Types Of Targeted Therapies
There are several different types of targeted therapies available for the treatment of breast cancer.
Trastuzumab and pertuzumab are the two most common monoclonal antibodies used to treat HER2-positive breast cancer. These medications are typically administered through an IV infusion and are used in combination with chemotherapy.
After chemotherapy has finished, treatment with medications like Herceptin generally continues every 3 weeks over a total period of 1 year.
Neratinib is another type of targeted therapy, which is taken orally and is designed to help prevent the recurrence of HER2-positive breast cancer for patients whove completed 1 year of Herceptin.
Other drugs like lapatinib and tucatinib , both oral medications, and ado-trastuzumab emtansine , which is administered through an IV, are also available for the treatment of advanced HER2-positive breast cancer.
Alkaloids Against Cancer Cells
Plant alkaloids block cell division. They may be given at any time during the cell cycle but may be most effective during specific stages of cell development.
Chemotherapy drugs target fast-growing cells. Cancer cells grow quickly and erratically, making them prime targets for this type of aggressive drug treatment.
Ovarian Ablation Or Suppression
In women who have not yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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Questions To Ask Your Doctor About Chemotherapy
Patients are sometimes reluctant to ask questions, but I tell my patients that any question is an important question when it comes to their cancer care. Oncologists deal with cancer every day, but its all new to the patient. Getting your questions answered will help you make informed decisions about your care.
Think about your questions before your appointment. Write them down and bring them with you. I also recommend bringing a family member or friend to take notes during the appointment because its easy to get overwhelmed by information.
Here are some questions to consider asking your doctor about chemotherapy:
- What drug or drugs are you recommending?
- Whats the goal of this treatment?
- How long will I be on it?
- How do I receive it?
- How often do I have to come in? Can someone come in with me?
- If Im taking this drug at home, where do I store it? How often do I take it? What if I forget to take it?
- What are the potential side effects? Are you going to give me anything ahead of time to deal with them?
- Am I likely to have long-term side effects from this drug?
- Who do I call if Im at home and I have a question?
- What kind of support is there to help me through this treatment?
- Is there any support for my caregivers?
If you think of more questions after your appointment, call back and ask them.
If you start chemotherapy and your experience is different from what you expected, talk to your care team. They may be able to make changes that help you.
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
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What You Need To Know About Breast Cancer Chemotherapy Pills
People commonly associate chemotherapy with intravenous cancer drugs in a hospital or doctors office. This has been the traditional nonsurgical method of treating cancer.
Due to recent advances in cancer treatments, oral chemotherapy pills have become more widely used for many types of cancer. There are a few that are approved for breast cancer, including capecitabine , which is often used to treat metastatic breast cancer.
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How Targeted Therapy Works
Targeted therapies are created to attack specific parts of cancer cells to prevent cancer growth or to shrink existing tumors.
Each type of targeted therapy works a little differently, but all tend to interfere with the ability of cancer cells to grow, divide, repair, and communicate with other cells.
Here are some of the common types of targeted therapy:
- Monoclonal antibodies. These medications are often combined with toxins, chemotherapy drugs, and radiation. They attach to targets on the surface of cancer cells and deliver these substances, causing cancer cells to die without harming healthy cells.
- Small molecule inhibitors. These drugs generally target and inhibit specific pathways and processes that cause cancer cells to proliferate. They must be small enough to be able to enter the cell and interfere with proteins on both the inside and outside of the cell.
- Angiogenesis inhibitors. These drugs inhibit the formation of new blood vessels, which fuel the growth of cancer cells.
Chemotherapy Regimens For Early
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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What Is Neoadjuvant Therapy
Neoadjuvant therapy is a treatment approach which focuses on this type of reverse order. The idea is to first shrink the tumor with chemotherapy before any next steps, specifically surgery.
This approach not only can improve surgical options, but also allows for a better assessment of the patients response to the chemotherapy, Dr. Moore says. It can also inform better recommendations for follow-up treatments after surgery. The approach doesnt work for everyone, but its certainly worth discussing with your doctor to find out if youre a candidate.
When Is Chemotherapy Used
Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:
- After surgery : Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can’t be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
- Before surgery : Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed . Also, by giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesnt shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that have spread but can’t be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.
For certain types of breast cancer, if there are tumor cells still found at the time of surgery , you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back .
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The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
What Are The Risks Of Chemotherapy
Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.
Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.
Short-term side effects can include:
- Nausea and vomiting.
- Hair thinning or hair loss.
- Mouth sores.
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What To Expect After Chemo
Once youâre home, you need to take care of yourself and take steps to manage chemo side effects. These include:
- Take medications the doctor prescribed for side effects.
- Stay away from anyone with a cold or infection — chemo makes it harder for your body to fight germs.
- Drink lots of fluids for the first 8 hours to move the medicine through your body.
- Manage bodily fluids and waste that may have traces of chemo. Usually, this means flushing the toilet twice.
Youâll see your doctor every 4 to 6 months for the next 5 years after treatment ends.
Why Is Chemotherapy Still The Go
So why in the world are doctors continuing to prescribe a treatment that doesnt work on most cancers?
Read my post on The Business of Chemo.
When I was where you are, back in 2004, I also knew chemo was a toxic poison, which is why I didnt want to do it.
It didnt make sense to me that I could poison my body back to health.
Nevertheless, in the back of my mind it was my last resort if nothing else worked.
Today, as Im writing this post, I know many people , whose bodies have been wrecked by chemotherapy.
Theyve spent tens of thousands of dollars on these treatments and they still have cancer.
That is why I do what I do here on this site.
I am not a doctor and cannot give cancer treatment advice, but as a friend I can certainly share what I did.
Theres no law against that!
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Adjuvant And Neoadjuvant Drugs
Although drug combinations are often used to treat early breast cancer, advanced breast cancer more often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat advanced breast cancer.
For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.
Why Isnt A Cure The Goal
It can be painful and shocking when you come to understand the differences between what chemotherapy may offer for early-stage breast cancer and what it may accomplish for metastatic breast cancer.
It is not that doctors dont want to attempt to cure advanced breast cancer with chemotherapy. They do. Its just that with the drugs we currently have, and the resistance which develops over time, the odds of chemotherapy curing an advanced cancer are very low. This is true even if you are treated with extremely high doses of several powerful drugs.
According to studies, many people who have breast cancer are expecting that chemotherapy will cure their metastatic cancer. There are some cancers that respond and continue to respond to chemotherapy for a long time. Still, its important to understand what chemotherapy can and cant do with the drugs we currently have.
If you are still hoping for a cure, talk to your doctor. At this time there are not any approved medications that can cure metastatic breast cancer, though new medications are always being evaluated in clinical trials. For a few people, some of these newer medications, such as immunotherapy drugs, may offer a greater chance for long-term survivalbut we dont know for sure, and that is why they’re being studied.
Breast Cancer Doctor Discussion Guide
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have chemotherapy after surgery
Reasons not to have chemotherapy
I want to do everything possible to treat the breast cancer.
I would rather wait and see if the cancer comes back before I have more treatment.
I would have strong feelings of failure if the breast cancer returned.
I know there’s no way to know for sure whether chemo would keep the cancer from coming back.
I want to have the added treatment and be done with it.
I would be comfortable having frequent follow-ups, without the added treatment.
I feel ready to deal with the possible side effects of chemo.
I am very worried about the side effects.
How Long Can Chemo Take To Work
A chemotherapy course usually lasts 36 months, although this can vary.
The timing depends on various factors, including the type and stage of cancer, the persons overall health, and the type of chemotherapy drug that the doctor uses.
Doctors do tests at intervals to assess the effectiveness of chemotherapy.
If tests show that chemotherapy is not having enough of an impact, other options are available. Some include:
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Progression While Being Treated With Hormone Therapy
For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or an aromatase inhibitor , along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while on an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy is usually the next step.
Chemotherapy For Metastatic Breast Cancer
Advances in treatment are making it possible for women with metastatic breast cancer to live for many years. New drug therapies can not only slow down or stop a tumors growth but also keep symptoms at bay.
Which treatment your doctor recommends will vary based on your medical history, age, and breast cancer type, among other factors. Combinations of drugs are commonly prescribed for women with early-stage disease. Most women with advanced breast cancer generally receive only one drug at a time.
Chemotherapy drugs that MSK doctors commonly prescribe for advanced breast cancer include:
Women with advanced disease can also benefit from genomic testing. This is also called tumor sequencing or molecular profiling. It is offered to all MSK patients with metastatic breast cancer. Genomic testing involves looking at the cancer cells to see if there are any genetic mutations that could be linked to the specific type of breast cancer you have.
Our experts use a highly sophisticated testing approach developed by MSK researchers called MSK-IMPACT. The information gained from MSK-IMPACT can help us personalize your care. We can rule out drug therapies that may not work for you or sometimes recommend cutting-edge clinical trials designed to target the specific mutations in your tumor.
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The Goals Of Chemotherapy
Chemotherapy in the treatment of cancer can have different goals. Doctors differentiate between the following types of chemotherapy:
Curative chemotherapy: Curative chemotherapy aims to eliminate all cancer cells from the body and make the cancer go away completely.
Adjuvant chemotherapy: Adjuvant chemotherapy mainly aims to fight the cancer cells that might be left in the body after surgery, but that can’t be detected. The goal of this kind of supportive therapy is to prevent recurrences.
Neoadjuvant chemotherapy: Some tumors are too big to be directly operated on. Neoadjuvant chemotherapy can often shrink the tumor enough for it to be surgically removed at all, or for it to be removed using less invasive surgery.
Palliative chemotherapy: Chemotherapy is called palliative when it is no longer possible to remove all tumor cells. Chemotherapy can then help to relieve certain symptoms, to slow down the progress of the disease or to stop it temporarily, and to avoid complications.