Women's Health

Chemotherapy Drugs for Breast Cancer

Chemotherapy Drugs for Breast Cancer

What is Chemotherapy?

Also called chemo, this is a treatment with cancer killing drugs, which can be given by mouth or intravenously wherein it is injected into the veins. The medication then travels through the bloodstream to reach the cancer cells, which are based on most parts of the body. Not all women suffering from breast cancer would be given this therapy, but there are certain situations which would decide if chemo is required or not:

  • After the surgery, also called adjuvant chemotherapy: This chemo session is mostly done after performing a surgery. This is done so as to try and kill cancer causing cells that may be left behind or have spread to other body parts and were not noticeable during the surgery. If these cells stay in the body, then they can grow and form new tumors in various other parts of the body. By conducting adjuvant chemo, it can at least reduce the risk of recurrence of breast cancer.
  • Prior to the surgery, also called neoadjuvant chemotherapy: This chemo session is mostly done prior to performing the surgery. The purpose of this session is to shrink the tumor cells so that it becomes easier and less extensive while performing the surgery to get the cancer cells removed. Due to this feature, neoadjuvant chemotherapy is often used to treat those cancers that are too big to be removed during the time of diagnosis. Also, by performing the chemo session, the doctor can judge how well the cancer responds to the therapy. If the first set of chemo medications are not successful in shrinking the tumor, then the doctor would need to use another set of medications.
  • Advanced stage of breast cancer: For those women who are at the advanced stage or whose cancer causing cells have spread widely outside the breast and area under the arm, this chemo length would depend on how well the treatment is working and how well it is being tolerated by the body.

Common Medicines for Chemotherapy

In the case of adjuvant chemotherapy, below are the common drugs that are used, and these medicines are usually used in combination of two or three at a time:

  • Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
  • Carboplatin (Paraplatin)
  • 5-fluorouracil (5-FU)
  • Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
  • Cyclophosphamide (Cytoxan)

In case of advanced stages of cancer, below are the common drugs that are used for the chemo sessions:

  • Docetaxel
  • Vinorelbine (Navelbine)
  • Capecitabine (Xeloda)
  • Gemcitabine (Gemzar)
  • Paclitaxel
  • Platinum agents (cisplatin, carboplatin)
  • Mitoxantrone (Novantrone)
  • Liposomal doxorubicin (Doxil)
  • Ixabepilone (Ixempra)
  • Albumin-bound paclitaxel (nab-paclitaxel or Abraxane)
  • Eribulin (Halaven)

Palbociclib Oral (Ibrance):

Palbociclib is mostly provided in combination with another drug called Ietrozole or with fulvestrant in those patients who have advanced breast cancer. Palbociclib belongs to the antineoplastics group of drugs. Palbociclib works by interfering with the growth of cancer cells, which eventually leads to destruction of those cells. However, during this process, the normal growth cells in the body are also damaged, thus leading to certain side effects during the course of the treatment. Some of the side effects would be serious and would need to be reported to the doctor. This medicine should only be taken with a doctor’s prescription, and it is available in capsule form. There are certain risks of this medicine that should be weighed before going ahead with the treatment. Hence, one should consider the following:

  • Inform the doctor if you are allergic to any of the contents in Palbociclib or are allergic to any other medicines or food.
  • Inform the doctor if you are pregnant or planning to get pregnant and also if you are nursing a baby.
  • This medicine has interactions with certain other medications; hence, you should inform your doctor if you are currently using any medicines, whether prescribed or non-prescribed. Here are certain medicines that can interact with Palbociclib: Cobicistat, Lopinavir, Mitotane, Ritonavir, Rifampin, St John’s Wort, Idelalisib, Carbamazepine, and Oxcarbazepine.
  • Inform the doctor if you are suffering from any kind of infections or blood clots in the lungs, which is also called pulmonary embolism.

Take this medicine exactly as prescribed by the doctor. It should not be taken in larger doses or more often than recommended. Since it is given in combination with two other drugs, each of the medicines should be taken at the exact time. The capsule should be swallowed as a whole, and the medicine has to be taken with food. There are various things a doctor would consider before prescribing the dosage. For adults, it would be 125 mg to be taken once a day for a period of 21 days. This is then followed by a rest period of 7 days on which no medicine should be taken. The common side effects of Palbociclib are fever, cough, congestion in the ear, black tarry stools, body pain, loss of voice, excessive hair fall, skin turning pale, chills, and unusual bleeding or getting bruised easily. The less common side effects would include irregular heartbeat, hoarseness in the voice, pain in the chest, bleeding nose, and anxiety.

Pertuzumab (Perjeta):

Pertuzumab is known as the anti-cancer drug used for chemotherapy. This medicine is a monoclonal antibody. Pertuzumab is also categorized as a targeted therapy or a biological therapy. It is used in combination with trastuzumab and docetaxel, which are used for treating patients with HER2 breast cancer. Pertuzumab is given as an injection or infusion into the vein. This is done for 60 minutes. The common side effects of Pertuzumab are a low count of white blood cells, rashes, diarrhea, loss of hair, numbness or tingling sensation in the hands and feet, fatigue, nausea, and vomiting.

The lesser known side effects would include anemia, weakness, irregular breathing or shortness of breath, watery eyes, change in taste, skin turning dry, and pain in the muscles. Pertuzumab has the component of an antibody type of targeted therapy. Pertuzumab targets the surface of the cells' human epidermal growth factor receptor, which is called HER2 on the cancer cell, thus interfering with the HER2 and leading to death of the cancer causing cells. Pertuzumab binds up into a different area of the HER2 protein than the other medication called trastuzumab.

Hence, when Pertuzumab combines with trastuzumab, a complete blockage of HER2 tends to occur. Pertuzumab can also be given prior to the surgery so as to treat the inflammation or avoid recurrence of breast cancer. Pertuzumab along with trastuzumab will be continued to be given to the patient even after completion of the surgery to complete one year of the treatment.

Trastuzumab (Herceptin):

Trastuzumab is used for treating HER2 breast cancer. This medication can be given prior to the surgery or after the surgery is performed. It has also been shown to reduce the risk of breast cancer to occur again after performing the initial surgery. The cancer causing cells grow in an uncontrolled manner. Some of the breast cancer cells are known to make too many copies of a gene that is called HER2, and this gene makes a protein that is called a HER2 receptor.

Trastuzumab is known to stop or slow down the growth of these breast cancer causing cells, especially in those who have metastatic disease in which there are tumors with too many copies of HER2 genes. Trastuzumab is currently approved for those women who have metastatic HER2 medical conditions and also those who are at the earlier stages of this disease. Trastuzumab can be given only through infusion in the veins or intravenously. This would mean it would be dripped into the body with a needle that is inserted into the vein.

The first dosage takes around 90 minutes of the treatment, after which it would take only 30 minutes for each dose of Trastuzumab. This medicine can be given on a three-week schedule; the doctor can provide more details on the dosage schedules. If one is in the early stages of breast cancer, then Trastuzumab would be given alone or together with a chemo session. One would receive it for a specific amount of time, either during or after completion of chemo. If the woman is having metastatic breast cancer, then Trastuzumab can be taken indefinitely so as to keep the cancer in control. The below chemo medicines can be taken with, before, or after Trastuzumab:

  • Taxotere (docetaxel)
  • Taxol (paclitaxel)
  • 5-fluorouracil (5-FU)
  • Xeloda (capecitabine)
  • Navelbine (vinorelbine)
  • Gemzar (gemcitabine)
  • Cytoxan (cyclophosphamide)

Certain common side effects of Trastuzumab are fever, chills, pain in the muscles, vomiting, and nausea. After the first treatment, the side effects become less severe. Those women who experience mild to serious types of heart disease can stop this medicine with consultation from the doctor and go in for heart strengthening medicines. This would bring the heart functioning back to normalcy.

Fulvestrant (Faslodex):

Fulvestrant is known as an anti-estrogen medicine, since it blocks the actions of estrogen in the body. The reason for blocking this is because there are certain types of breast cancer that use estrogen to grow and multiply in the body. Hence, it is also a medicine that is used to treat hormone based breast cancer, which is found in postmenopausal women, as well as when the cancer grows and spreads to other parts of the body. Fulvestrant is used in conjunction with Palbociclib so as to treat this hormone related breast cancer.

Before the doctor starts the treatment with Fulvestrant, let the doctor know if you are suffering from any liver problems, bleeding issues, or thrombocytopenia. Also, let him know if you are on blood thinners. Do not use this medicine if you are pregnant or planning to get pregnant or also while nursing. Fulvestrant is given in two injections into the muscle of the buttock. Each of these injections should be given slowly, and it would take two minutes to complete this procedure.

Fulvestrant is usually given once every two weeks at first, and then the schedule would be once a month. The adult dosing for Fulvestrant would be initially 500 mg IM on 1, 15, and 29; thereafter, it would be once per month.  The common side effects of this medicine are nausea, loss of appetite, vomiting, pain in the bones, joints, and muscles, hot flashes, and headache. Let your doctor know if there are any signs of nerve damage, such as tingling sensations, weakness, or numbness.

Fluorouracil (Adrucil):

Fluorouracil is used for treating symptoms pertaining to breast cancer, pancreas cancer, and colon cancer. It is an antimetabolite and the working of the same is by interfering in the production of proteins that are necessary for the growth and reproduction of the cells. One should not take Fluorouracil if she is allergic to any of its ingredients, if one is taking sorivudine, or if there are any serious infections in the body. Before the use of this medicine, inform the doctor if you are pregnant or planning to get pregnant or nursing a baby. Also, let the doctor know if there are any medications being taken.

Fluorouracil should be taken as directed by the doctor or by the details mentioned on the label of the medicine. Fluorouracil is given only in the form of injections. It should not be taken if the medicine contains any particles, cloudy, or is discolored. The common side effects of this medicine are nausea, vomiting, changes in the nails, loss of hair, headaches, or rashes that are itchy. The serious types of side effects would include bloody stools, pain, or tightness in the chest, swelling of the face, lips, mouth, or throat, pain in the abdomen, unusual breeding, or getting bruises easily.

Cyclophpsphamide (Cytoxan):

Cyclophpsphamide is an anti-cancer drug used for chemotherapy. It is also classified as an alkylating agent. Cyclophpsphamide can be given in a number of ways, which would depend on the dosage, the condition that is being treated, the severity of the condition, and the purpose of the drug in the specific circumstances. In most cases, this medicine is given via infusion in the veins or through injection. It is also available in tablet form.

Cyclophpsphamide is also approved to be given by a shot into a muscle IM, abdominal lining IP, or lining in the lung called intrapleural. The tablet form can be taken with or without meals, and it should not be crushed or chewed. It should be swallowed as a whole. The common side effects of this medicine are hair loss, vomiting, nausea, loss of fertility, loss of appetite, skin and nail discoloration. There is a very rare case of one developing a blood cancer, such as leukemia, after the intake of this medicine.

Capecitabine (Xeloda):

Capecitabine is known to treat the symptoms pertaining to breast cancer, colon cancer, and colorectal cancer. It can be used alone or combined with some drugs. Capecitabine is an antimetabolite, and it works by interfering with the production and development of proteins, which are necessary for the growth and reproduction of cancer cells. One should not use Capecitabine if she is allergic to any of the ingredients of this medicine. Also, those who suffer from severe kidney related issues should not use this medicine.

Before taking the medicine, do let the doctor know if you are pregnant or planning to get pregnant, or nursing a baby, if one is taking drugs, which are prescribed or non-prescribed, and if there are any kinds of allergies to food or medicines. If the patient has a history of problems relating to the heart, liver, or kidneys, or if there has been any bone marrow related problems in the past, let the doctor know. The risk of bleeding can increase with the intake of certain anticoagulants along with Capecitabine.

Also, with the intake of Capecitabine and Leucovorin, there is an increased risk of a severe form of intestinal problem. Capecitabine should be taken exactly as prescribed by the doctor, or one can check the label of the medicines for directions of use. Capecitabine should be taken within 30 minutes of having a meal. Capecitabine comes in a capsule form, and it should be swallowed as a whole. Do not break, chew, or crush the medicine. Certain common side effects of Capecitabine are dizziness, pain in the muscles, headache, dry and itchy skin, mild case of nausea, loss of appetite, diarrhea, or finding it difficult to sleep. The severe cases of Capecitabine are severe forms of allergic reactions, fainting, mood or changes in mental state, bloody or tarry stools, severe forms of headache, and sudden weight gain.

Epirubicin (Ellence):

Epirubicin is used for certain types of breast cancer after the surgery. It is an antineoplatic, and it works by killing the cancer causing cells; however, studies are still going on to understand exactly how this medicine works. One should not take this medicine if she is allergic to any of its ingredients, if she has a low count of white blood cells, if the individual has a severe form of liver disease, or if she is suffering from heart related problems or irregular heartbeat. Using Epirubicin along with calcium blockers or Trastuzumab can lead to an increase in the risk of heart related problems.

Palifermin can lead to mouth sores, and they may become more severe. The effectiveness of hydantoins can be decreased with the use of Epirubicin. The risk of Epirubicin side effects can increase with the intake of cyclosporine or paclitaxel. Epirubicin should be taken exactly as prescribed by the doctor, or one can check the label of the medicine for usage instructions. Epirubicin should only be used in injection form and infused in the vein. The common side effects of Epirubicin are hot flashes, changes in the menstrual cycle, changes in the skin, diarrhea, or tiredness. The severe forms of side effects are discharge from the eyes, swelling in the mouth, pain at the injection site, pain in the chest or tightness, coughing blood, absence of menstrual cycle, tenderness, or pain in the stomach.

Docetaxel Anhydrous (Taxotere):

Docetaxel Anhydrous is used for chemotherapy to treat various numbers of cancer disease. It can be used alone or in conjunction with another medication. Docetaxel Anhydrous is given by infusing it into the vein or injection. Docetaxel Anhydrous is available as a generic medicine. Docetaxel Anhydrous increases the survival time of the cancer patient.

If Docetaxel Anhydrous is used in combination with prednisone, then the survival rate has shown a lot of improvement, and also the person can have a normal quality of life. The common side effects of this medicine are a low count of white blood cells, loss of hair, shortness of breath, vomiting, nausea, and pain in the muscles, whereas the severe forms of side effects include liver related problems and, if used during pregnancy, then it can harm the unborn child.

Paclitaxel (Abraxane):

Paclitaxel is used for treating breast cancer patients. Paclitaxel is used along with carboplatin so as to treat lung cancer in certain types of patients. Paclitaxel is medicine for chemotherapy, and it works by slowing down or stopping the cancer cells from diving and multiplying; hence, they die eventually. One should not be using this medicine if she is allergic to any of its contents or if she has a low white blood cell count. Paclitaxel should be taken exactly as prescribed by the doctor, or you can check the label of the medicine for detailed instructions.

Paclitaxel is given as an injection. The common side effects of Paclitaxel are nausea, numbness, pain or weakness in the hands or feet, redness or sores in the mouth leading to ulcers, vomiting, and hair loss. The severe form of side effects are allergic reactions, sudden weight gain, severe forms of muscle or joint pain, unusual bleeding or bruising, swelling and redness at the site of the injection, pale skin, and shortness of breath.

Key Takeaways

  • Chemotherapy is given to stop the growth of cancer causing agents.
  • Chemo medications can be given either before the surgery or after the surgery or for those at the advanced stage.
  • Doctors give chemotherapy in cycles with each period of treatment, and it is followed by a rest period.