Chemotherapy for breast cancer

Chemotherapy (chemo) utilizes anti-cancer drugs that may be injected into a vein or by mouth. The drugs move through the blood to reach cancer cells in most of the body parts. Sometimes, if cancer metastases to the spinal fluid, which surrounds as well as cushions the brain and spinal cord, chemo may be administered directly into this area (known as intrathecal chemotherapy). Here, let us deep dive to understand application of chemotherapy for treatment of breast cancer:

When is chemotherapy used for breast cancer?

Not all women who have breast cancer will require chemo, but there is an array of situations in which chemo may be suggested.

After surgery (adjuvant chemotherapy)

Adjuvant chemo might be administered to try to destroy any cancer cells that might have been left behind or have spread but can't be observed, even on imaging tests. These cells are considered microscopic because the naked eye can't observe them. If these cells were permitted to grow, they could form new tumors in other body parts. Adjuvant chemo can lower the probability of breast cancer coming back. There are tests available, like Oncotype DX, that can aid in determining which women will most likely reap benefits from chemo post-breast surgery. 

Before surgery (neoadjuvant chemotherapy)

Neoadjuvant chemo might be administered to try to shrink the tumor so it can be taken out with less extensive surgery. Because of this, neoadjuvant chemo is often utilized to treat cancers that are too big to be taken out by surgery when first diagnosed, have a lot of lymph nodes involved with cancer, or are inflammatory breast cancers.

Suppose post neoadjuvant chemo; cancer cells are still found when surgery is conducted (also known as a residual disease). In that case, the patient might be offered more chemotherapy (adjuvant chemotherapy) to lessen the chances of the cancer coming back (recurrence).

There are a few other reasons patients might get neoadjuvant chemo:

• By giving chemo before the tumor is taken out, medical professionals can see how the cancer responds to it. If the first set of chemodrugs doesn't shrink the tumor, the doctor will know that other drugs are required. It should also destroy any cancer cells that might have spread but can't be observed by the naked eye or on imaging tests. Similar to adjuvant chemo, neoadjuvant chemo can lower the chances of breast cancer coming back.  
• Some women who have early-stage cancer who get neoadjuvant chemo might have better longevity if the cancer entirely cures with that treatment. This can be observed most often in women suffering from triple-negative breast cancer or HER2-positive breast cancer.  
• Getting chemo prior to surgery can also give some individuals extra time to get genetic testing or plan reconstructive surgery.

For metastatic breast cancer

Chemo can be utilized as the major treatment for women whose cancer has metastasized outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be administered either when breast cancer is diagnosed or post-initial treatments. The treatment's length relies on how well the chemo is working and how well patient tolerate it.

Chemotherapy drugs used for breast cancer

In majority of cases, chemo has the greatest effect when more than one drug is utilised at a time. Generally, combinations of 2 or 3 drugs are utilised. 

Adjuvant and neoadjuvant chemo drugs

• Anthracyclines, like doxorubicin (Adriamycin)
• Carboplatin (Paraplatin)
• 5-fluorouracil (5-FU) 
• Cyclophosphamide (Cytoxan)

Chemo drugs for breast cancer that has metastasized (metastatic breast cancer)

• Taxanes: Paclitaxel (Taxol), and albumin-bound paclitaxel (Abraxane)
• Anthracyclines: liposomal doxorubicin (Doxil)
• Gemcitabine (Gemzar)
• Platinum agents (Cisplatin)

Although drug combinations are often utilised to treat early breast cancer, advanced breast cancer generally is treated with single chemo drugs. Still, some combinations, like paclitaxel plus gemcitabine, are commonly utilized to treat metastatic breast cancer.

In case of cancers that are HER2-positive, one or more than one drugs that target HER2 may be utilized with chemo. 

How is chemotherapy for breast cancer given?

Chemo drugs for breast cancer are typically administered into a vein (IV), either in the form an injection over a few minutes or as an infusion over a longer duration. This can be performed in a doctor's office, infusion center, or in a hospital setting.

Often, a slightly larger as well as sturdier IV is required in the vein system to give chemo. These are called as central venous catheters (CVCs), central lines, or central venous access devices (CVADs). They are utilised to administer medicines, blood products, nutrients, or fluids right into blood. They can also be utilized to take out blood for testing.

There are several kinds of CVCs. The most predominant types are the port and the PICC line. For patients suffering from breast cancer, the central line is typically positioned on the side opposite of the breast cancer. If a woman is suffering from breast cancer in both breasts, the central line will mostly be placed on the side that had less lymph nodes taken out or involved with cancer.

Chemo is administered in cycles, followed by a rest period to give the patient time to recover from the side drugs side effects. The length of chemo cycles is 2 or 3 weeks. The schedule varies based on the drugs utilized. For instance, with some medicines, chemo is administered only on the first day of the cycle. With others, it is administered one day a week for some weeks or every other week. Then, at the completion of the cycle, the chemo schedule repeats to commence the next cycle.

Adjuvant and neoadjuvant chemo are often given for a total of 3 to 6 months, based on the drugs utilized. The treatment's length for metastatic (Stage 4) breast cancer relies on how well it is working and what side effects the patient has.

Dose-dense chemotherapy

Medical professionals have found that giving the cycles of certain chemo drugs closer together can reduce the probability that the cancer will come back and improve survival for few women suffering from breast cancer. For example, a drug usually given every three weeks might be given every two weeks. This can be done for both neoadjuvant as well as adjuvant treatment. It can lead to lot of problems with low blood cell counts, so it's not a choice for all women.  For instance, a chemo combination sometimes administered this way is doxorubicin (Adriamycin) along with cyclophosphamide (Cytoxan) every two weeks, followed by paclitaxel (Taxol) every two weeks.

Side effects of chemo for breast cancer

Chemo drugs can cause side effects based on the type and dose of drugs given and the treatment's length. Some of the most common possible side effects comprise:

• Hair loss
• Nail abnormalities.
• Mouth lesions.
• Loss of appetite or weight changes
• Nausea and vomiting
• Diarrhoea
• Tiredness
• Hot flashes and vaginal dryness from menopause
• Nerve injury 

In a nutshell, chemotherapy plays a crucial role in the treatment of breast cancer, offering various approaches tailored to individual requirements and circumstances. Whether administered before or after surgery or as a primary treatment for metastatic breast cancer, chemotherapy treatment aims to target cancer cells throughout the body. Utilizing a combination of drugs, often in cycles, chemotherapy strives to shrink tumours, eradicate microscopic cancer cells, and prevent recurrence. While it's an efficacious tool in the battle against breast cancer, chemotherapy may also induce side effects, ranging from temporary discomforts such as hair loss and Nausea to more severe complications like immune suppression. Despite these challenges, chemotherapy remains a cornerstone in the multifaceted approach to managing breast cancer, offering hope, and extending survival for many patients.

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