Profiles of Breast Cancer Drugs
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Many women are prescribed drugs as part of their breast cancer treatment. The type of drug and dosage will vary from patient to patient depending on her medical situation. This section outlines some of the drugs commonly used to treat breast cancer: Please note: This is not an exhaustive list of all drugs used to treat breast cancer.
Abraxane (paclitaxel protein-bound particles for injectable suspension)Abraxane was approved by the U.S. Food and Drug Administration in 2005 to help treat women with advanced breast cancer who have not responded well to combination chemotherapy, or who have relapsed within six months of chemotherapy. Abraxane is similar to the drug Taxol but unlike Taxol, is not required to be dissolved in a toxic solvent prior to administration. This solvent can cause allergic reactions in some patients, and to counteract these reactions, patients are often treated with steroids and antihistamines. Patients receiving Abraxane do not need these treatments. Side effects of Abraxane may include:
Full prescribing information is available from Abraxis BioScience, Inc. at http://www.abraxane.com/ Adriamycin (generic name, doxorubicin)Adriamycin (generic name, doxorubicin) is a chemotherapy drug commonly used to treat breast cancer and other cancers. Adriamycin first disrupts, then destroys the growth of cancer cells. It is usually administered intravenously (through the vein). Common side effects may include:
Patients should be tested for heart problems before beginning Adriamycin and should be continuously monitored for developing problems during treatment. Click here for additional information and full prescribing information on Adriamycin (courtesy of Pfizer; requires Adobe Acrobat). Aredia (generic name, pamidronate disodium)Breast cancer has the potential to spread to almost any area of the body. After the axillary (armpit) lymph nodes, bone is the most common place to which breast cancer can spread. Aredia (generic name, pamidronate disodium) is a medication that is used to reduce bone complications and bone pain in patients whose breast cancer has spread to the bone. Clinical studies have shown that patients who are given Aredia tend to experience a delay in or reduction of bone pain, fractures, and other bone complications than patients who do not receive Aredia. Aredia is usually administered by intravenous injection along with the patient's other cancer therapies, such as chemotherapy. Possible side effects of Aredia include:
Click here for additional information and full prescribing information on Aredia (courtesy of Novartis). Arimidex (generic name, anastrozole)Arimidex (generic name, anastrozole) was FDA approved in 1996 to treat advanced (metastatic) breast cancer patients who have not responded well to treatment with the drug, tamoxifen. Clinical trials are currently underway to determine whether women with advanced breast cancer would benefit more from taking Arimidex than tamoxifen, either alone or in combination. Early results of a large clinical trial called ATAC (Arimidex, Tamoxifen, Alone or in Combination) showed no significant difference among women who received tamoxifen alone compared to those who received a combination of Armidex and tamoxifen, which suggests that tamoxifen should not be given in combination with Armidex. Researchers are also investigating Arimidex for treatment of early stage breast cancer. Possible side effects of Arimidex include:
Click here for additional information and full prescribing information on Arimidex (courtesy of Astra Zeneca). Aromasin (generic name, exemestane)Aromasin (generic name, exemestane) was FDA approved in 1999 to treat advanced (metastatic) breast cancer in post-menopausal women. Aromasin works by binding to the body’s aromastase enzyme, an enzyme responsible for producing the hormone, estrogen. Many breast cancer cells depend on estrogen to grow and multiply quickly. Once aromasin has binded to the aromastase enzyme, estrogen cannot be produced by the enzyme. This lack of estrogen "starves" cancer cells, preventing them from growing. Aromasin is usually taken orally in pill form. Possible side effects of Aromasin include:
A 2007 study found that some breast cancer patients that take Aromasin (ore Femara) experience side effects such as joint and muscle pain and more than 10% of the patients in the study stopped treatement due to these effects. The researchers are investigating alternative treatments or methods to managing side effects in such patients. They suggest that tamoxifen may be a better choice for treatment of women who experience these side effects. Click here for more information. Click here for additional information and full prescribing information on Aromasin (courtesy of Pharmacia). Chemotherapy Regimens
Examples of chemotherapy combinations used to treat breast cancer include:
(the brand name of the drug is shown in parenthesis) Other chemotherapy drugs commonly used for treating women with breast cancer include docetaxel (Taxotere), vinorelbine (Navelbine), and gemcitabine (Gemzar), and capecitabine (Xeloda). *Source: American Cancer Society The side effects a breast cancer patient experiences while undergoing chemotherapy vary significantly depending on several factors, including the types of drugs used, their dosages, and the duration of treatment. The benefits of treating cancer with chemotherapy drugs outweighs the risk of complications for most women, and effects are often tolerable with proper care and rest. Click here for detailed information on chemotherapy for breast cancer patients. Cytoxan (generic name, cyclophosphamide)Cytoxan (generic name, cyclophosphamide) is a chemotherapy drug commonly used to treat breast cancer and other cancers. Like Adriamycin, Cytoxan first disrupts cancer cells, then destroys them. Cytoxan is taken in tablets by mouth or intravenously (through the vein) over 30-60 minutes. Common side effects may include:
Ellence (generic name, epirubicin)Ellence (generic name, epirubicin) was approved by the FDA in 1999 to treat early-stage breast cancer after breast surgery (lumpectomy or mastectomy) in patients whose cancer has spread to the axillary (underarm) lymph nodes. Ellence helps reduce the likelihood that breast cancer will return (recur) and improves a patient’s chances of survival. Ellence is given intravenously (through the vein) in combination with two other chemotherapy drugs, cyclophosphamide and fluorouracil. Possible side effects of Ellence include:
Click here for additional information and full prescribing information on Ellence (courtesy of Pharmacia). Evista (generic name, raloxifene)Evista (generic name, raloxifene) belongs to a group of drugs called SERMs (selective estrogen-receptor modulators). Raloxifene was approved in December 1997 by the FDA to prevent osteoporosis. In 2007, based on results of several clinical trials, the FDA approved Evista to reduce the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. The trials showed that Evista reduced the risk of invasive breast cancer by 44 to 71 percent. Despite these positive results, women should be aware that Evista can cause serious side effects including blood clots in the legs and lungs, and death due to stroke. Women with current or prior blood clots in the legs, lungs, or eyes should not take Evista. Other potential side effects include:
The FDA cautions that Evista should not be taken by pre-menopausal women and women who are or may become pregnant because it may cause harm to the unborn baby. In addition, Evsita should not be taken with cholestyramine (a drug used to lower cholesterol levels) or estrogens. Finally, the FDA also warns that raloxifene does not provide complete prevention against breast cancer. Women should continue to get annual mammograms and clinical breast exams. More information about Evista, including prescribing information, can be found on the Eli and Lilly website at http://www.evista.com/ Click here for additional information and full prescribing information on Ellence (courtesy of Pharmacia). Fareston (generic name, toremifene)Similar to tamoxifen, Fareston (generic name, toremifene) is an anti-estrogen (SERM, selective estrogen-receptor modulator). Fareston binds to estrogen receptors on breast cancer cells, preventing the cells from growing and dividing. Advanced breast cancer patients are usually prescribed one 60-milligram tablet of Fareston daily. Possible side effects include:
Click here for additional information on Fareston (courtesy of GTx, Inc.). Femara (generic name, letrozole)Femara (generic name, letrozole) was approved by the U.S. Food and Drug Administration (FDA) in 1997 to help treat advanced (metastatic) breast cancer in women whose breast cancer tumors have not responded well to tamoxifen. Femara works by reducing the total amount of estrogen in the body (circulating estrogen levels), thereby limiting the amount of estrogen that can affect breast cancer cells. In post-menopausal women, the body produces estrogen from other hormones known as androgens by the action of an enzyme called aromatase. Femara is an aromatase inhibitor and blocks aromatase from converting androgen into estrogen, thus lowering the amount of estrogen in the body. Researchers are investigating whether Femara should be considered as a first option ("first-line therapy") in treating some women with advanced breast cancer. Possible side effects of Femara may include:
A 2007 study found that some breast cancer patients that take Aromasin (ore Femara) experience side effects such as joint and muscle pain and more than 10% of the patients in the study stopped treatement due to these effects. The researchers are investigating alternative treatments or methods to managing side effects in such patients. They suggest that tamoxifen may be a better choice for treatment of women who experience these side effects. Click here for more information. Click here for additional information and full prescribing information on Femara (courtesy of Novartis Oncology). Herceptin (generic name, trastuzumab)Herceptin (generic name, trastuzumab) is FDA approved to treat advanced (metastatic) breast cancer in women who over-express the HER2 gene. HER2 (also written HER-2/neu) is a growth factor found on the surface of cells that plays a key role in regulating cell growth. Some women are born with or experience a mutation of the HER2 gene throughout their lifetime. When altered, extra HER2 receptors may be produced. This over-expression of HER2 causes cells to grow, divide, and multiply more rapidly than normal and may lead to breast cancer. Women who over-express the HER2 gene tend to have aggressive breast cancers that spread quickly to other regions of the body. Herceptin seeks out HER2 and attaches itself to the protein receptor on the surface of cells. By binding to the cells, Herceptin has been shown to slow the growth and spread of tumors that have an overabundance of HER2 protein receptors. Herceptin is usually given intravenously (through the vein) in an outpatient clinical setting. Possible side effects of Herceptin include:
Click here for additional information and full prescribing information on herceptin (courtesy of Genentech). Megace (generic name, megestrol)Megace (generic name, megestrol) is used to treat advanced breast cancer, typically in women who do not respond well or become resistant to tamoxifen. Megace is a synthetic form of the hormone, progesterone. Progesterone is normally secreted by the corpus luteum of the ovary and by the placenta and acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of secondary sexual characteristics. Progesterone also counteracts some of the negative effects of estrogen (many breast cancers depend on estrogen to grow and reproduce). In addition to treating advanced breast cancer, Megace may also be used to treat advanced stages of endometrial cancer (cancer of the uterine lining) or to increase appetite in HIV patients. Because Megace is considered non-toxic, there are few documented side effects associated with the drug. The most common side effect is fluid retention. Click here for additional information and full prescribing information on Megace (courtesy of Bristol Myers Squibb; requires Adobe Acrobat).
Resources: TamoxifenTamoxifen
has been the most commonly prescribed drug to treat breast cancer
since its approval by the U.S. Food and Drug Administration (FDA) in the 1970s. Tamoxifen
is an anti-estrogen and works by competing with the hormone estrogen to bind to estrogen
receptors in breast cancer cells. By blocking estrogen in the breast, tamoxifen helps slow
the growth and reproduction of breast cancer cells. In 1998, tamoxifen became the first
drug to be approved by the FDA to prevent breast cancer after research showed it reduced
the chances of developing breast cancer by 50% in women at high
risk for the disease. Tamoxifen is taken orally in pill form.
Click here for additional information on tamoxifen (courtesy of the National Cancer Institute). Taxol (generic name, paclitaxel)Taxol (generic name, paclitaxel) was first approved by the FDA in 1992 to treat advanced (metastatic) breast cancer. In 1999, the FDA also approved Taxol to treat early stage breast cancer in patients who have already received chemotherapy with the drug, doxorubicin. Taxol is called a mitotic inhibitor because of its interferes with cells during mitosis (cell division). Taxol is usually given intravenously (through the vein) over one or more hours. Possible side effects of Taxol include:
Interestingly, Taxol was first isolated from a Pacific yew tree. Recently, scientists have discovered paciltaxel, the active agent in Taxol, in hazelnuts (though eating hazelnuts all day long will not prevent or treat breast cancer). Click here to learn more about the history of Taxol. Click here for additional information and full prescribing information on Taxol (courtesy of Bristol-Myers Squibb; requires Adobe Acrobat). Taxotere (generic name, docetaxel)Taxotere (generic name, docetaxel) is a cancer drug that resembles Taxol in chemical structure. Taxotere was FDA approved in 1996 to treat advanced breast cancer in patients who have not responded well to chemotherapy with the drug, doxorubicin. In 1998, Taxotere was also approved by the FDA to treat breast cancer that has spread into other areas of the breast or to other parts of the body after treatment with standard chemotherapy. Docetaxel inhibits the division of breast cancer cells by acting on the cell’s internal skeleton. The drug is usually given intravenously (through the vein) once every three weeks. Each treatment typically takes around one hour, though the dosage will vary depending on the patient’s medical situation. Because the side effects of docetaxel can be bothersome, many physicians will prescribe additional drugs to help counter these effects. For example, dexamethasone is commonly used to prevent fluid retention while on Taxotere. Possible side effects of Taxotere include:
Click here for additional information and full prescribing information on Taxotere (courtesy of sanofi-aventis). Xeloda (generic name, capecitabine)Xeloda (generic name, capecitabine) has been FDA approved since April 1998 as a treatment for advanced breast cancer in patients who have not responded well to chemotherapy that included Taxol (generic name, paclitaxel) and an anthracycline (such as Adriamycin or doxorubicin). Xeloda works by converting to a substance called 5-fluorouracil in the body. In some patients, Xeloda helped shrink tumor size by killing cancer cells. Side effects of Xeloda may include:
Some of the side effects from Xeloda may become severe. Patients should report any side effects to their physicians immediately. Xeloda is taken orally in pill form. Xeloda is usually prescribed in a 21-day cycle: 14 days of treatment followed by a seven-day rest period. Click here for additional information and full prescribing information on Xeloda (courtesy of Roche Laboratories). Zoladex (generic name, goserelin acetate)Zoladex (generic name, goserelin acetate) is FDA approved to treat advanced breast cancer and prostate cancer. Zoladex works by blocking estrogen from breast cancer cells (and blocking testosterone in men), thereby starving these cells. The drug is typically given by injection under the skin. Zoladex is a systemic treatment; it cannot distinguish between normal cells and cancer cells. Therefore, a variety of side effects are possible. Possible side effects of Zoladex include:
Click here for additional information and full prescribing information on Zoladex (courtesy of AstraZeneca). Zometa (generic name, zoledronic acid)Zometa (generic name, zoledronic acid) was approved by the FDA in 2002 to treat breast cancer that has spread to the bone (a condition commonly referred to as bone metastases). Zometa is also FDA-approved to treat both multiple myeloma (a type of bone cancer), all other solid tumors, and bone metastases resulting from prostate cancer. Zometa belongs to a class of drugs called bisphosponates, which may be helpful treat bone metastases by slowing the destruction of bone cells in breast cancer patients. Zometa may also prevent cancer cells from growing in bone. Studies involving more than 3,000 patients taking Zometa have shown an approximate 14% decrease in the number of patients with bone problems, compared to those who did not take Zometa. Zometa is administered intravenously (through the vein), a process which takes approximately 15 minutes after preparation. Possible side effects of the drug include:
Women who are pregnant or breast-feeding should avoid Zometa. In rare cases, Zometa can cause injury to the kidneys. Click here for additional information and full prescribing information on Zometa (courtesy of Novartis; access to some information requires Adobe Acrobat). Additional Resources and References
Updated: December 28, 2008 |
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