Chemotherapy Before Breast Cancer Surgery Might Fuel Metastasis
When breast cancer patients get chemotherapy before surgery to remove their tumor, it can make remaining malignant cells spread to distant sites, resulting in incurable metastatic cancer, scientists reported;last week.
The main goal of pre-operative chemotherapy for breast cancer is to shrink tumors so women can have a lumpectomy rather than a more invasive mastectomy. It was therefore initially used only on large tumors after being introduced about 25 years ago. But as fewer and fewer women were diagnosed with large breast tumors, pre-op chemo began to be used in patients with smaller cancers, too, in the hope that it would extend survival.
But pre-op chemo can, instead, promote metastasis, scientists concluded from experiments in lab mice and human tissue, published in Science Translational Medicine.
The reason is that standard pre-op chemotherapies for breast cancer paclitaxel, doxorubicin, and cyclophosphamide affect the bodys on-ramps to the highways of metastasis, said biologist John Condeelis of Albert Einstein College of Medicine, senior author of the new study.
Hi Kim I’m Stage Ii Also I
Hi Kim, I’m stage II also.; I am 45.; I opted to have the chemo .; Totally up to me.; My thought process was if there is even a slight possibility that it will help I’m doing it.; It didn’t hurt that my oncologist said if I was his daughter he’d want me to do it.; :); So far I’ve had 5 of my 12 treatments and it’s going well.; They removed the oxiliplatin after round 3 because the neuropathy was getting pretty bad.; So now it’s just the 5FU and the Leucovorin.; This has made treatment much;more tolerable.; Everyone reacts differently, but if you are just getting the 5FU, I don’t think you’ll have a rough time of it.; It’s pretty well tolerated.;
Feel free to message me if you’d like to discuss this more.
Brachytherapy Via Implantable Device
There are two common types of internal radiation treatment: interstitial brachytherapy and intracavitary brachytherapy.
During interstitial brachytherapy, a doctor will insert several small tubes into your breast where the cancer was removed. The tubes deliver radioactive pellets to that area a few times each day over several days. This procedure is not commonly used today.
Intracavitary brachytherapy is the most common type of internal breast cancer radiation. Your doctor will place a tube-like device into your breast to send radiation to the location of the cancer. The end of the device expands in the breast to keep it in place, while the other end sticks out of the breast. Outpatient treatment sessions happen twice a day for five days.
Side effects of intracavitary brachytherapy may include:
Read Also: How Many People Survive Breast Cancer
Targeted Therapy For Breast Cancer
Targeted therapy refers to a variety of drugs that enter the bloodstream and treat cancer throughout the body. Targeted therapy drugs aim to attack cancer cells without harming healthy cells, and tend to have fewer side effects than chemotherapy drugs.
Common targeted therapy drugs for HER2-positive breast cancers include:
- Monoclonal antibodies like trastuzumab are synthetic antibodies designed to attach to HER2 proteins and stop cells from growing.
- Antibody-drug conjugates like ado-trastuzumab emtansine attach to HER2 proteins on cancer cells and help chemotherapy reach them.
- Kinase inhibitors like Lapatinib block HER2 proteins.
Targeted therapies are also used to treat hormone receptor-positive breast cancer along with hormone therapy.
Common targeted therapy drugs for people with hormone receptor-positive cancers include:
- CDK4/6 inhibitors, which block CDK proteins in cancer cells to stop them from dividing and slow cancer growth.
- mTOR inhibitors, which block mTOR proteins in cancer cells to stop them from dividing and growing. This treatment is believed to help hormone therapy drugs work more efficiently.
- PI3K inhibitors, which block the PI3K proteins in cancer cells and helps prevent them from growing.
Common targeted therapy drugs for people with TNBC include:
Complementary And Alternative Treatments
Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.
These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.
Examples of alternative therapy include:
- using massage to relax
- using peppermint tea to reduce nausea
- using cannabis to relieve pain
While some alternative medicine treatments might help you feel more comfortable, its important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments youre interested in pursuing.
Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.
Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs , such as ibuprofen.
For severe pain in a later stage, your doctor may recommend an opioid such as morphine, oxycodone, hydromorphone, or fentanyl. These opioids have the potential for addiction, so they are only recommended in certain cases.
While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.
Read Also: Is Breast Cancer Internal Cancer
External Beam Breast Cancer Radiation
External beam radiation is the most common kind of radiation treatment for breast cancer. Its a painless treatment, like getting an X-ray. A doctor will place a machine on the outside of your body and aim the radiation beams at the area of the cancer. Your doctor will figure out where to aim the rays and how much radiation to use before each treatment. They will mark the area with temporary or permanent ink.
Each treatment only lasts a few minutes. The session setup will take longer. External radiation treatment happens five days a week for about five to seven weeks. Its the longest type of radiation treatment available.
Short-term side effects of external radiation include:
- swelling and pain in the arm or chest
- weakened and fractured ribs
- future cancer in the inner lining of your blood vessels
External radiation does not leave radiation in your body. You will not be radioactive during or after treatment.
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
Treatment Modalities Of Tnbc
Patients with TNBC do not benefit from hormonal or trastuzumab-based therapy because of the loss of target receptors such as ER, PGR, and HER-2. Hence, surgery and chemotherapy, individually or in combination, appear to be the only available modalities. However, some studies have identified certain receptors as targets for new therapeutic drugs.
How Does Chemotherapy Work
Chemotherapy works by attacking fast-growing cells in your body, including cancer cells. There are many different types of chemotherapy; your medical oncologist will talk to you about whats most suitable for you. Sometimes more than one type of treatment may be effective for you, and you may be asked to decide which one to have. Your medical oncologist can tell you about the pros and cons of each.
Some questions you might like to ask include:
- What are the possible side effects of each treatment?
- How long is the course of each treatment?
- How will the treatment fit in with my lifestyle and personal circumstances?
Some chemotherapy drugs are given in tablet form, however, most are administered intravenously . As a result, it is useful to drink plenty of fluids, relax and keep your hands and arms warm, as this can help the nurse or doctor find your veins.
Menstrual And Fertility Changes
If you have a menstrual cycle, you may find that it changes under chemotherapy. Some people start menopause after completing chemotherapy. This becomes more common the closer you are to menopause, which typically starts around the age of 51.
Periods can return after treatment is completed, but this often depends on your age and what kind of chemotherapy drugs were used. Typically, the younger you are, the greater the chance is that your period will return and youll produce fertile eggs.
Talk with your doctor if you hope to get pregnant after chemotherapy. They can help design a treatment plan that least affects your fertility.
Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
Other Drug Treatments For Cancer
The traditional drugs used for chemotherapy are an important part of treatment for many cancers. The drugs affect both cancer cells and healthy cells. But scientists have designed newer drugs that work more specifically to treat cancer. These treatments cause different side effects.
Doctors may use these newer cancer drugs as the only drug treatment. But they are often added to traditional chemotherapy. These types of treatment include:
Hormonal therapy. These treatments change the amount of hormones in your body. Hormones are chemicals your body makes naturally. They help control the activity of certain cells or organs. Doctors use hormonal therapy because hormone levels control several types of cancers. These include some breast and prostate cancers.
Targeted therapy. These treatments target and disable genes or proteins found in cancer cells that the cancer cells need to grow.
Immunotherapy. This type of treatment helps your body’s natural defenses fight the cancer. Immunotherapy is now an important part of treatment for several types of cancer and will play an increasingly important role in treatment in the future.
Inflammatory Breast Cancer Treatment
Inflammatory breast cancer is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.
All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic , its considered stage 4.
Treatments for IBC depend on what stage the cancer is in.
Read Also: Does Breast Cancer Metastasis To Bone
What Happens If Chemo Doesnt Work
Your oncologist might suggest new treatments, such as trying different combinations of chemotherapy drugs that include experimental options. Still, you and your oncologist must consider whether more treatment will improve your health, or whether its best to stop treatment altogether and pursue palliative care.
Target Therapy In Tnbc
Mammalian target of rapamycin inhibitors
mTOR is one of the intracellular kinases. mTOR inhibitors have been shown to improve outcome in several cancer types including renal cancer. TNBC presents a high frequency of PTEN loss and mTOR activation. There is therefore a rationale to develop mTOR inhibition in patients with TNBC that show PTEN loss. Interestingly, several reports say that mTOR activation could lead to cisplatin resistance, a phenomenon reversible by everolimus which is mTOR inhibitor.
Beuvink et al. reported that adding everolimus to cisplatin could increase by 5-fold the loss of viability in vitro. These data suggest that there is a rationale to combine cisplatin and mTOR inhibitors in patients with TNBC.
FGFR inhibitors represent a new drug family. These drugs are either FGFR specific or target FGFR as part of their tyrosine kinase panel in addition to VEGFR inhibition. At least four compounds are currently under clinical trials on TNBC.
EGFR signaling has been inhibited in other cancer types with clinical success either by using EGFR directed antibodies such as cetuximab or the inhibitors of receptor phosphorylation as gefitinib and erlotinib. Cetuximab is a chimeric monoclonal antibody targeting EGFR, elicits little response to single-agent therapy in the setting of advanced TNBC.
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Sex Contraception And Pregnancy
You can still have sex during treatment. Its thought that chemotherapy drugs cant pass into vaginal fluids or semen, but this cant be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids. Most treatment teams will advise using barrier methods of contraception, such as condoms during treatment, and for a few days after chemotherapy is given.;
If you havent been through the menopause, its important to use contraception because chemotherapy drugs can harm a developing baby in the first three months of pregnancy. Its still possible to become pregnant even if your periods become irregular or stop completely.
Your specialist will usually recommend barrier methods of contraception, such as condoms. The contraceptive pill is not usually recommended because it contains hormones. Emergency contraception such as the morning after pill can still be used.
An interuterine device can be used as long as its not the type that releases hormones. If you have a coil in place that does release hormones, such as the Mirena or Jaydess, when youre diagnosed, you may be advised to have this removed.
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.
Also Check: How To Detect Breast Cancer Early
How Will I Know If The Chemotherapy Treatments Are Working
Some people may think that their chemotherapy treatment is not working if they do not experience side effects. However, this is a myth.
If you are receiving adjuvant chemotherapy , it is not possible for your doctor to directly determine whether the treatment is working because there are no tumor cells left to assess. However, adjuvant chemotherapy treatments have been proven helpful in studies in which some women were given chemotherapy, while others were not. If you are receiving chemotherapy for metastatic disease, the effects will be monitored, routinely, by blood tests, scans, and/or other imaging studies. These may include CT scans, bone scans, and/or X-rays).
After completing adjuvant chemotherapy, your doctor will evaluate your progress through periodic physical examinations, routine mammography, and appropriate testing if a new problem develops.
Last reviewed by a Cleveland Clinic medical professional on 09/05/2013.
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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How I Feel During Round 1
I feel as if I am constantly on coming off of the most intense roller coaster EVER. Big time motion sickness! This lasted for almost a full week for me. Sitting up in bed was even tricky. My mother in law and husband were always close by in case I needed help walking to the restroom. I have not been alone, which is a blessing.
Here are some details about the photo above:
The pic of me in the chair was taken on March 26, 2018 and was my first chemo infusion. After this round, right before my 2nd dose, I felt better and decided to cut off my hair before it fell out everywhere. The short hair selfie pic was taken on my way to my second treatment, I think. Finally, the bottom right pic was taken maybe 4 or 5 days after my super cut cut! My hair was really, really falling out all over the house, so my husband gave me a buzz cut.