When Will I Start Chemotherapy And Targeted Therapy
In general, chemotherapy and HER2-targeted therapies are more likely to be given prior to surgery. Youll receive these treatments in cycles, with each period of treatment followed by a period of rest to let your body recover.
Chemotherapy begins on the first day of the cycle. Cycles can last anywhere from about two to four weeks, depending on the combination of drugs.
Chemotherapy generally lasts about three to six months. The total length of chemotherapy treatment may vary depending on the stage of breast cancer and a number of other factors.
Herceptin is usually given every three weeks for one year , initially in combination with chemotherapy and then on its own after chemotherapy is complete.
Can Oral Chemotherapy Be Effective
Oral chemotherapy can be as powerful and effective as traditional chemotherapy.
When it comes to oral therapy, following directions and not skipping doses is key. It takes commitment to track your medications and take them on time and in the right dose. It also takes a lot of communication between you and your oncologist.
How effective your therapy is depends on:
- the type of cancer
- how well your body responds to therapy
- the severity of your side effects
Talk with a doctor about what you can expect from oral chemotherapy.
Less Common Types Of Hormone Therapy
Some other types of hormone therapy that were used more often in the past, but are rarely given now include:
- Megestrol acetate , a progesterone-like drug
- Androgens , like testosterone
These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.
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Hormone Therapy After Surgery For Breast Cancer
After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.
These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:
- Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
- Tamoxifen for 2 to 3 years, followed by an AI for 5 years
- Tamoxifen for 4Â½ to 6 years, followed by an AI for 5 years
- Tamoxifen for 5 to 10 years
- An AI for 5 to 10 years
- An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
- For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option
For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.
These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosedï»¿:
Drug Interactions And Supplements
Coumadin and other blood thinners are drugs that interact with Xeloda. It’s important to note that some nutritional supplements may also work as blood thinners, and you should talk to your oncology team before taking them.
In those 80 years old or older, Xeloda may cause more diarrhea, nausea, and vomiting than in younger people.
Hand-foot syndrome can occur with Xeloda. It often starts with darkening of the palms of the hands and soles of the feet. As it progresses, it can become more like a sunburn. There are several things you can do to help prevent this including keeping your hands and feet cool, wearing good shoes, and not going barefoot.
Xeloda can cause , which means you may get a sunburn more easily. Consider the following precautions to help protect your skin:
- Avoid sun exposure if possible
- Use a good sunscreen
- Cover up using UV clothes, hats, or an umbrella
Since Xeloda can make you more susceptible to infections, its best to avoid situations that might put you at risk, such as crowded places and visiting ill friends.
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Choosing A Chemo Combination
Your doctor will probably talk to you about combining different chemo drugs. They may refer to them by abbreviations for their names. Some of the most common include:
- AC: Adriamycin and Cytoxan
- CMF: Cytoxan, methotrexate, and fluorouracil
- FAC: Fluorouracil, Adriamycin, and Cytoxan
- CAF: Cytoxan, Adriamycin, and fluorouracil
Will I Ever Feel Normal Again After Breast Cancer
In many ways, it will be a lot like the life you had before, but in other ways, it will be very different. Call it your new normal. From your relationships with your family and your spouse to eating habits and exercise, breast cancer will change your life in ways that last well after treatment ends.
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Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
Where You Have Chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so its a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Clare Disney : Hello, my name is Clare and this is a cancer day unit.
So when you arrive and youve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. Were going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
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What Is Triple Negative Breast Cancer
Triple negative breast cancer is a less common type of breast cancer. It develops in about 1 in 5 women with breast cancer . It is more common in women under 40. It also seems to be more common in black women.
We need further research to understand this more. But triple negative breast cancer can develop in women of any age and ethnicity.
Breast cancer cells may have receptors that hormones or a protein called HER2 can attach to. A specialist breast cancer doctor takes a sample of cancer cells during a biopsy orsurgery to test for these receptors. If these receptors are found, you are usually treated with hormonal or targeted therapies.
Triple negative breast cancer does not have receptors for hormones, or HER2. This means treatment with hormonal or targeted therapy will not work.
Triple negative breast cancer is sometimes described as a faster growing type of breast cancer. This may make you feel worried about it coming back. But the risk of it coming back depends on the same factors as any other type of breast cancer.
Is Chemotherapy The Only Treatment For Breast Cancer
No. Occasionally, chemotherapy is the only breast cancer treatment, but most often, healthcare providers use chemotherapy with other treatments, such as:
- Lumpectomy: Removing the tumor and a small amount of surrounding breast tissue.
- Mastectomy: Removing one or both breasts.
- Hormone therapy: Taking medicines that lower estrogen or block estrogens effects on cancer cells.
- Targeted therapy: Taking medicines that target the changes in cancer cells to destroy them or slow their growth.
- Radiation therapy: Using high-energy X-rays to destroy cancer cells.
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What Happens Before Chemotherapy For Breast Cancer
A few days before your chemotherapy treatment, youll have blood tests. The blood tests tell your oncologist and pharmacist how to tailor your treatment based on your laboratory values and body mass index .
You may receive chemotherapy through a large, sturdy tube called a central venous catheter . If your healthcare provider recommends a CVC, it will be surgically implanted before treatment. It stays in place until you finish chemotherapy. Types of CVCs include:
- Central line: Long, plastic tube inserted near your heart or in a neck vein.
- Peripherally inserted central catheter : A central line that goes in through an arm vein.
- Port-a-cath : A small, implantable chamber where your nurse gives drug injections.
How Can I Prevent Breast Cancer
Over 40% of breast cancers that are diagnosed are self-detected and the National Breast Cancer Foundation recommends you perform a self-examination of your breasts once a month. Always seek further investigation if you ever feel any sort of lump in your breast or breasts.
Mammograms are a type of X-ray that is commonly used for screening. They can detect tiny lumps, as small as 2 millimeters in size, which is about the size of a pencil tip. You would never be able to feel a lump this small. Most breast cancer tumors cannot be felt until they are at least 22 mm in size, or about the size of a small pea.
In general, the earlier cancer cells are detected, the better the outcome. Very effective treatment is available for all stages of breast cancer however, outcomes are usually more favorable when the cancer is found at stage 1 or stage 2.
To reduce your chances of developing breast cancer, keep to a healthy weight, exercise daily, sleep well, don’t drink alcohol, avoid exposure to chemicals including nicotine, and breastfeed your babies if possible.
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Possible Side Effects Of Ais
The most common side effects of AIs are:
- Bone and joint pain
AIs tend to have side effects different from tamoxifen. They don’t cause uterine cancers and very rarely cause blood clots. They can, however, cause muscle pain and joint stiffness and/or pain. The joint pain may be similar to a feeling of having arthritis in many different joints at one time. Options for treating this side effect include, stopping the AI and then switching to a different AI, taking a medicine called duloxetine , or routine exercise with nonsteroidal anti-inflammatory drugs . But the muscle and joint pain has led some women to stop treatment. If this happens, most doctors recommend using tamoxifen to complete 5 to 10 years of hormone treatment.
Because AIs drastically lower the estrogen level in women after menopause, they can also cause bone thinning, sometimes leading to osteoporosis and even fractures. If you are taking an AI, your bone density may be tested regularly and you may also be given bisphosphonates or denosumab , to strengthen your bones.
Why It Gets Accelerated Approval
The FDAs accelerated approval is granted for certain drugs that treat serious conditions and fill an unmet need. The manufacturer of the drug is still required to conduct additional trials and is expected to submit more findings by September next year. Upon those results, the drug could garner traditional approval.
When breast cancer cell growth isnt triggered by estrogen, progesterone, or human epidermal growth factor 2 , its known as triple-negative breast cancer. This type of breast cancer is considered aggressive with poor prognosis.
It doesnt respond to hormonal cancer treatments that have helped improve survival rates for people with other forms of the disease. However, it does respond to chemotherapy, but cancer cells can develop a resistance to chemotherapy agents. The treatment can also be very difficult on the patient as it kills off healthy cells along with cancer cells.
Triple-negative breast cancer is most likely to affect Hispanic and African-American women, along with people who have the BRCA1 gene mutation. It can develop in women in their 40s and 50s.
Approximately 15 percent of breast cancers are triple-negative, the National Breast Cancer Foundation reports.
About one-fifth of people with triple negative breast cancer have the PD-L1 protein, which is what atezolizumab targets.
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What To Expect During Treatment
You usually get chemo in an outpatient center at a hospital or clinic. If you have early stage breast cancer, youâll probably get treatments for 3 to 6 months. It may last longer for advanced breast cancer. Youâll have treatment in cycles, which could be just once a week or as often as three times a week. If youâre getting radiation and chemo together, youâll get the radiation after the chemo treatment. You may want to have someone drive you home the first few times until you know how it affects you.
On the day of treatment:
- Technicians will take some of your blood for tests.
- Your doctor will go over the blood test results and talk about your overall health.
- The doctor orders the treatment.
- Youâll meet with the person on your health care team whoâs going to give you the chemo.
- Theyâll check your temperature, pulse, and blood pressure.
- Theyâll put the IV into your vein.
- Theyâll give you medications to prevent nausea, anxiety, and inflammation along with the chemotherapy.
- When your treatment is done, theyâll remove your IV and check your vital signs again.
- Youâll get prescriptions for dugs you can take at home to help with side effects.
- Theyâll tell you what is OK to eat and drink once youâre home.
Possible Serious Side Effects With Herceptin
Not all people have serious side effects, but side effects with HERCEPTIN therapy are common.
Although some people may have a life-threatening side effect, most do not.
Your doctor will stop treatment if any serious side effects occur.
HERCEPTIN is not for everyone. Be sure to contact your doctor if you are experiencing any of the following:HEART PROBLEMS
These include heart problemssuch as congestive heart failure or reduced heart functionwith or without symptoms. The risk for and seriousness of these heart problems were highest in people who received both HERCEPTIN and a certain type of chemotherapy . In a study of adjuvant breast cancer, one patient died of significantly weakened heart muscle. Your doctor will check for signs of heart problems before, during, and after treatment with HERCEPTIN.INFUSION REACTIONS, including:
- Feeling sick to your stomach
These signs usually happen within 24 hours after receiving HERCEPTIN.Be sure to contact your doctor if you: Are a woman who could become pregnant, or may be pregnant
HERCEPTIN may result in the death of an unborn baby or birth defects. Contraception should be used while receiving HERCEPTIN and for 7 months after your last dose of HERCEPTIN. If you are or become pregnant while receiving HERCEPTIN or within 7 months after your last dose of HERCEPTIN, you should immediately report HERCEPTIN exposure to Genentech at 1-888-835-2555.
Have any signs of SEVERE LUNG PROBLEMS, including:
- Severe shortness of breath
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Here Are Some Important Things To Know When Beginning A Course Of Oral Chemotherapy:
A 2018 study by several Fox Chase Cancer Center physicians showed that both providers and patients face barriers to starting oral chemotherapy when it comes to insurance. This is largely due to the fact that insurers cover OAMs as a prescription drug benefit, whereas IV chemotherapy is covered as a medical procedure. The distinction can lead to delays from the time an OAM is prescribed until the patient receives the medication. These delays can last days or even weeks. The researchers found that the process was labor intensive, taking an average of two weeks and five phone calls for a patient to start a drug.
Additionally, the study found that out-of-pocket costs could vary and required a lot of staff support to mitigate these costs through financial assistance. Many medical centers like Fox Chase offer financial counselors and insurance advocates to help patients and providers navigate this process.
Being treated for cancer in the comfort of home is a big convenience for patients. But its important to remember that OAMs are powerful drugs and should be taken with the same care as traditional chemotherapy given in a hospital setting.