Cancer cells in most parts of the body can get the drugs because they get into the bloodstream. It is possible to give breast cancer chemotherapy options directly to the spinal fluid, which surrounds and protects the brain and spinal cord, if the cancer has spread there. This is known as intrathecal chemotherapy.

What kinds of breast cancer chemotherapy options work?

There are times when a breast cancer chemotherapy options may be suggested for women with breast cancer, but not all of them will need it. Some people may get extra breast cancer treatment to try to kill any cancer cells that have spread or been left behind and can’t be seen on imaging tests. You can’t see these cells with the naked eye, so they are called microscopic. If we let these breast cancer cells grow, they might spread to other parts of the body and grow into new tumors. Getting extra chemotherapy can make it less likely that breast cancer will come back. Chemotherapy doesn’t always seem like a good idea. Some tests, like Oncotype DX, can help figure out which women will probably benefit the most from chemotherapy after breast surgery. To learn more, go to Breast Cancer Gene Expression Tests. 

Neoadjuvant chemotherapy:

It is chemotherapy that is given before surgery if early-stage breast cancer is detected. It is used to try to shrink the tumour so that it can be removed with less cancer surgery. When cancer is too big to remove through surgery at first, when it spreads to a lot of lymph nodes, or when it causes inflammatory breast cancer, neoadjuvant chemotherapy is often used to treat it.

Adjuvant chemotherapy

You may be given more chemotherapy (adjuvant treatment) to lower the chance that the cancer will come back (recurrence) if cancer cells are still found after surgery after neoadjuvant chemotherapy.

Next-step chemotherapy may also be given for the following reasons:

So that they can see how the cancer reacts, chemotherapy is given before the tumour is taken out. Your doctor will know that you need more drugs if the first set of chemo drugs doesn’t shrink the tumour. It should also kill any cancer cells that have spread but can’t be seen with the naked eye or a scan. New adjuvant chemotherapy can also lower the chance that breast cancer will come back, just like adjuvant chemotherapy.
  • Some people with early-stage cancer who get neoadjuvant chemotherapy might live longer if it gets rid of all of their cancer.
  • This happens most often in women with HER2-positive or triple-negative breast cancer. 
  • Some people can get more time to get genetic tests or plan breast reconstruction surgery if they get chemotherapy before surgery.
  • Remember that neoadjuvant chemotherapy isn’t right for every woman with breast cancer.

Metastatic Breast Cancer

Chemo can be the main treatment option for women whose cancer has spread to organs other than the breast and armpit, like the liver or lungs. Chemo can be given before or after the first treatments for breast cancer. How long you get to get chemo depends on how well it works and how well you can handle it.

Chemotherapy Drugs for Breast Cancer

When more than one drug is used at the same time, chemo usually works better. Most of the time, two or three drugs are mixed together. Doctors use a variety of drug combinations, and it’s not always clear which one is best.

Neoadjuvant and Adjuvant chemo drugs

  • Some examples of anthracyclines are doxorubicin (Adriamycin) and epirubicin
  • Taxanes are drugs like paclitaxel (Taxol) and docetaxel (Taxotere); 5-FU or capecitabine (Xeloda)
  • Cytoxan, or cyclophosphamide
  • Paraplatin, or carboplatin

Metastatic Breast Cancer Drugs

  • Taxanes are medicines like paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane).
  • With Ixabepilone (Ixempra) and Eribulin (Halaven),
  • Anthracyclines: epirubicin (Ellence), liposomal doxorubicin (Adriamycin), and doxorubicin (Adriamycin)
  • Cysplatin and carboplatin are platinum agents.
  • Novatelbine (Vinorelbine) and Capecitabine (Xeloda)
  • Taking Gemcitabine (Gemzar)
  • Ado-trastuzumab emtansine [Kadcyla], Fam-trastuzumab deruxtecan [Enhertu], and Sacituzumab govitecan [Trodelvy].
 
Combinations of drugs are often used to treat early breast cancer, but single-chemo drugs are often used to treat advanced breast cancer. Still, some combinations are often used to treat breast cancer that has spread, like paclitaxel plus gemcitabine.
 
Chemotherapy may be used with one or more drugs that target HER2-positive breast cancers that are positive for it. (Read Targeted Therapy for Breast Cancer to learn more about these medicines.)

How can Chemotherapy for Breast Cancer given?

Chemotherapy drugs for breast cancer are usually injected or infused into a vein over a longer period of time. This can be done in a hospital, an infusion centre, or a doctor’s office.
 
Most of the time, a slightly bigger and stronger IV is needed in the vein system to give chemotherapy. People use these things to get blood to their veins. They are called central lines, central venous catheters, or CVADs. They are used to directly inject drugs, blood products, nutrients, or fluids into the bloodstream. You can also use them to draw blood for tests.
 
CVCs come in a lot of different styles. There are mainly two types: the port and the PICC line. The central line is usually put on the side opposite the breast cancer in people who have breast cancer. While a woman may have breast cancer in both breasts, The main line will probably be put in the breast that had less cancer removed or more lymph nodes removed.
 
There are cycles of chemotherapy and then a break so that the body can heal from the drugs’ effects. Most chemo cycles last for two or three weeks. The schedule changes based on the drugs being used. Along these lines, chemo is only given on the first day of the cycle for some drugs. For some, it’s given once a week for a few weeks or every other week. Then, when the cycle is over, the chemo schedule starts all over again for the next cycle.
 
Different types of chemotherapy are often given for 3 to 6 months, depending on the drugs used. If you have metastatic (Stage 4) breast cancer, the length of your treatment will depend on how well it works and how bad the side effects are.
 

Chemotherapy with a high dose

Doctors have found that giving some chemotherapy drugs more often can help some women with breast cancer live longer and lower the chance that the cancer will come back. One example would be giving a drug every two weeks instead of every three weeks. This can be done for both treatments before and after surgery. For that reason, not all women can do it because it can make low blood cell counts worse.  Doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan) are two types of chemotherapy that are sometimes given together in this way. Following them every two weeks is paclitaxel (Taxol).

Possible side effects of Breast Cancer Chemotherapy

Chemo drugs can have side effects, which depend on the type of drug, the dose, and the length of service. These are some of the most common side effects that could happen:

  • Ø  Loss of hair
  • Ø  Changes in nails
  • Ø  Sores in the mouth
  • Ø  Lack of hunger or changes in weight
  • Ø  Vomiting and feeling sick
  • Ø  Having diarrhea
  • Ø  Feeling tired
  • Ø  During or after chemo, women may experience hot flashes and/or vaginal dryness related to menopause (see below for more on those issues).
  • Ø  Damage to the nerves (see below for more on this)

Chemotherapy can also hurt the cells in the bone marrow that make blood, which can cause:

  • Ø  More likely to get infections (because white blood cell counts are low)
  • Ø  Low blood platelet counts can make it easy to get bruises or bleeding.
  • Ø  Tiredness (because of low red blood cell counts and other things)
  • Ø  Most of the time, these side effects go away when the treatment is over. Most of the time, these side effects can be lessened.
  • Ø  For instance, drugs can be used to help stop or lessen nausea and vomiting.

There may be other side effects as well. With some chemo drugs, some of these happen more often. Talk to your cancer care professional about the side effects that the drugs you are taking might have.

 

Changes in periods and problems getting pregnant

Many younger women who are getting chemotherapy have changes in their periods. Infertility (not being able to get pregnant) and premature menopause (not having any more periods) can happen and could last a lifetime. This can make you more likely to get heart disease, bone loss, and osteoporosis. Some medicines can treat bone loss or help keep it from happening.
 
You might still be able to get pregnant even if your periods stop while you are getting chemotherapy. Getting pregnant while on chemotherapy could cause birth defects and make the treatment less effective. It is important to talk to your doctor about birth control if you are sexually active and have not gone through menopause before treatment. If you have hormone receptor-positive breast cancer, you shouldn’t take hormonal birth control pills. You should talk to both your oncologist and your gynecologist (or family doctor) about what choice is best for you. It is safe for women to have children after treatment (like chemo), but it is not safe for them to get pregnant while they are being treated.
 
Talk to your doctor as soon as you are diagnosed with breast cancer and before you start treatment if you think you might want to have children after the treatment plan. Along with chemotherapy, some women can have a successful pregnancy after treatment if they take certain medicines, such as getting monthly injections of an LHRH analog. Read more about female fertility and cancer to find out more.
 
Even if you are pregnant when you get breast cancer, you can still get help. Some chemodrugs are safe to use during the last two trimesters of pregnancy. You can read more about how to treat breast cancer while you are pregnant.

Damage to the heart

Some chemo drugs, like doxorubicin and epirubicin, can damage the heart permanently, though this doesn’t happen very often. This is called cardiomyopathy. People who take the drug for a long time or in large amounts are most likely to get sick. Another thing that makes the damage from these drugs worse is that it is more likely to happen when other drugs that can hurt the heart are used.  You may be more likely to get heart failure if you have a family history of heart problems, high blood pressure, or diabetes. This is especially true if you take one of these drugs.
 
Before prescribing one of these medications, your doctor will typically perform an echocardiogram (also known as an ECHO) or a MUGA scan to assess how well your heart is functioning. They also carefully control the doses, watch for signs of heart problems, and may do heart tests more than once while the patient is being treated. If the heart function gets worse, these drugs will no longer be used, either temporarily or permanently. Still, damage may not show up in some people for months or even years after treatment ends.

Neuropathy means nerve damage

There are many drugs used to treat breast cancer that can hurt nerves in the hands, arms, feet, and legs. These include taxanes (docetaxel, paclitaxel, and protein-bound paclitaxel), platinum agents (carboplatin, cisplatin), vinorelbine, eribulin, and ixabepilone. Some of the symptoms that can happen are numbness, pain, burning or tingling, being sensitive to heat or cold, or feeling weak. Most of the time, these symptoms go away when the treatment stops. But for some women, they may last a long time or become permanent. Some medicines might be able to help with these signs.

The hand-foot syndrome

Chemo drugs like capecitabine (Xeloda) and liposomal doxorubicin (Doxil) can make the palms and soles of the feet and hands feel itchy. The name for this is hand-foot syndrome. Numbness, tingling, and redness are early signs. Because it’s getting worse, the hands and feet might get swollen and painful. The skin could get blisters, which could peel off or even turn into open sores. No one treatment works for everyone, but creams or steroids given before chemotherapy may help. When the drug is stopped or the dose is lowered, these symptoms get better over time. If you want to avoid getting severe hand-foot syndrome, you should tell your doctor as soon as you notice any symptoms. This way, the drug dose can be changed or other medicines can be given.

Brain chemo

A lot of women who are getting chemotherapy for breast cancer treatment say that their mental abilities get a little worse. This could make it hard for them to focus and remember things for a long time. This has been seen in women who did not get chemo as part of their treatment, even though many women have linked it to it. Still, most women can do well after treatment. Cancer research has found that chemo brain can happen after treatment. The symptoms usually last for a few years.

More likely to get leukemia

Some chemotherapy drugs, like doxorubicin (Adriamycin), can very rarely cause diseases of the bone marrow, like myelodysplastic syndromes, or even acute myeloid leukemia, a type of cancer that affects white blood cells. Most of the time, this happens 10 years or less after treatment. For most women, the benefits of chemotherapy, like stopping breast cancer from coming back or making them live longer, are much greater than the risk of this rare but serious side effect.

Not feeling well or being tired

After chemo, a lot of women don’t feel as healthy as they did before. People often feel pain or achiness in their bodies for a long time after the injury and have a mild loss of physical functioning. These changes might be very small and take a while to happen.
 
Another common issue for women who have had chemo is feeling tired. This could last anywhere from a few months to a few years. It can help a lot of the time, so tell your doctor or nurse about it. It might be suggested that you work out, take naps, and save your energy. You can get help if you have trouble sleeping. Being tired can sometimes be a sign of depression, which can be helped by therapy and/or medicine.
 

Conclusion:

Getting  breast cancer chemotherapy options involves a lot of different factors, such as when to start treatment, how to do it, and the possible side effects. The choice to give chemotherapy is not always made. It depends on several things, such as the type of breast cancer and the patient’s needs.