Breast Cancer
Medications
Treatment before surgery for breast cancer (neoadjuvant treatment)
In some cases, chemotherapy or hormone therapy is used before surgery to shrink the breast cancer. This is called neoadjuvant therapy. It may allow you to save your breast if the cancer is large. Talk with your doctor about the risks and benefits of neoadjuvant therapy and whether it is an option for you.
Treatment after surgery for breast cancer (adjuvant treatment)
Depending on a variety of factors, such as tumor size, grade, and lymph node involvement, you may have several treatment options. Hormone therapy, chemotherapy, or a combination of the two therapies may be used after surgery to try to destroy any cancer cells that may be left in your body. This is called adjuvant therapy, and it is used to lower the chances that your breast cancer will come back. Your doctor may suggest gene tests to find out if chemotherapy will help you. Talk with your doctor about the risks and benefits of each type of treatment. Your personal preferences and considerations are important when choosing a treatment that is right for you.
Medicines to treat breast cancer
- Hormone therapy. Tamoxifen or an aromatase inhibitor is recommended for estrogen receptor-positive (ER+) breast cancer. These medicines stop estrogen from fueling ER+ breast cancer.
- Tamoxifen is a medicine that blocks the effect of estrogen on breast cancer cells and normal breast cells. But this medicine may also increase other risks, such as for endometrial cancer, stroke, and blood clots in veins and in the lungs.
- Aromatase inhibitors, such as letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin), are medicines that stop estrogen production in postmenopausal women. Aromatase inhibitors are used to treat early estrogen receptor-positive (ER+) breast cancer. They are also used to treat metastatic or recurrent ER+ breast cancer. An aromatase inhibitor can be used alone or after tamoxifen treatment.
- Trastuzumab (Herceptin) is recommended after surgery and chemotherapy for HER-2/neu breast cancer. This medicine is a monoclonal antibody that targets the HER-2 protein. It helps chemotherapy work better.
- Chemotherapy. A combination of medicines is generally used to treat breast cancer. The number of cycles of treatment will depend on the medicines that are used and how the medicines are given. Some of the most commonly used combinations are:
- Doxorubicin and cyclophosphamide. Paclitaxel or docetaxel may sometimes be added.
- Paclitaxel, doxorubicin, and cyclophosphamide.
Medicines to control nausea and vomiting
Treatment of breast cancer can cause nausea and vomiting. Your doctor will prescribe medicines for you to take with your treatments and when you get home to help relieve any nausea that you may have. Medicines to control and prevent nausea and vomiting include serotonin antagonists, corticosteroids, and phenothiazines, among others.
Medicines that may help to prevent breast cancer recurrence
Tamoxifen and raloxifene are medicines that block the effects of estrogen on breast cancer cells and normal breast cells.
Raloxifene works as well as tamoxifen to prevent invasive breast cancer from coming back in postmenopausal women after surgery. Raloxifene is less likely to cause endometrial cancer than tamoxifen, although raloxifene doesn't work as well as tamoxifen to reduce the risk of non-invasive breast cancer.27
What to Think About
The side effects of chemotherapy depend mainly on the medicines you receive. As with other types of treatment, side effects vary from person to person.
Hormone-blocking treatments, such as tamoxifen or an aromatase inhibitor, act on cells all over the body but generally cause fewer side effects than chemotherapy. If you are deciding what type of medicine to use, weigh the side effects and risks along with the benefits for your type of cancer.
Comparing hormone-blocking treatments Name(s)
tamoxifen (Nolvadex) anastrozole (Arimidex), exemestane (Aromasin), letrozole (Femara) Class of drug
Selective estrogen receptive modulator (SERM) Aromatase inhibitor What it does
Blocks harmful estrogen in the breast Limits how much estrogen the body makes Treats breast cancer?
Yes, before and after menopause Yes, after menopause (instead of or after tamoxifen) Side effects and risks
Side effects can include hot flashes and vaginal dryness.
Increased risks of:
- Uterine precancer, uterine cancer
- Dangerous blood clots, which can travel to the lungs (pulmonary embolism) or cause a stroke
- Cataracts
Side effects can include hot flashes, vaginal dryness, muscle/body ache, mild nausea, diarrhea/constipation, weakness, and fatigue.
Increased risk of osteoporosis after 5 years of treatment for women who started out with weak bones (osteopenia)
When taking tamoxifen, you will need a pelvic exam every year. If you have any vaginal bleeding, other than normal menstrual bleeding, tell your doctor as soon as possible. This can be a sign of uterine precancer or cancer.
Neither chemotherapy nor hormone therapy is likely to cure breast cancer that has spread to another area of the body (metastasized), but either therapy can reduce symptoms and may prolong life.
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| Author: | Bets Davis, MFA | Last Updated: August 18, 2009 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Douglas A. Stewart, MD - Medical Oncology | |
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