Sunday, February 25, 2024

Chemotherapy Drugs For Breast Cancer

Combination Drug Therapy For Early

Having chemotherapy for breast cancer – patient guide

Combination drug therapy means that you receive more than one type of drug at a time.

Combining drug therapies allows your care team to increase the chances that your treatment will be effective against the breast cancer. If a tumor becomes resistant to one drug, your treatment may still be effective because the tumor responds to the second or third drug in the combination you receive.

Combination therapy can be given before or after breast surgery. Most women receive a combination of two or three drugs at the same time. Some of these drugs are breast cancer targeted therapies. These drugs work by targeting specific molecules involved in breast cancer development.

Here are some of the drug combinations that MSKs medical oncologists commonly prescribe:

Dose-Dense AC-T Chemotherapy

  • Doxorubicin and cyclophosphamide, followed by paclitaxel
  • Used to treat early-stage breast cancer, particularly in younger women or women with aggressive disease
  • Given intravenously before or after surgery

Dose-Dense AC-TH Chemotherapy and Targeted Therapy

  • Doxorubicin and cyclophosphamide, followed by paclitaxel and trastuzumab
  • Used to treat early-stage HER2-positive breast cancer
  • Given intravenously before or after surgery

Dose-Dense AC-THP Chemotherapy and Targeted Therapy

  • Doxorubicin and cyclophosphamide, followed by paclitaxel, trastuzumab, and pertuzumab
  • Used to treat early-stage breast cancer
  • Given intravenously before or after surgery

CMF Chemotherapy

TC Chemotherapy

Enhancing Healthcare Team Outcomes

Since the administration of most chemotherapy agents occurs at infusion centers, nursing and allied health professionals play a significant role in taking care of patients on such drugs. They are usually the first point of contact for the patients. All health professionals need to understand the type of drug in use and its associated side effects for the patient. Close monitoring and early recognition of side effects can help prevent significant morbidity and mortality. For example, patients with a history of anemia, thrombocytopenia should avoid the use of NSAIDs. Intra-muscular injections and rectal suppositories should be avoided in such patients.

Thorough buccal cavity assessments and avoidance of commercial mouthwashes in patients with mucositis can help decrease patient discomfort. Many chemotherapeutic agents have specific known side effects that are minimizable prophylactically. For instance, following folate inhibitors such as methotrexate with folate analogs such as leucovorin help reduce bone marrow suppression severity. This concept applies to general chemotherapy side effects. For example, oral mucositis is a common chemotherapy side effect, which can be minimized by administering Palifermin, a keratinocyte growth factor that helps reduce mucosal endothelial cell damage.

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.

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How Effective Are Taxanes For Breast Cancer Treatment

For early breast cancer:

Taxanes have been used for many years to treat breast cancer because they can be very effective. A few years ago, researchers reviewed 29 breast cancer treatment studies that included thousands of women. They found that taxanes improved survival rates among women with early breast cancer who would be treated with surgery, and they lowered the rate of returning cancer. The taxanes did, however, increase the risk of some side effects â most commonly low white blood cell counts and nerve damage that causes weakness and pain or numbness in the hands and feet â compared with women who had chemotherapy without taxanes.

For metastatic breast cancer:

Given as palliative chemotherapy â that means treatment that extends life but doesnât cure cancer â taxanes with other chemotherapy drugs can increase chances for survival. Researchers looked at studies evaluating taxanes as treatment for metastatic breast cancer. And they showed that overall, taxanes usually slowed down the cancerâs progress.

Although taxanes are often used for HER-positive breast cancer, they can also be used for women with triple-negative breast cancer. Itâs called triple-negative breast cancer, or TNBC, because the cancer cells donât have estrogen receptors, progesterone receptors, and the HER2 protein.

How Breast Cancer Is Treated

Chemotherapy for Breast Cancer

In cancer care, doctors specializing in different areas of cancer treatmentsuch as surgery, radiation oncology, and medical oncologywork together with radiologists and pathologists to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. For people older than 65, a geriatric oncologist or geriatrician may also be involved in their care. Ask the members of your treatment team who is the primary contact for questions about scheduling and treatment, who is in charge during different parts of treatment, how they communicate across teams, and whether there is 1 contact who can help with communication across specialties, such as a nurse navigator. This can change over time as your health care needs change.

A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. You can also provide your doctor with a copy of the ASCO Treatment Plan form to fill out.

Learn more about making treatment decisions.

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Chemotherapy As The Primary Treatment For Advanced Breast Cancer

If breast cancer has spread to other parts of your body and surgery isn’t an option, chemotherapy can be used as the primary treatment. It may be used in combination with targeted therapy.

The main goal of chemotherapy for advanced breast cancer is generally to improve quality and length of life rather than to cure the disease.

Common Types Of Chemotherapy For Breast Cancer

Chemotherapy drugs are a specific class of medications called cytotoxic agents. Theyre designed to kill cancer cells.

Cancer cells grow faster than regular cells. These drugs disrupt the growth of fast-growing cells and leave slower-growing cells generally unharmed.

Some chemotherapy drugs damage the genetic material of the cells. Others interfere with the way the cells divide. However, some also affect other fast-growing cells in the body, such as hair, blood cells, and cells in the stomach lining and mouth. This accounts for some of the more common side effects.

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Chemotherapy Before Surgery For Breast Cancer

Chemotherapy is sometimes given before surgery to shrink larger cancers. This may:

  • Allow the surgeon the best chance of removing the cancer completely
  • Enable the surgeon to remove only the cancer, rather than the entire breast
  • Help your doctor understand how well your cancer responds to chemotherapy, which helps clarify prognosis and the best chemotherapy drug choice

Neoadjuvant therapy is often used for:

  • Inflammatory breast cancer
  • Cancers that have spread to the lymph nodes
  • Larger breast cancers

After A Chemotherapy Session

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Following a chemotherapy session, you may:

  • Have your temporary IV catheter removed.
  • Have your vital signs checked.
  • Review side effects with your doctor.
  • Receive prescriptions for medications you can take at home to help with side effects.
  • Be advised on what to eat and drink.

Some people feel fine after a chemotherapy session and can return to their schedules and activities. Others may feel side effects more quickly. You may want to arrange for someone to drive you home afterward, at least for the first few sessions, until you see how you feel.

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Physical Emotional And Social Effects Of Cancer

In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Supportive care treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies.

  • Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.

  • Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.

  • Meditation and yoga to improve general quality of life.

  • Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.

Breast Cancer: Types Of Treatment

Have questions about breast cancer? Ask here.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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What Happens During Chemotherapy For Breast Cancer

Most people receive chemotherapy for breast cancer through one of their veins . You may receive chemotherapy as one short injection or as an infusion. Infusions last longer and usually take place in a hospital or specialized infusion center.

When you get to the infusion center, your nurse administers your chemotherapy drugs and any additional medications you need. For example, you may also receive an anti-nausea medication before the chemotherapy drugs.

During the infusion:

  • Your nurse accesses your CVC or starts an IV.
  • You may read, watch television or visit with others during your treatment. Chemotherapy infusions may last a few hours or more.
  • Your nurse flushes the IV line or CVC with a saline solution and removes it.
  • You wait in a recovery area for about 30 minutes to make sure you do not have a negative reaction to treatment.
  • Chemotherapy Regimens For Early

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    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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    Chemotherapy For Breast Cancer

    Chemotherapy uses anti-cancer drugs that may be given intravenously or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area .

    On this page

    What To Know About Leftover Oral Chemotherapy Drugs

    You might be left with unused drugs when you finish treatment or if your treatment plan changes. These are powerful drugs, so you should never flush them down the toilet or sink. You also shouldnt put them in the trash.

    Check with your pharmacist or doctors office. Many will take them off your hands or let you know how to dispose of them properly.

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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

    During The Course Of Chemotherapy

    How Does Chemotherapy For Breast Cancer Work?

    After a few sessions, you may be able to predict more accurately when you’ll feel fine and when you may need to cut back on activities. Marking your calendar or keeping a journal may help you track your general response to chemotherapy sessions and plan events accordingly.

    Following your treatment plan closely is the best way to get the most benefit from chemotherapy. If side effects become too bothersome, discuss them with your doctor. He or she may be able to adjust the dose or type of chemotherapy medication you’re receiving or prescribe other medications to help relieve some symptoms such as nausea. If the number of white cells in your blood drops, your doctor may stop your chemotherapy until your white cells return to a safe level.

    Relaxation techniques such as meditation and deep breathing may help reduce stress. And exercise has been shown to help improve sleep and lessen fatigue caused by chemotherapy. Wearing wigs, hats or turbans can make hair loss less obvious.

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    What To Ask A Doctor Before Starting Oral Chemotherapy

    Here are some questions you may want to ask a doctor:

    • Whats each drug expected to do?
    • Exactly how should I take this medication?
    • Can the pills be broken or crushed? Do they need to be taken with a meal?
    • Are there any particular foods I should avoid while taking this medication?
    • What should I do if I miss a dose?
    • What happens if I throw up after taking it?
    • How should I handle and store the drug?
    • What side effects can I expect from this drug, and what should I do if I have them? What are the warning signs of serious problems?
    • How often should I check in with your practice? When will I need blood tests or scans?
    • How long will I need to take it?
    • How will we know its working?

    Treatment Of Breast Cancer Stages I

    The stage of your breast cancer is an important factor in making decisions about your treatment.

    Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:

    • If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
    • If the cancer cells have large amounts of the HER2 protein
    • How fast the cancer is growing
    • Your overall health
    • If you have gone through menopause or not

    Talk with your doctor about how these factors can affect your treatment options.

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    Chemo Drugs For Breast Cancer That Has Spread

    Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.

    For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.

    What Are The Potential Side Effects Of Chemotherapy Drugs


    The specific side effects you may experience will depend on the type and amount of medications you are given and how long you are taking them. The most common temporary side effects include:

    • Higher risk of infection
    • Premature menopause and infertility are potential permanent complications of chemotherapy.
    • Heart damage can be a permanent complication of some chemotherapy.

    Please contact your health care provider about specific side effects you can expect to experience from your specific chemotherapy medications. Also discuss troubling or unmanageable side effects with your provider.

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