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How Is Chemotherapy Administered For Breast Cancer

How Chemotherapy Is Given

What to Expect from Chemotherapy for Breast Cancer

Many chemotherapy drugs for breast cancer are given in liquid form, as intravenous infusions or injections , but some are available as pills or tablets.

Some drugs may be given alone, and other drugs are combined to work together. When chemo drugs are given in combination, the treatment is called a regimen.

Some of the common regimens are:

  • AC: Adriamycin and Cytoxan
  • ACT: Adriamycin and Cytoxan followed by a Taxol or Taxotere
  • ECT: Epirubicin and Cytoxan followed by a Taxol or Taxotere
  • CAF: Cytoxan, Adriamycin, and 5-FU
  • CEF: Cytoxan, Ellence, and 5-FU
  • CMF: Cytoxan, Trexall , and 5-FU
  • TC: Taxotere and Cytoxan
  • TAC: Taxotere, Adriamycin, and Cytoxan

Several types of targeted therapies have been approved for many cancer types, including breast cancer. For example, a therapy that targets the HER2 receptor is an antibody treatment called trastuzumab.

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What To Expect On Your First Day Of Chemotherapy

Chemotherapy. It’s not a word people want to hear and certainly not something they want to go through. But, for those of us with cancer, we often don’t have a choice. I remember how terrified I was of getting my first chemotherapy treatment. Would I be sick? Would I have a reaction to the medication? Would I be in a room by myself or with other chemo patients?I really didn’t know what to expect the first day. However, almost 4 years later, I feel like a pro.

Targeted Therapy Vs Chemotherapy

Chemotherapy is a type of cancer treatment that works by killing fast-growing cells in your body to help prevent the growth and spread of cancer cells. It can be given as an oral medication or administered through an IV.

But because chemotherapy can kill both healthy and cancerous cells in your body, it can cause many side effects.

On the other hand, targeted therapy is a treatment that attacks cancer cells specifically by interfering with certain pathways that control their growth.

Unlike chemotherapy, targeted therapy is designed to only affect cancer cells, meaning that its less likely to harm the normal, healthy cells in your body. But targeted therapy pills do have side effects as well.

Furthermore, while chemotherapy kills off cancer cells that have already been produced, targeted therapy also works by preventing cancer cells from multiplying and spreading.

Targeted therapy can be administered orally or through an IV for the treatment of breast cancer. Its often used alone or in combination with other cancer treatments, including chemotherapy.

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How Often You Receive Chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

  • your type of cancer and how advanced it is
  • whether chemotherapy is used to:
  • cure your cancer
  • the type of chemotherapy you are getting
  • how your body responds to the chemotherapy
  • You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

    Success For Certain Cancer Types

    My Breast Cancer Journey, Part 2

    Certain factors are considered in the choice to give neoadjuvant chemotherapy. These include the size of the tumor, evidence of lymph node involvement as well as the type of breast cancer.

    Some specific types of breast cancer are more likely to respond to neoadjuvant chemotherapy, Dr. Moore says.

    Unless the tumor is very small and shows no lymph node involvement most patients with either triple-negative breast cancer or HER2-positive breast cancer will be candidates for chemotherapy either pre-operatively or post-operatively.

    In the best cases, this therapy can completely eradicate all visible tumor from the breast, producing what is called a pathologic complete response. This means a pathologist finds no trace of the invasive tumor in the breast or lymph nodes after treatment.

    Thats good news not only in the short term, but also over a patients lifetime as the presence of a complete response is generally associated with an excellent prognosis.

    For patients who do not have a complete response to neoadjuvant chemotherapy, additional treatments can also be administered in the post-operative or adjuvant setting to improve long-term outcomes. In this way, treatments can be individualized. Often this means applying more intensive treatments to those at higher risk.

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    Procedures Required Prior To Neoadjuvant Chemotherapy

    In order to be able to accurately assess the status of the response to therapy, it is critically important to have a definitive diagnosis of breast cancer and obtain information about tumor type, tumor grade, presence or absence of necrosis, and/or lymphatic and vascular invasion. This information is helpful in making decisions about the initiation of neoadjuvant chemotherapy and selection of medication. A clip should be placed at the time of initial tissue sampling or during the first few cycles of neoadjuvant chemotherapy. This will make it possible to reliably identify the tumor bed after therapy. Access to sufficient tumor tissue is also required to be able to assess the status of biomarkers such as hormone receptors and HER2/neu oncogene. In addition, the status of axillary lymph nodes has to be known, clinically and by imaging, prior to neoadjuvant chemotherapy. Clinically positive axillary lymph nodes should be sampled by minimally invasive procedures such as fine needle aspiration biopsy and/or core needle biopsy. Clinically negative axillary lymph nodes should be sampled by sentinel lymph node biopsy.

    Are There Ways To Prevent Hair Loss With Chemotherapy

    Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.

    Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.

    People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.

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    Cancer Researchers Worry Immunotherapy May Hasten Growth Of Tumors In Some Patients

    Depending on characteristics such as how many tumor cells, blood vessel cells, and immune cells are touching each other, the tumor microenvironment can nearly triple the chance that a common type of breast cancer that has reached the lymph nodes will also metastasize, Condeelis and colleagues showed in a 2014 study of 3,760 patients. The discovery of how the tumor microenvironment can fuel metastasis by whisking cancer cells into blood vessels so impressed Dr. Francis Collins, director of the National Institutes of Health, that he featured it in his blog.

    The new study took the next logical step: Can the tumor microenvironment be altered so that it promotes or thwarts metastasis?

    To find out, Einsteins George Karagiannis spent nearly three years experimenting with lab mice whose genetic mutations make them spontaneously develop breast cancer, as well as mice given human breast tumors. In both cases, paclitaxel changed the tumor microenvironments in three ways, all more conducive to metastasis: The microenvironment had more of the immune cells that carry cancer cells into blood vessels, it developed blood vessels that were more permeable to cancer cells, and the tumor cells became more mobile, practically bounding into those molecular Lyfts.

    Pre-op chemo may have unwanted long-term consequences in some breast cancer patients, the Einstein researchers wrote.

    When Is Fec Given

    Are There Benefits to Chemotherapy before Breast Cancer Surgery?

    FEC may be given after surgery for primary breast cancer to reduce the risk of breast cancer coming back in future.

    It usually starts within a few weeks of your operation. If youre going to have radiotherapy youll usually complete your course of FEC first.

    FEC can be given before surgery to shrink a larger breast cancer. This may mean breast-conserving surgery is an option, rather than a mastectomy. Or it might be given before surgery to slow down the growth of a rapidly growing breast cancer and reduce the chance of it spreading to other parts of the body.

    FEC may also be given to people with secondary breast cancer, when breast cancer has spread to other parts of the body.

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    At What Stage Of Cancer Is Chemotherapy Used

    The decision to use chemotherapy may vary depending on the aggressiveness, stage and type of cancer. Usually, chemotherapy may be used for all stages in most cancer types. Chemotherapy is a type of medicine or combination of medications that is used to treat or kill cancer cells.

    Cancer treatment may include more than one type of therapy . The following describes the common ways that chemotherapy treatments are used

    • Adjuvant therapy: Chemotherapy may be used after surgery to reduce the risk of cancer recurrence .
    • Neoadjuvant therapy: Chemotherapy may be given before surgery to shrink the tumor. This is to help the surgery be more successful.
    • Concurrent therapy: Chemotherapy may be adjusted with other therapies . It is mostly used for aggressive or stubborn cancer types.
    • Palliative chemotherapy: This may also be used to relieve symptoms, improve quality of life and extend life for people with advanced cancer.

    Common type of chemotherapy drugs are as follows

    How Long Does Treatment Take

    It normally takes about an hour for the drugs to be given, although youre likely to be at the hospital for longer than this.

    The treatment is repeated every three weeks. The break between each treatment gives your body time to recover from any short-term side effects. It may vary depending on whether the number of blood cells has returned to normal.

    The treatment and period of time before the next one starts is known as a cycle.

    You will usually have six cycles of treatments.

    The total length of your treatment is usually three to four months.

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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.

    Palliative 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 palliative 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.

    Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

    • 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.

    Where Do I Go To Get A Chemotherapy Infusion Or Injection

    Clinical overview of metronomic chemotherapy in breast ...

    The place you get your chemo infusion or injection depends on which chemotherapy drugs youre getting, the drug doses, your hospitals policies, your insurance coverage, what you prefer, and what your doctor recommends.

    You may get chemotherapy:

    • In your doctors office
    • In a clinic
    • In a hospitals outpatient infusion center
    • In a hospital

    Some places may have private treatment rooms, while others treat many patients together in one large room. Ask your doctor or nurse about this ahead of time so you know what to expect on your first day.

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    Is Chemotherapy The Only Treatment For Breast Cancer

    No. Occasionally, chemotherapy is the only breast cancer treatment, but most often, healthcare providers use chemotherapy with other treatments, such as:

    • Lumpectomy: Removing the tumor and a small amount of surrounding breast tissue.
    • Mastectomy: Removing one or both breasts.
    • Hormone therapy: Taking medicines that lower estrogen or block estrogens effects on cancer cells.
    • Targeted therapy: Taking medicines that target the changes in cancer cells to destroy them or slow their growth.
    • Radiation therapy: Using high-energy X-rays to destroy cancer cells.

    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.

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    How Will I Know If My Chemotherapy Is Working

    You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

    You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

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    What Happens Before Chemotherapy For Breast Cancer

    Having chemotherapy for breast cancer – patient guide

    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 Long Is A Cycle Of Chemo

    Chemotherapy often involves several sessions or cyles of treatment. A cycle of chemotherapy is the amount of time that elapses between the start of one round of chemotherapy to the start of the next.

    Cancer Research UK states that it is very important for a person to receive their chemotherapy treatment in cycles. While chemotherapy drugs kill cancer cells, they also kill fast-growing healthy cells within the body. Receiving chemotherapy in cycles helps to effectively kill off the cancerous cells, while allowing the persons body time to replenish its healthy cells.

    A single course of chemotherapy will typically involve four to eight chemotherapy cycles. For instance, a 4-week cycle could involve someone taking medications on the first, second and third days, then no further medication until the 29th day.

    A doctor will decide the length and structure of a persons chemotherapy cycles.

    Chemotherapy treatment typically lasts between 36 months. However, some people will receive chemotherapy for shorter or longer periods of time.

    Which Chemotherapy To Use In Early Breast Cancer

    The successful history of adjuvant chemotherapy in early breast cancer started almost 4 decades ago when Bonadonna et al. in 1976 published the first report on the efficacy of cyclophosphamide, methotrexate, and fluorouracil as adjuvant treatment for node-positive breast cancer.

    Later trials showed that substitution of methotrexate with epirubicin was even more efficacious both in terms of DFS and OS in premenopausal women with axillary node-positive breast cancer . The advantage of anthracycline-containing 3-drug combinations over CMF was unequivocally confirmed in an individual-patient data meta-analysis of the Early Breast Cancer Trialists Collaborative Group . Altogether, 100,000 patients in 123 randomized trials were included. Anthracycline-based regimens with substantially higher cumulative dosage than standard 4 × AC or CEF) were superior to standard CMF 0.78 p = 0.0004).

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    What Is An Anthracycline

    An anthracycline is a type of chemotherapy that attacks enzymes inside of cancer cells DNA which helps them divide and grow. Anthracyclines used in breast cancer treatment include doxorubicin, liposomal doxorubicin, and epirubicin. These anthracyclines are bright red in color and may cause temporary discoloration of urine and bodily fluids.

    A side effect of all anthracyclines is that they may cause a type of permanent heart damage, called cardiomyopathy. Because of this, there is a limit to how much anthracycline a person can receive in their lifetime. People receiving treatment with anthracyclines should have their heart function monitored with an echocardiogram or a MUGA scan, a special type of heart imaging technique.

    Evidence From Other Trials

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    Other trials have tested the dose dense hypothesis, with positive results however, not all of them are ‘clean’ tests of the dose density concept. In fact, the interpretability of studies may often be confounded by the design, in that the two arms are not equal in terms of the number of cycles or total drug dose, or even different drugs are delivered .

    Möbus and colleagues from the Arbeitsgemeinschaft für Gynaekologische Onkologie group recently demonstrated the superiority of adjuvant dose dense epirubicin, paclitaxel, and cyclophosphamide , every 2 weeks with filgrastim support, over sequential EC followed by paclitaxel every 3 weeks . The authors defined this trial as a comparison of both dose dense and dose intense chemotherapy versus standard chemotherapy: in fact, the experimental ETC arm had higher cumulative doses of chemotherapy than did the 3-weekly arm. The study revealed a benefit in terms of DFS and OS for the ETC arm, although, given the higher doses delivered, it is not clear whether the superiority was purely conveyed by dose density alone.

    Figure 5

    Phase III, prospective, randomized, multicenter Arbeitsgemeinschaft für Gynaekologische Onkologie group trial. Adapted from Möbus and coworkers .

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