Hormonal Therapy For Idc
If the cancer tested positive for hormone receptors, your doctor likely will recommend some form of hormonal therapy. Hormonal therapy, also called anti-estrogen therapy or endocrine therapy, works by lowering the amount of estrogen in the body or blocking the estrogen from signaling breast cancer cells to grow. Because hormonal therapy affects your whole body, its sometimes called a systemic treatment.
In some cases of advanced-stage IDC, hormonal therapy can be given before surgery to help shrink the cancer . Still, it’s more common for hormonal therapy to start after other treatments, such as chemotherapy or radiation therapy, unless these treatments arent needed.
Hormone receptors are special proteins found on the surface of certain cells throughout the body, including breast cells. These receptor proteins are the eyes and ears of the cells, receiving messages from the hormones in the bloodstream and then telling the cells what to do. In other words, the receptors act like an on-off switch for a particular activity in the cell. If the right substance comes along that fits into the receptor like a key fitting into a lock the switch is turned on and a particular activity in the cell begins.
You and your doctor will work together to decide which form of hormonal therapy is best in your situation. Two types of hormonal therapy are most frequently used:
What Does Chemotherapy Do
Chemotherapy slows or stops the growth of the primary tumor and other cancer cells that may have metastasized . It may be used to shrink the tumor before surgery or to treat any remaining cancer cells in the body after surgery. Chemotherapy drugs reach almost all areas of the body. Some chemotherapy drugs are used in combination because they work in different ways and may be more effective.
Chemotherapy is usually given into a vein and may cause side effects such as nausea, hair loss, tiredness, and trouble with focusing and memory . Your doctor can help to reduce some of these side effects, such as nausea, and hair loss is almost always temporary.
Is Oral Chemotherapy As Effective As Iv Chemotherapy
Yes, the potential results are the same no matter which method you choose. The purpose of chemotherapy is to kill cancer cells. It has the potential to reduce the size of tumors, control disease progression and, in some cases, may lead to cancer regression.
Chemotherapy may be used before and/or after another treatment, such as surgery, or alone as the primary treatment method. Its sometimes used in combination with other treatments, such as radiation therapy or immunotherapy.
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What Are Some Common Chemotherapy Combinations Used In Breast Cancer
Chemotherapy regimens usually have acronyms to help simplify what theyre called. They can also include other medications like HER2 target therapy, discussed below. A few examples of some common breast cancer chemotherapy regimens are:
AC T: Doxorubicin and cyclophosphamide followed by paclitaxel
AC T: Doxorubicin and cyclophosphamide followed by docetaxel
AC THP: Doxorubicin and cyclophosphamide followed by paclitaxel, trastuzumab, and pertuzumab
TC: Docetaxel and cyclophosphamide
TAC: Docetaxel, doxorubicin, and cyclophosphamide
CMF: Cyclophosphamide, methotrexate, and fluorouracil
TCHP: Docetaxel, carboplatin, trastuzumab, and pertuzumab
These acronyms consist of the first letter of each medications name in the regimen, but it varies if the first letter refers to the medications brand or generic name. For example in the TC regimen the letter T refers to Taxotere, which is the brand name of docetaxel. The C refers to cyclophosphamide.
These medications are discussed individually below.
How Often Is Chemotherapy Given For Breast Cancer
Chemotherapy for breast cancer is given in cycles, usually 2 to 3 weeks long, with a short break in between. This gives the body time to recover after receiving chemotherapy. Some chemotherapy is only given on one day per cycle, while others are given on multiple days per cycle. For example, gemcitabine is often given on day 1, day 8, and day 15 of an overall 28-day treatment cycle .
A chemotherapy schedule depends on the type of chemotherapy medications given. Chemotherapy is usually given over 3 to 6 months, or longer in some cases, depending on the type and stage of breast cancer. If you experience bothersome side effects or the treatment is no longer working, you may need to switch treatment to a different chemotherapy or therapy option.
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Chemo Drugs For Breast Cancer That Has Spread
- Taxanes: Paclitaxel , docetaxel , and albumin-bound paclitaxel
- Antibody drug conjugates
Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.
For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.
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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What Is The Difference Between Oral And Iv Chemotherapy
Most cancer treatment includes chemotherapy, a process that delivers strong drugs to your body to kill cancerous cells. You receive these drugs at regular intervals and for a specified length of time.
Your doctor at UHC Cancer Center may recommend oral or IV chemotherapy based on your specific type of cancer, its progression, and your personal preferences. Both have equal strength and deliver similar results.
Summary Of Treatment Options For Metastatic Breast Cancer
Hormone receptor-positive, HER2-negative breast cancer
Hormonal therapy is considered the standard initial treatment for HER2-negative metastatic breast cancer that is also hormone receptor-positive, and is often given in combination with targeted therapy. However, chemotherapy may also be given. A clinical trial may also be an option for treatment at any stage.
Hormone receptor-negative, HER2-negative breast cancer
In general, chemotherapy or targeted therapy is given for treatment of triple-negative breast cancer. A clinical trial may also be an option for treatment at any stage.
HER2-positive breast cancer that has spread to parts of the body other than the brain
In general, HER2-targeted therapy is regularly added to treatment for HER2-positive breast cancer that has spread. The drugs used depend on the treatments already given and whether the cancer is hormone receptor-positive. The treatment recommendations for first-line, second-line, and third-line or higher treatment are listed below. A clinical trial may also be an option for treatment at any stage.
Second-line treatment is used for people with early-stage breast cancer who had the cancer either spread during initial treatment with trastuzumab or return within 12 months after stopping treatment with trastuzumab. It is also used for people whose cancer worsens while receiving first-line treatment.
The preferred second-line treatment is the drug T-DM1.
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Does Insurance Cover Tamoxifen
While costs vary, tamoxifen is usually less expensive than an aromatase inhibitor because it is a generic medicine. If you have health insurance, check with your insurance company to see if and how much of the cost of tamoxifen is covered. If you don’t have health insurance or your insurance doesn’t cover the cost of tamoxifen, ask your doctor or nurse about programs in your area that may be able to help.
Soltamox is available to patients who qualify at the same co-pay cost as generic tamoxifen. Patients can download a $10 co-pay per prescription card for unlimited use.
You can also read Breastcancer.org’s Paying for Your Care section for information on additional types of financial assistance and cost-lowering tips.
What Are The Disadvantages Of Oral Chemotherapy
While the oral administration of chemotherapy has the advantage of convenience and flexibility, it comes with a few potential disadvantages.
The potentially significant disadvantages of oral chemotherapy, however, are associated with a patient’s ability to take their medication properly and with cost or access to the medication itself.
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Key Points To Remember
- Chemotherapy is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
- Some types of cancer have a very small chance of coming back. Women who have these types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
- Your age, type of cancer, tumour size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
- Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren’t.
Breast cancer occurs when abnormal cells grow out of control in one or both breasts. These cells can invade nearby tissues and form a mass, called a malignant tumour. The cancer cells can spread to the lymph nodes and other parts of the body.
The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy and hormone therapy, that may help keep cancer from coming back.
Some people think of added treatment as an insurance policy designed to destroy any cancer cells that may still be in the body.
The type of added treatment you have depends on the stage and classification of your breast cancer:
What To Know About Paying For Oral Chemotherapy
Most oncology practices help you figure out your health coverage and how youll pay for your treatment.
If you have health insurance, theres a good chance that traditional chemotherapy is covered under major medical benefits. Depending on your policy, oral chemotherapy may fall under pharmacy benefits, which could mean youll have a much higher copay.
Make sure you understand your coverage so youre not blindsided by bills. If you do have high out-of-pocket costs, these services may be able to help you:
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Here Are Some Important Things To Know When Beginning A Course Of Oral Chemotherapy:
A 2018 study by several Fox Chase Cancer Center physicians showed that both providers and patients face barriers to starting oral chemotherapy when it comes to insurance. This is largely due to the fact that insurers cover OAMs as a prescription drug benefit, whereas IV chemotherapy is covered as a medical procedure. The distinction can lead to delays from the time an OAM is prescribed until the patient receives the medication. These delays can last days or even weeks. The researchers found that the process was labor intensive, taking an average of two weeks and five phone calls for a patient to start a drug.
Additionally, the study found that out-of-pocket costs could vary and required a lot of staff support to mitigate these costs through financial assistance. Many medical centers like Fox Chase offer financial counselors and insurance advocates to help patients and providers navigate this process.
Being treated for cancer in the comfort of home is a big convenience for patients. But its important to remember that OAMs are powerful drugs and should be taken with the same care as traditional chemotherapy given in a hospital setting.
Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
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How Long Do You Take Oral Chemotherapy
Chemotherapy in either form is usually given in cycles over a period of a few weeks at a time, but this may vary depending on the specifics of your treatment plan.
If you have advanced cancer and chemotherapy is being used to slow the progression of cancer or to relieve its symptoms, it may be used for longer periods of time if youre tolerating it well and it improves your quality of life.
When Should I Call My Doctor Or Oncologist
- You have a fever of 100.5Â°F or higher or chills.
- You have bleeding from your gums.
- You have nausea or vomiting and cannot take your chemo.
- You vomit after you take your oral chemo.
- You miss a dose of chemo.
- You have sores or white spots in your mouth.
- You have constipation or diarrhea for more than 1 day.
- You feel depressed.
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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 my breast cancer.
I would rather wait and see if my cancer comes back before I have more treatment.
- Increased chance of bruising, bleeding, and infection.
- Memory and concentration problems.
Long-term side effects of chemotherapy can include:
- Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones .
- Concentration problems that may last for many months after your treatments are finished.
- In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.
How To Take And Store
When taking your chemotherapy pill or liquid, wash your hands before and after handling the medication. Oral chemotherapy should always be swallowed as directed never cut, chew, or crush it.
Chemo you swallow is as strong as other forms of chemo, and many are considered hazardous. You may be told to be careful not to let others come into contact with your medication or your body fluids while taking it and for a time after taking it. You may need to wear gloves when touching the pills or capsules.
Some drugs have to be kept in the bottle or box they came in, while some drugs and the packages they come in need to be disposed of in a certain way. Some may have to be taken back to the drug store to be thrown away safely. Some drug manufacturers will include materials for safely disposing of your medication.
Keeping your medication in a weekly pill box may help you remember to take it each day. Most chemotherapy pills and liquids can be stored at room temperature. There are some forms of oral chemotherapy that require refrigeration.
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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.
is approved in oral form for breast cancer.
Cyclophosphamide is another type of oral chemotherapy thats included as part of a combined treatment regimen called CMF .
Although most commonly administered intravenously for the treatment of breast cancer, methotrexate is another chemotherapy agent thats available in pill form.
Its important to know the difference between the various forms of oral medication prescribed to fight breast cancer, says Dr. Hannah Luu, California-based oncologist and CEO and founder of OncoGambit, an online service that creates personalized cancer treatment plans.
She outlines three categories of oral medications cancer patients may take as part of their treatment plan:
- chemotherapy pills
- antihormonal pills
- targeted therapy pills
Each therapy works differently and serves a different purpose, and not every medication will be right for everyone. Which therapy is right for you will depend on various factors including the type and stage of cancer youre fighting, and other health considerations.