| This section is intended to provide general information on chemotherapy for breast cancer
patients and to discuss a variety of possible side effects of chemotherapy drugs. Because
chemotherapy regimens are individually tailored, the types of drugs administered and their
side effects will vary considerably. While this article discusses many of the side effects
of chemotherapy in detail, it is important to note that the majority of the side effects
associated with chemotherapy are temporary and only occur during or immediately after
treatment. In the vast majority of cases, the benefits of treating cancer with chemotherapy
far outweighs the risks or inconveniences of any side effects. Chemotherapy is only one
possible treatment for breast cancer and may be used in addition to surgery or other
treatments. Patients should discuss all aspects of chemotherapy and breast cancer treatment
with their physician or cancer treatment team.
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Chemotherapy involves using anticancer drugs to help control or prevent the growth of
cancerous tumors. Chemotherapy is often used as an adjuvant (supplemental) therapy
in addition to other treatments, such as surgery or
radiation therapy, which
are designed to achieve local (breast/chest) control of the cancer. Normally, chemotherapy
is administered through a semipermanent catheter (a flexible tube) implanted into a large vein,
or by a smaller, temporary, intravenous catheter placed into the smaller veins in the arm or
hand. Some chemotherapy drugs are administered orally in form of pills or liquid. Chemotherapy
may also be given intramuscularly (injected in the muscle), under the skin, topically (on the skin),
or injected locally into the cancer area.
Chemotherapy may be used to:
- cure cancer
- stop cancer from spreading to other parts of the body
- slow cancer growth
- kill cancer cells
- relieve symptoms of cancer
Chemotherapy is a systemic form of treatment; that is, it is distributed throughout
the bloodstream, affecting tissues and organs in the entire body. In this way, chemotherapy
is different from local treatments such as surgery or radiation therapy, which only target specific
parts of the body. Both local and systemic treatments are used to provide optimal cancer
control, and the approach is tailored to the individual patient.
Breast cancer patients who undergo chemotherapy may be given one drug or a combination of
two or more drugs during treatment. Most physicians believe that combination
chemotherapy (administering two or more drugs) is most effective for breast cancer patients
because combination therapy has been shown to provide better cancer cell control with lower
doses of individual drugs. With combination chemotherapy, better results may be achieved
while causing fewer of the side effects associated with higher doses of an individual
drug. At this time, there are over 90 chemotherapy drugs used to treat different types of cancer.
Chemotherapy may be the only treatment a breast cancer patient receives, or it may be given
before or after breast cancer surgery or other treatments. Neoadjuvant chemotherapy is the
term given to chemotherapy that is administered before surgery to help shrink the size of a
cancerous tumor. Neoadjuvant chemotherapy also allows physicians to determine the effectiveness
of a particular regimen on a patient's tumor and to monitor the progress of chemotherapy and make
adjustments in drugs or dosages if needed.
Adjuvant chemotherapy is the term used to described chemotherapy that is given in addition to
local breast cancer treatments, such as surgery. Because chemotherapy after
lumpectomy or mastectomy has been
shown to significantly reduce the chances
of breast cancer recurrence, a panel of
national and international cancer experts who convened at the National Institutes of Health
Consensus Development Conference on Adjuvant Therapy for Breast Cancer in November 2000
recommended that most women with localized breast cancer be offered chemotherapy.
A chemotherapy regimen is usually tailored specifically to the breast cancer patient. When
planning a chemotherapy regimen, physicians and patients consider the patient's age, her
overall health, specific elements of her cancer (i.e., stage, grade),
other health problems, and past or future treatments. In general, chemotherapy for breast cancer
patients is typically given in three to six month courses. These courses may occur daily, weekly,
monthly or on some other schedule, depending on the body's response to the drugs. Chemotherapy
sessions are not usually continuous; they typically include rest cycles because chemotherapy
drugs target both healthy and cancerous cells. Physicians have a variety of ways to monitor
the effects of chemotherapy on the patient's cancer, including physical examinations, blood
tests, CT scans, MRI scans, and x-rays.
Examples of chemotherapy combinations used to treat breast cancer include:
- cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and fluorouracil (Fluorouracil, 5-Fu, Adrucil) (this therapy is called CMF)
- cyclophosphamide, doxorubicin (Adriamycin), and fluorouracil (this therapy is called CAF)
- doxorubicin (Adriamycin) and cyclophosphamide (this therapy is called AC)
- doxorubicin (Adriamycin) and cyclophosphamide with paclitaxel (Taxol)
- doxorubicin (Adriamycin), followed by CMF
- cyclophosphamide, epirubicin (Ellence), and fluorouracil
(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
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