Previous Section
Treatment of Breast Cancer
Overview of Treatment Options for Breast Cancer
- Chemical Ovarian Ablation - The primary agents used are luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin (Zoladex). These drugs block the release of the reproductive hormones LH-RH, which results in the cessation of ovulation and estrogen production. Studies are now suggesting that women with estrogen-positive early stage cancer who take goserelin have similar survival rates to those who are treated with standard chemotherapy and they experience fewer serious side effects.
Chemotherapy for Breast Cancer
Chemotherapy is treatment with cancer-killing drugs that may be given intravenously or orally to reach cancer cells that may have spread beyond the original site of the tumor.
The decision to offer chemotherapy is based on the size of the tumor, grade of the tumor, the presence or absence of lymph node involvement and the risk of developing a spread of the cancer in the future. Chemotherapy can also be used as the primary treatment for women whose cancer has already metastasized (spread outside the breast and underarm area) at the time of diagnosis, or if it spreads after initial treatments.
Adjuvant therapy is the use of chemotherapy following surgery to kill any undetected cancer cells so as to reduce the risk of recurrence and increase the chance of cure.
Neoadjuvant therapy is the use of chemotherapy before surgery with the goal of shrinking large tumors so that they are able to be removed by lumpectomy instead of mastectomy. Neoadjuvant chemotherapy also allows the doctors to see how the cancer responds to chemotherapy. If the tumor does not shrink, then different chemotherapy drugs may be substituted.
Chemotherapy drugs are given in cycles, with each period of treatment followed by a recovery period. The usual course of chemotherapy lasts between 3 to 6 months.
In most cases, chemotherapy is most effective, either as an adjuvant or neoadjuvant therapy, when combinations of more than one chemotherapy drug are used together.
The most commonly used combinations of chemotherapeutic agents for the treatment of breast cancer are:
CMF - cyclophosphamide (Cytoxan), methotrexate (Amethopterin, Mexate, Folex), and fluorouracil (Fluorouracil, 5-FU, Adrucil)
CAF - cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and fluorouracil (Fluorouracil, 5-FU, Adrucil)
AC - doxorubicin (Adriamycin) and cyclophosphamide
TAC - docetaxel (Taxotere) concurrent with AC
AC -->T - doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan) followed by paclitaxel (Taxol) or docetaxel (Taxotere)
Doxorubicin (Adriamycin), followed by CMF
CEF - cyclophosphamide (Cytoxan), epirubicin (Ellence), and fluorouracil (with or without docetaxel)
TC - cyclophosphamide (Cytoxan) and Docetaxel (Taxotere)
GT - gemcitabine (Gemzar) and paclitaxel (Taxol)
Some other chemotherapy drugs used for treating women with breast cancer include carboplatin (Paraplatin), cisplatin (Platinol), vinorelbine (Navelbine), capecitabine (Xeloda), pegylated liposomal doxorubicin (Doxil), and albumin-bound paclitaxel (Abraxane).
In March 2007, the FDA approved a new drug called Tykerb (lapatinib) for women with advanced breast cancer who have failed to respond to treatment with other drugs such as taxanes, anthracyclines, and trastuzumab (Herceptin). Tykerb is a pill that is taken once a day and is used in conjunction with capecitabine (Xeloda). Tykerb, like Herceptin, targets a protein known as HER-2/neu that is overexpressed (overproduced) by about 25% of all breast cancer tumors. Both Tykerb and Herceptin are approved for women with advanced HER-2 positive breast cancer. Tykerb is now considered an option for women whose breast cancer fails to respond to Herceptin after a period of time. Because Tykerb is a newly approved drug, it is not yet known whether women being treated with a combination of Tykerb and Xeloda will survive longer than those receiving Xeloda alone.
