Publications
Insight, Spring 2008
Learn how to manage the acute side effects of treatment and understand how chemotherapy works to eliminate cancer. A profile of a young woman affected by breast cancer explores issues of fertility and describes her work as an advocate.
Table of Contents
Living Well: Managing the Acute Side Effects of Treatment
It is normal to have concerns and fears about treatment side effects, but being in treatment does not mean you have to suffer. Knowing what questions to ask your doctor and how to lessen the impact of short-term side effects may significantly improve the quality of your life.
Healing After Surgery
Kebby Kelley, an employee of the U.S. Coast Guard, was 43 when she was diagnosed in July 2005. She had a lumpectomy followed by a re-excision and axillary node dissection (the removal of armpit lymph nodes to test for the presence of cancer).
Kebby wore camisoles and loose clothing to lessen pain from her incision. However, her arm movements were limited weeks and months after surgery. She experienced painful "cording," a potential side effect of surgery to remove the lymph nodes. Cording, which develops from scarred lymphatic vessels, is a tight and painful band of tissue that can be felt (like a cord) running down the arm toward your hand. Cording pain can resolve itself in a few weeks or last for months.
While attending a support group, Kebby learned that exercise might help. She went to her breast surgeon, who prescribed physical therapy. The therapist stretched, massaged and "broke up" the cords.
"My range of motion improved after each treatment," she says. "They also gave me a list of stretches to do every night."
She also tried Reiki, a Japanese technique for stress reduction and relaxation. "It was very calming and helped me psychologically, which seemed to help me deal with the pain," she says.
Debra Thaler-DeMers, RN, OCN, PRN-c, an oncology nurse from Stanford Hospital and Clinics, says getting out of bed within 24 hours of surgery helps lessen your risk of developing deep vein thrombosis (blood clots) and pneumonia. If you cannot leave bed, you may use a compression stocking to prevent deep vein thrombosis and an incentive spirometer, a simple medical device, to exercise your lungs. Wall climbing exercises after a mastectomy can help your muscles and tissues stretch and regain range of motion.
Talk to your doctor before surgery about exercises and pain medications. Find out if you can use cold packs to ease pain or swelling. By having these conversations when you are feeling well, you will know what to expect after surgery and feel more prepared.
If you have lymph nodes removed, protect yourself from lymphedemathroughout your life by getting blood drawn or blood pressure measured using the unaffected arm. Attend to cuts immediately by cleansing and applying antibacterial cream, and wear gloves when cleaning or gardening. If you develop lymphedema, talk to your physician about seeing a physical therapist who is a lymphedema specialist.
Life During Chemotherapy
Chemotherapy kills rapidly dividing cells, including cancer cells and those found in your hair and nails. Hair loss can evoke strong emotions.
"When my hair fell out, I was crying and finally saying, ‘this is really happening to me,’" says Patty Merritt, 58, an editor from Lake Elsinore, California. "The emotions of the hair loss made me come to terms with the reality of what I was dealing with."
Not all women lose hair, but Patty prepared because her oncologist warned her that her chemotherapy medicines almost always cause hair loss.
"Before my chemotherapy, I went to a shop and found a wig I liked," she says. "Since it was a little different than my hair, I went to my hairdresser and she styled and highlighted my own hair exactly like the wig so the transition would be easier."
If you don’t feel comfortable wearing a wig, it is perfectly fine to go bald. You also can purchase head scarves or comfortable cotton or terry cloth caps if you prefer covering your head. Heat escapes from the tops of our heads, so without hair you may find yourself feeling cooler than usual. Buy fun hats to protect your scalp from sun exposure and to keep warm.
Along with hair changes, some women develop ridges in their nails or their nails become brittle or discolored. Bacteria enter your body at this area, so wash your hands often and don’t bite your nails. Consider wearing cotton gloves to protect your hands. Avoid manicures and pedicures, but if you do have your nails done, choose a clean environment and do not have your cuticles cut.
Unlike hair loss and nail changes, nausea and vomiting can sometimes be physically debilitating. You may experience mild nausea or none at all. Your doctor may prescribe anti-nausea medications (also called anti-emetics) such as aprepitant (Emend), ondansetron (Zofran), dolasetron (Anzemet) or granisetron HCl (Kytril) before or during chemotherapy.
"To prepare for nausea that occurs in the days after your chemotherapy, get a prescription and start taking medication at the first sign of nausea—don’t wait until you are throwing up," says Ms. Thaler-DeMers.
If anti-nausea medications cause constipation, drink plenty of liquids, eat high-fiber foods and exercise. For diarrhea, avoid high fiber items and eat foods with potassium, such as bananas and potatoes. If you are vomiting, prevent dehydration by drinking plenty of fluids, including sports drinks and broths.
Anti-anxiety medications may provide relief before treatments for "anticipatory" nausea related to anxiety, Ms. Thaler-DeMers says. Sip ginger ale, suck on ginger candies and avoid spicy or greasy foods. If you are sensitive to smells, eat cool foods, and stay away from areas where foods are prepared.
Along with nausea, you may experience appetite loss and taste changes. To help, always keep something in your stomach and eat fruits, vegetables, cottage cheese, dry foods, broiled meats, plain potatoes and rice.
Mouth sores can become infected from bacteria or make you dread eating. Patty didn’t want to eat anything too hot, cold or hard, and brushing her teeth hurt. She used a prescription artificial saliva solution for dry mouth, a prescription Benadryl, Mylanta and Xylocaine (BMX) solution for healing and over-the-counter Hurricane Anesthetic Gel to numb sores. (Check with your doctor before using over-the-counter products.) Avoid mouthwashes that contain alcohol. Many brands contain 10 percent or more, so check labels carefully.
If you develop mouth sores, eat soft foods such as jello or liquid yogurts at room temperature, and avoid acidic foods. Use toothpaste for sensitive teeth, a soft toothbrush for painful gums and lip balms or petroleum jelly for dry lips. Before you start chemotherapy, schedule a cleaning with your dentist and take care of dental procedures to facilitate faster healing and lower your risk of infection.
Another unsettling side effect is neuropathy, a condition characterized by pain, numbness or tingling in the hands or feet caused by damage to nerves during chemotherapy, explains Ms. Thaler-DeMers. Wear supportive and comfortable shoes at all times and tell your doctor about neuropathy.
"Anything you can do to increase circulation to peripheral nerves may help," she says. "Walk, exercise or flex your ankles up and down ten times in three sets. Maintaining or increasing blood flow can help healing."
Regardless of your other side effects, fatigue and weakness are common and can impair your ability to function normally. Physical activity may increase energy, so walk if you are able. Ask relatives and friends to help with household chores or errands. Sleep as often as necessary, and don’t feel guilty if you can’t do everything yourself.
With fatigue, you may experience foggy thinking, commonly referred to as chemo brain. Ms. Thaler-DeMers suggests doing crossword puzzles or mind exercises, writing notes to yourself and repeating names when you meet someone new.
If you are pre- or peri-menopausal, you may be surprised to find that you experience early menopausal changes. Your periods may stop or become irregular, and you may have hot flashes, vaginal dryness, insomnia, night sweats and decreased sex drive.
"To this day, [experiencing early menopause] is the thing I’m most angry about and the thing I was least prepared for," Kebby says. "I wish I would have asked my doctor what all the symptoms were and when they would occur."
If your doctor does not bring up menopausal changes before treatment, ask if you are likely to begin menopause early, what side effects you may experience and how you can ease them.
For hot flashes and night sweats, Kebby dressed in light layers and avoided spicy foods. She carried a pocket fan, used cool packs on her forehead and wrists and avoided stressors.
"There have been some successful clinical trials using anti-depressants to treat hot flashes," explains Ms. Thaler-DeMers. Anti-depressants may also alleviate insomnia because they make some people feel drowsy. If you are taking tamoxifen, make sure to discuss possible drug interactions. Small studies have shown selective serotonin reuptake inhibitors, a type of anti-depressant, impact the way our bodies metabolize tamoxifen, making it less effective.
Some women lose their sex drive during treatment or find that sex is painful because of vaginal dryness. If you want to have intercourse, your oncologist or gynecologist may suggest a variety of lubricants to minimize discomfort. Explore other kinds of intimacy that can provide closeness with your partner.
Depending on your age and treatment type, you may have temporary or permanent fertility loss. Ms. Thaler-DeMers recommends seeing a reproductive endocrinologist before treatment. You may be able to have your eggs fertilized and stored as embryos or, if you do not have a partner, have your eggs harvested. Your doctor can discuss the timing of your treatments or make other suggestions to help preserve your fertility.
Calling Your Doctor
If you experience discomfort, call your doctor and ask for help. If one medication or method doesn’t work, ask to try another.
Ms. Thaler-DeMers recommends calling your doctor any time you have unusual new symptoms or side effects for which you cannot get relief. Before you call, write down how long you have been experiencing the side effects, words to describe them and a rating of discomfort on a scale of one (not uncomfortable) to 10 (the most uncomfortable you have ever been).
Call your doctor or go to the emergency room immediately if you have:
- Uncontrolled nausea or vomiting for days
- Shortness of breath
- Chest pain (call 911)
- Chills or fever of 100.5 degrees Fahrenheit or higher, which can be a sign of infection
- New bleeding or an increase in old bleeding
- Dizziness or lightheadedness and diarrhea four to six times per day, or red or black stool
- New onset of pain, or sudden increase in old pain or weakness in arms or legs
Targeted therapies may cause flu-like symptoms such as fever, chills, fatigue or muscle aches. Because some of these medications prevent the building of capillaries (small tubes within body tissues that transport blood from the arteries to the veins) and some types of healing, they also may cause you to cough up blood or have bloody stools. If you have unusual bleeding, chest pain or signs of allergic reaction, call your doctor immediately, says Ms. Thaler-DeMers.
Extreme changes in blood counts are cause for concern but can be managed. Soon after beginning chemotherapy, Patty’s white blood cell count decreased and she developed a fever of 101.5. She was hospitalized for neutropenia, a condition characterized by low white blood cell counts. She received antibiotics and her dose of chemotherapy was changed.
Anemia, or lowered red blood cell counts, may cause fatigue or weakness during chemotherapy. Doctors often prescribe medications such as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp) to increase blood counts. Get extra rest and eat leafy green vegetables.
Impact of Radiation
During radiation treatments, Michelle Peeples, 37, a loan specialist from West Hill, California, had a sunburn-like rash that became itchy, blistered, hot, inflamed and swollen.
"I’m not a big advocate for pain medications, so I tried other things," she says. "The radiation oncologist recommended some over-the-counter ointments to help the irritation, hotness and itching. I also tried cooling gels for the blisters, and I got a prescription of extra-strength hydrocortisone cream."
Michelle took ibuprofen and wore a soft cotton support tank instead of a bra. She found that comfortable workout materials like Dri-FIT® reduced the burning and irritation by absorbing heat and sweat. Cool water and mild baby shampoo were comfortable and soothing for bathing.
Managing Your Emotions
During treatment, Ms. Thaler-DeMers suggests getting support from family and friends by communicating your feelings and fears. She says yoga and exercise classes, acupuncture, support groups and focusing on activities you enjoy may alleviate emotional distress.
For support, get matched with a woman who knows what you are going through by calling our Survivors’ Helpline at (888) 753-LBBC (5222). To learn more about dealing with your emotions or about treatments and side effects, order free copies of LBBC’s Guide to Understanding Your Emotions and Guide for the Newly Diagnosed. Search lbbc.org to learn more about long-term side effects, complementary therapies and side effects of hormonal therapies.
Anjali Biswas: Profile of a Young Breast Cancer Advocate
In November 2006, Anjali Biswas*, a former high school teacher, was beginning a promising career as a professor in New York City after receiving her PhD. She had started training for a triathlon, and she planned to go off tamoxifen so she and her husband could start a family. It had been six years since her breast cancer diagnosis at age 23, and she was looking forward to putting the experience behind her.
But after a tumor-marker test came back high during a check-up, Anjali learned the cancer had returned in her bones and liver.
"Two years before, I began having chronic pain in both my hips. Because I was young and physically active, I initially thought it was a running injury, and my doctor might have taken my word for it," Anjali says. "But after my markers came back high, and I considered the bone pain and other physical problems I was having, I felt I was somewhat prepared for bad news. I have a sense of my own body, and I had an intuitive feeling about where the evidence might be going."
Anjali started on hormonal therapy with letrozole (Femara) and leuprolide (Lupron). Despite side effects including fatigue, bone pain and joint pain, she continued to train for the triathlon and participated in May 2007.
"I don’t have the patience for being physically debilitated, and I’m likely to question the value of treatments if I have quality-of-life issues," Anjali says. "I always try to be physically active, even if I’m feeling bad."
When hormonal therapy stopped working, in June 2007, Anjali enrolled in a clinical trial testing whether the chemotherapy capecitabine (Xeloda) given with the targeted therapy bevacizumab (Avastin) offers clinical benefit in metastatic disease. The treatment worked until January 2008, and then Anjali switched to the chemotherapy gemcitabine (Gemzar). She also began taking zoledronic acid (Zometa) to prevent fractures resulting from the cancer.
Throughout treatment, Anjali’s biggest concern has been fertility, especially with adoption options closed to her because of her metastatic status. Immediately after diagnosis, she enrolled in a clinical trial exploring the long-term survival of women with estrogen-sensitive cancer who get hormone stimulation to harvest eggs. Although her oncologists did not object to her participation on medical grounds, they advised her against having children. Anjali was devastated.
"If my doctor had told me before that if I developed mets I couldn’t have kids, I might have made some different decisions," Anjali says. "I’m sure my doctor had my best interests at heart, but having a discussion about fertility issues is preferable to not talking about it at all."
Initially, Anjali and her husband still considered having children: "There is a belief in the medical community that women with mets shouldn’t have children, because of the question of whether it is responsible or ethical. But at the end of the day, it’s my decision."
The couple produced several viable embryos during the clinical trial, but they ultimately made the very difficult decision not to have children.
"It’s been challenging because I have tons of friends who are pregnant. It’s been hard on my relationship [with my husband]—it’s the thing we fought about the most," Anjali says. "It’s also been challenging to convey to my family that we’re not having kids."
To cope, Anjali and her husband went to a counselor. Now she sees a counselor who specializes in fertility issues, and she has become involved in young people’s lives by babysitting and tutoring.
Anjali’s challenges surrounding fertility also prompted her to channel her energy into advocacy.
"Learning as much as I can about my choices, particularly surrounding quality of life, gives me a sense of order and control in a world that feels unpredictable and chaotic," she says. "If I can’t control the direction of my disease, then there is some aspect of this experience that I can contribute to and have a say in."
Anjali began interfacing with cancer organizations. She attended the Annual Conference for Young Women Affected by Breast Cancer in 2006 and LBBC’s advanced breast cancer conference in 2007. She is on the leadership council for I’m Too Young For This!; a participant in the New York group of Project LEAD of the National Breast Cancer Coalition; and a patient advocate reviewer for breast cancer research grants. Recently, she became a volunteer for our Survivors’ Helpline, where she answers calls from women with advanced breast cancer.
Anjali says it’s important to be a strong advocate because all treatment choices have implications for quality of life. "It’s helpful to have the information because you don’t feel like you’re walking into the unknown," she says.
She also advises women to reflect on how much they want to take part in decision-making about their medical care.
"For some women, the extra information is a distraction to what they really want in life. You have to know yourself," Anjali says. "But if you want the information, speak up. So many people follow their doctor’s instructions without asking questions, because they don’t want to take too much of the doctor’s time. It’s easy to feel like you’re bugging people, but it’s hard to remember to say, ‘this is important to me.’ Continue to ask, and be politely persistent."
- LBBC used a pseudonym at Anjali’s request because of her concerns about potential employers searching online for personal information about her.
Preparing for Chemotherapy Treatment
A day in the oncologist’s office can be lengthy, and you may find yourself becoming more familiar with the details of the waiting and treatment rooms than you would like. To occupy your time, be sure to pack some snacks, a book/magazine, music and a notepad to take notes during your visits.
Although some people find it both possible and helpful to work the day of chemotherapy, please allow ample time for your treatment. Talk with your medical care team to find out how long your treatment will take. It is also recommended to have someone accompany you, at least for the first treatment. Anxiety often makes it difficult to take in new information, and some of the medications given in advance of chemotherapy can make you feel sleepy. It is best to have a companion be your second set of ears as well as your designated driver.
Before your treatment date, see if it is possible to tour the treatment area; becoming familiar with the site may lessen your fears. Infusion areas vary by facility and may consist either of private rooms or communal areas where multiple people receive treatment in the same large room.
At any point in your chemotherapy treatment or even before you begin, your doctor may recommend a port-a-cath or "port." There are many reasons to have a port placed, including longer durations and certain types of chemotherapy, your personal preference, facility policy and, most commonly, poor venous access (difficulty placing an IV catheter in your hand or arm).
The port is a quarter-sized disc placed in your upper chest wall and appears as a bump under the skin. This allows your nurse to access your port with a special needle to draw labs and administer fluids and medications, including chemotherapy.
The port is placed on an outpatient basis, either in surgery or interventional radiology. Before using your port, your nurse will confirm that is has been placed correctly by checking your chest x-ray or the surgery report.
Understanding Chemotherapy for Early and Advanced Breast Cancer
Even as treatment strategies change and new therapies become available, chemotherapy remains an important and powerful tool against breast cancer. Understanding chemotherapy and its types, mechanisms and indications can help you become more informed and active in making decisions about your care.
How Chemotherapy Works
Normally, human cells grow and divide in a controlled manner. In cancer, cells misbehave and grow rapidly, dividing without limit. Chemotherapy acts by attacking rapidly dividing cells and preventing them from dividing or growing.
A disadvantage is that rapidly dividing healthy cells also are affected. The destruction of healthy cells causes side effects like hair loss and low white blood cell counts. However, we have made strides in symptom management and many side effects are manageable. For more information, please read "Living Well: Managing the Acute Side Effects of Treatment."
Types of Medicines
Chemotherapy medicines are organized into classes. Each class has a specific mechanism and attacks a cell at a certain point as the cell rests, grows or divides. Classes, and some common breast cancer medicines within them, include:
- Antitumor antibiotics: doxorubicin (Adriamycin) and epirubicin (Ellence)
- Alkylating agents: cyclophosphamide (Cytoxan)
- Antitubulins: paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine) and ixabepilone (Ixempra)
- Antimetabolites: gemcitabine (Gemzar) and capecitabine (Xeloda)
Who Gets Chemotherapy?
Determining who should receive chemotherapy is an individualized process and involves careful consideration of the type and stage of cancer, including characteristics such as tumor size, grade and lymph node involvement. Your medical team will also look at other characteristics of the cancer, including estrogen and progesterone (hormone) receptor status, and whether the cancer overproduces a protein called HER2. After examining all these features, your healthcare team will determine whether chemotherapy is indicated.
Historically, chemotherapy was recommended for all cancers greater than 1 centimeter or with involved lymph nodes, regardless of hormone receptor status. With the availability of new tests for helping to determine the risk for recurrence, especially in hormone receptor-positive tumors, this is changing.
Early Breast Cancer
A cancer is considered early-stage if it is contained to the breast and lymph nodes and has not traveled to areas such as the liver or bones. Here, the goal of treatment is to eliminate the cancer and prevent it from coming back.
If your risk of recurrence is thought to be high, chemotherapy will be given after the surgical removal of the tumor to minimize the risk of the cancer returning. This is referred to as "adjuvant" chemotherapy because it is given "in addition" to surgery. Chemotherapy given in this setting is often viewed as added insurance in attacking and killing microscopic cancer cells that cannot be seen but nonetheless may be present. Adjuvant chemotherapy is initiated four to six weeks after surgery, but can safely be delayed for a couple of months sometimes; for example, if you have problems healing after surgery.
Neo-adjuvant chemotherapy is given before surgery to shrink the tumor to make it easier to remove. If the tumor is large, neo-adjuvant chemotherapy may allow you to undergo breast conserving surgery with lumpectomy (removal of the tumor and a rim of surrounding tissue only) rather than mastectomy (removal of the entire breast). Neo-adjuvant chemotherapy may also be recommended if you are diagnosed with inflammatory breast cancer.
Making Decisions
Several tools can assist your medical team in determining if you need adjuvant chemotherapy. Adjuvant! Online is a software program that uses a formula comprised of your age, tumor size, node involvement and other important tumor characteristics to determine the likelihood of the cancer coming back and how much you may benefit from chemotherapy and hormonal therapy.
Oncotype DX is a test performed on tumor tissue to determine the likelihood of recurrence. The Oncotype test is approved for use in people with newly diagnosed, node-negative cancer with positive hormone receptors, although it may be used with node-positive cancers in the future. If a tumor is associated with a "high" recurrence risk, your doctor is more likely to recommend chemotherapy in addition to hormonal therapy. For a "low" recurrence risk, you will likely only need hormonal therapy and not chemotherapy. If there is an "intermediate" risk of recurrence, it is not known if chemotherapy is useful, and you and your team will make a decision together.
You may be eligible to participate in a trial to help determine the best therapy for women whose breast tumors have an "intermediate" risk of recurrence. To learn more about the Trial Assigning IndividuaLized Options for Treatment (Rx), or TAILORx, please visit lbbc.org or clinicaltrials.gov.
Although these tools are not "crystal balls," they can help you and your healthcare team make better informed decisions about the need for chemotherapy treatment.
When Recurrence Risk Is Low
If your doctors determine you have a relatively small chance of the cancer coming back, you may still fall into the category where chemotherapy could be beneficial. This may be the case if the cancer is node negative or it has a low-risk, node-positive profile. In this setting, commonly used combined chemotherapy regimens include Adriamycin and Cytoxan (AC), Taxotere and Cytoxan (TC) and, less commonly, Cytoxan, Methotrexate and 5-FU (CMF).
At the San Antonio Breast Cancer Symposium in December 2007, researchers reported that women who received TC lived slightly longer than those who received AC, and TC was tolerated well in older women and was not toxic to the heart. More doctors are moving toward using TC given these findings, although TC has other side effects (such as low blood counts, joint pains and slight risk of permanent hair loss) that should be considered.
When Recurrence Risk Is High
If you have a higher risk of the cancer returning, particularly if cancer is present in your lymph nodes, you probably will be counseled to undergo chemotherapy treatment. Chemotherapy for high-risk cancer was transformed in 2002 with studies of "dose-dense" treatment with AC followed by paclitaxel (Taxol). Dose-dense chemotherapy refers to administration of standard dose chemotherapy treatment every two weeks instead of every three weeks. It is associated with a survival benefit in node-positive breast cancers. Other chemotherapy regimens for high-risk breast cancer may include CAF, TAC and AT.
Targeted therapies, such as trastuzumab (Herceptin), have revolutionized treatment options. As the name indicates, this medication is targeted to a specific protein receptor site on cancer cells. About one-fourth of all breast cancer cells overexpress the HER2 protein receptor. (See our Summer 2007 issue for further information on targeted therapies).
Trastuzumab was approved in 2006 for use with chemotherapy in the adjuvant setting because it decreases risk of recurrence by over 50 percent. It usually is given for one year, but studies are trying to determine if longer (two years) versus shorter (a few months) treatments would be best.
Your doctor may recommend chemotherapy treatments with trastuzumab, even if you have a low risk of recurrence, if the cancer overexpresses the HER2 protein. Some studies have shown that chemotherapy containing anthracyclines (doxorubicin, epirubicin) may work better on HER2 positive tumors. Such treatment regimens include Adriamycin and Cytoxan for four treatments, followed by Taxol for four cycles with Herceptin. Recently, the regimen TCH [Taxotere (docetaxel), Paraplatin (carboplatin) and Herceptin (trastuzumab)] was found to be equally effective as existing regimens, yet had a five-fold decrease in significant effects on the heart. Many clinicians have changed their practice to such newer regimens.
Clinical trials evaluating adjuvant chemotherapy regimens are looking at adding medications like bevacizumab (Avastin), a medication that targets the blood supply to the cancer cells or tumor, or Abraxane (albumin-bound paclitaxel), a new formulation of Taxol, to traditional adjuvant chemotherapy regimens.
Advanced Cancer Therapies
In advanced disease, cancer cells that originated in the breast spread, or metastasize, to different parts of the body, including the bones, lung, liver and brain.
In these instances, chemotherapy may be used to control the cancer and prevent it from growing or spreading to other organs. Sometimes other treatments such as hormonal therapy (tamoxifen, aromatase inhibitors or fulvestrant [Faslodex]) or targeted therapies (for example, trastuzumab) are used instead of or in addition to chemotherapy.
To determine whether chemotherapy is needed, a number of factors are taken into consideration. These include tumor characteristics (ER, PR and HER2 status), amount of time between completion of adjuvant treatment and recurrence of breast cancer, the sites of cancer metastasis and the degree of symptoms you are experiencing.
Chemotherapy treatments for advanced breast cancer can be given multiple ways. For example, an oral form of chemotherapy called capecitabine (Xeloda) may be prescribed twice a day for a one- to two-week period followed by a week of rest. It can be given alone or in combination with other medicines like docetaxel, ixabepilone or lapatinib (Tykerb).
Lapatinib is an oral targeted therapy approved for advanced breast cancer. It binds to HER2 receptors and a HER2 signaling mechanism (called tyrosine kinase) inside the cancer cell, which prevents the cell from receiving the signal to grow.
The most common way chemotherapy is given in this setting is by intravenous infusion, and includes medicines like paclitaxel (Taxol), docetaxel (Taxotere), vinorelbine (Navelbine), gemcitabine (Gemzar) and Doxil (a special liposomal form of doxorubicin [Adriamycin]). Although not yet FDA approved for the treatment of breast cancer, agents like pemetrexed (Alimta) and carboplatin (Paraplatin) may be used as part of treatment regimens. Bevacizumab (Avastin), approved for metastatic breast cancer in late February, also may be prescribed.
In 2005, Abraxane was approved for advanced breast cancer. Abraxane chemotherapy is the medicine paclitaxel (Taxol) in a new formulation. Traditionally, paclitaxel is diluted in a liquid called cremophor. Cremophor has side effects that can add to the toxicity of paclitaxel, especially the risk for allergic reactions. With Abraxane, the active ingredient paclitaxel is suspended in albumin, a protein found naturally in the body. Therefore, Abraxane is usually very well tolerated.
The Future
Chemotherapy, in many different forms, plays a vital role in the treatment of many types of breast cancers. By meeting and speaking with your healthcare team, an individualized approach will be developed to manage your treatment, which may include chemotherapy. As the saying goes, the journey of a thousand miles begins with one step. Take each day as it comes, and know that it is okay to ask questions and ask for help.
