If you are receiving targeted therapy for early HER2-positive breast cancer, treatment could last up to a year.

For some people, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between treatments. You will not need to have a larger dose of chemotherapy.

Research has shown that dose-dense chemotherapy can improve survival and lower the risk of the breast cancer coming back compared to a traditional chemotherapy schedule. Dose-dense chemotherapy does not result in more side effects.

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What Are The Side Effects Of Chemotherapy For Breast Cancer

Chemotherapy side effects vary based on what kind of drugs you take and for how long. Common chemotherapy side effects include:

During chemotherapy treatment, many people still work, exercise and care for their families. For others, the treatment can be exhausting and time-consuming. It may be difficult to keep up with usual activities.

Speak with your healthcare provider about the risks and benefits of chemotherapy. You may manage side effects with supportive medications, such as anti-nausea drugs. Chemotherapy side effects generally go away after you finish treatment.

An Abbreviated History Of Adjuvant Systemic Therapy

Patient with breast cancer and bone metastasis.A. CT sc

The initial approach to therapy for breast cancer was based on the premise that the disease metastasized via locoregional spread in an orderly fashion, and thus could be cured with aggressive surgery. The radical mastectomy was thus the standard surgical procedure for breast cancer in the early 20th century . Randomized trials subsequently showed no benefit from radical mastectomy compared with less aggressive surgical procedures, and demonstrated that distant recurrence remained a major clinical problem irrespective of the primary surgical therapy .

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What Are The Side Effects Of This Treatment

The following table lists side effects that you may have when getting AC or PACL treatment. The table is set up to list the most common side effects first and the least common last. You may not have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Keep the link to this page during your treatment so that you can refer to it if you need to.

Side effect and what to do

When to contact healthcare team

Who Might Be Offered Ac Chemotherapy

AC chemotherapy can be used to treat primary breast cancer breast cancer that hasnt spread beyond the breast or the lymph nodes under the arm. Sometimes its used in combination with other anti-cancer drugs. Chemotherapy is given to reduce the risk of breast cancer returning or spreading.

AC chemotherapy may be given before surgery, known as neo-adjuvant treatment , or after surgery, known as adjuvant treatment.

It may also be given to people with:

  • local recurrence breast cancer that has come back in the chest/breast area or in the skin near the original site or scar, but has not spread to other parts of the body
  • locally advanced breast cancer breast cancer that has come back and has spread to the tissues and lymph nodes around the chest, neck and under the breastbone
  • secondary breast cancer breast cancer that has spread to other parts of the body

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Hair Thinning Or Loss

  • Feeling like you need to pee badly all of a sudden.
  • Pain in your belly or lower belly area or pain when peeing.
  • If severe, you may have blood in your pee.

What to do:

  • Drink at least 6 to 8 cups of liquids per day on AC treatment days, unless your healthcare team has told you to drink more or less.
  • Tell your healthcare team if your pee is red for more than 2 days after your AC treatment or if you have other symptoms of bladder problems. Get emergency help right away for severe symptoms.

Talk to your healthcare team if it does not improve or if it is severe.

Immunohistochemistry And Molecular Classification

My Breast Cancer red devil Chemotherapy Journey Round 3- ACT treatment & Symptoms

All pathologic specimens were reviewed by two experienced pathologists who determined the status of ER, PgR, and HER2 using immunohistochemical techniques. According to the Allred scoring system, ER and PgR negativity was defined as a total score from 0-2 by IHC using antibodies to the ER and PgR . According to National Comprehensive Cancer Network guidelines, HER2 was assessed using IHC techniques and/or fluorescence in situ hybridization . IHC grades 0 and 1 were defined as a negative result for HER2, and the lack of HER2 amplification was confirmed by FISH if HER2 was rated 2+ by IHC. Triple negativity was defined as a lack of expression of ER, PgR, and HER2. The HER2+ subtype was defined as HER2-positive with ER- and PR-negative, while hormone receptor-positive was defined as ER- and/or PR-positive, regardless of HER2-positivity subtypes. Ki-67 growth fractions and p53 status were assessed using antibodies: Ki-67 , and p53 . The percentage of positive nuclei stained for Ki-67 was calculated for each section based on approximately 1,000 carcinoma cell nuclei. High proliferative index was defined as 50% or more stained nuclei. Immunoreactivity of p53 was defined as greater than 5% of cells having distinct nuclear staining.

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Chemotherapy For Metastatic Breast Cancer

Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.

Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.

Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:

Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.

Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.

What Types Of Breast Cancer Should Be Treated With Chemotherapy

Almost all women with HER2-positive cancers still need some amount of chemotherapy. And women with triple-negative tumors still need a relatively intensive course of chemotherapy, Dr. Lustberg says.

Chemotherapy may also be used to treat certain larger HR-positive cancers that have spread to lymph nodes, even if the tumor is estrogen-positive. “Specialized testing can determine which of these breast cancers will benefit from chemotherapy,” Dr. Lustberg says. Because of the personalized therapy made possible by these predictive biomarkers, the use of chemotherapy in lymph node-negative and lymph node-positive HR-positive cancers has decreased in recent years, with excellent clinical outcomes.

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How Will This Treatment Affect Sex Pregnancy And Breast Feeding

Talk to your healthcare team about:

  • How this treatment may affect your sexual health.
  • Changes to your menstrual cycle , if this applies to you.
  • Symptoms of menopause such as hot flashes, vaginal dryness or changes in your mood, if this applies to you.
  • How this treatment may affect your fertility .

This treatment may harm an unborn baby. Tell your healthcare team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

  • If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until 6 months after your last treatment dose and until 12 months after your last treatment dose . Talk to your health care team about which birth control options are best for you.
  • Do not use hormonal birth control , unless your healthcare team told you that they are safe. Talk to your healthcare team about the safest birth control for you.
  • Do not breastfeed while on this treatment.

Will I Be Able To Work While I Am Having Treatment

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Most women are able to continue working during chemotherapy if they wish to. If you plan to keep working, it helps to have a supportive work place that gives you flexible work hours. You may need to have a few days off after each cycle of chemotherapy and when you get back to work you may find it difficult to work long hours. Your doctor can provide a medical certificate for time off this can be just a few days or a few months depending on your individual situation.

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If You Have Any Of The Following Talk To Your Cancer Healthcare Team Or Get Emergency Medical Help Right Away:

  • Irregular heartbeat, shortness of breath or chest pain
  • Sudden, severe pain in your belly or arm
  • Sudden confusion, trouble speaking or difficulty moving your arms or legs
  • Coughing up blood or trouble breathing
  • Pain and swelling of a vein in your arm or leg
  • Any changes in your vision
  • Severe bloating or feeling of fullness
  • Belly pain that extends to your back
  • Passing out or seizure
  • Severe rash that causes your skin to blister or peel

For more information on how to manage your symptoms, ask your healthcare provider or go to Managing Symptoms, Side Effects & Well-Being.

The information set out in the medication information sheets, regimen information sheets, and symptom management information contained in the Drug Formulary is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

For Metastatic Breast Cancer

Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.

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Do I Need Genetic Counseling And Testing

Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.

If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.

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What If I Have Side Effects

My Breast Cancer Taxol Chemotherapy Journey Round 2 – ACT red devil treatment & Symptoms

You will see your doctor regularly while you are having treatment. Before each dose of chemotherapy you will have a blood test and a consultation with your medical oncologist to review your treatment. You will be able to discuss any side effects you have experienced and to ask questions. If necessary, the treatment can be adjusted for the next cycle.

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How Has A Better Understanding Of Breast Cancer Changed Treatment

Years ago, people thought about breast cancer as a single, monolithic, often life-threatening disease. The disease was subdivided into four stages: In Stage I, the tumor is small and has not spread beyond the original site with Stage II and III cancers, the tumor is larger than in Stage I and may have spread to the lymph nodes and in Stage IV, cancer has spread, or metastasized, to other parts of the body.

Outside of their stages, these cancers were thought to be the same disease, and every patient was given the same treatment.

But stage is really just the amount of cancer, Dr. Winer says. And while the stage is still part of determining treatment, its more important to take into account the type of cancer, he adds.

To that end, the types of breast cancers are categorized by their hormone receptors and whats called HER2 status.

Breast cancer cells that contain receptors for hormones like estrogen and/or progesterone are said to be hormone receptor -positive. And cancer cells that have high levels of receptors are called human epidermal growth factor receptor 2 -positive.

Cancer cells that do not contain hormones or HER2 receptors are called hormone receptor -negative or HER2-negative, respectively.

And breast cancers that do not have receptors for estrogen, progesterone, and HER2 are known as triple-negative.

How Is Chemotherapy Given

Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.

Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.

There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the underarm that had lymph nodes removed for the breast cancer surgery.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced breast cancer depends on how well it is working and what side effects you have.

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