Chemotherapy is considered a systemic therapy in the treatment of breast cancer.  It is most often given as an adjuvant therapy after surgery, but can also be given before surgery (or neoadjuvantly). Chemotherapy is also often used to treat breast cancer that has recurred or spread.

Chemotherapy is usually prescribed by a medical oncologist. It is most often given intravenously through a port-a-catheter, a catheter that is inserted into a large vein leading to your heart and implanted under the skin to provide easy access for both chemotherapy and blood tests. Some chemotherapy drugs, however, do come in pill form.

Usually chemotherapy is given in cycles with time to recover between treatments.  The type of chemotherapy drug your medical oncologist prescribes will determine how long each cycle will be. Some drugs are given only once every 2 to 3 weeks, others are given daily for a week or two, and still others are given weekly. 

Chemotherapy Drugs

Many different chemotherapy drugs can be used to treat patients with breast cancer, including the following, which are the most commonly prescribed:

Chemical Name Carboplatin Cyclophosphamide Docetaxel Doxorubicin Epirubicin Fluorouracil Methotrexate Nab-paclitaxel Paclitaxel

Brand Name (Paraplatin) (Cytoxan) (Taxotere) (Adriamycin, Doxil) (Ellence) (5-FU, Adrucil) (Amethopterin, Maxtrex, Mexate, Folex) (Abraxane) (Taxol)

These chemotherapy drugs are also used to treat breast cancer:

Chemical Name Capecitabine Daunorubicin Eribulin Gemcitabine Ixabepilone Mitoxantrone Mutamycin Thiotepa Vincristine Vinorelbine

Brand Name (Xeloda) (Cerubidine, DaunoXome) (Halaven) (Gemzar) (Ixempra) (Novantrone) (Mitomycin) (Thioplex) (Oncovin, Vincrex, Vincasar) (Navelbine)

In many instances, chemotherapy drugs are given as combinations. The following combinations of chemotherapy drugs are the ones most commonly used to treat breast cancer:

AC ACT AT CAF/FAC   CEF CMF GET TAC

Adriamycin and Cytoxan Adriamycin, Cytoxan, and either Taxol or Taxotere Adriamycin and Taxotere Cytoxan, Adriamycin, and Fluorouracil  (CAF and FAC use the same chemotherapy drugs, but in different doses and cycles) Cytoxan, Ellence, and Fluorouracil Cytoxan, Methotrexate, and Fluorouracil Gemzar, Ellence, and Taxol Taxotere, Adriamycin, and Cytoxan

 

These newer special medications that are “targeted” for the HER2/neu protein are also given in combination or by themselves at various times in a HER2/neu-positive breast cancer patient’s life:

• Herceptin or Trastuzumab
• Perjeta or Pertuzumab
• Tykerb or Lapatinib

Your medical oncologist will discuss these different chemotherapy drugs with you.  The type of chemotherapy drugs recommended for you will depend on the type of breast cancer you have, the stage of the cancer, and the other medical problems you may have.  Together you and your medical oncologist will decide the best treatment regimen for your type of breast cancer. 

Side Effects

Chemotherapy drugs work by killing cells that are dividing quickly, but they cannot tell the difference between cancer cells and other cells in your body that are also dividing quickly. Because chemotherapy drugs affect the hair follicles, bone marrow, intestinal lining, and cells of your mouth, they can also cause the following common side effects:

• Hair loss
• Fatigue
• Nausea and vomiting
• Immunosuppression (increased susceptibility to infection)
• Easy bruising

Other side effects of chemotherapy drugs include the following:

• Neuropathy (nerve damage)
• Decreased mental function (chemo brain)
• Osteoporosis
• Damage to other organs such as the heart
• Infertility
• Premature menopause

Most of these side effects are temporary and will resolve shortly after chemotherapy is stopped. Others may take a few months to resolve, and a few side effects, such as heart damage, infertility, and premature menopause, may be permanent. Your doctor can offer you treatments to minimize side effects; therefore, it is very important to tell your doctor of any new symptoms you are experiencing.