Breast Cancer - Medications

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. 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.

Should I use chemotherapy for early-stage breast cancer?

Medicines to treat breast cancer

Tamoxifen or an aromatase inhibitor is recommended for estrogen receptor-positive (ER+) breast cancer. These medicines stop estrogen from fueling ER+ breast cancer. (Only tamoxifen is used before menopause. Aromatase inhibitors seem to be more effective than tamoxifen after menopause.)^{23, 21, 22, 32}

Trastuzumab (Herceptin) is recommended after surgery and chemotherapy for HER-2/neu breast cancer. This medicine targets the HER-2 protein. It helps chemotherapy work better.

Chemotherapy. A combination of medicines is generally used to treat breast cancer. The most commonly used combinations are:

• AC, which combines the medicines Adriamycin and Cytoxan. Taxol or Taxotere may sometimes be added.
• CMF, which combines the medicines Cytoxan, methotrexate, and 5-FU.

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 may include:⁴⁰

• Serotonin antagonists, such as ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi), or dolasetron (Anzemet). These medicines work by blocking the effects of a chemical that affects vomiting (serotonin), which is made in the brain and in the stomach. They are often more effective when they are combined with aprepitant and/or corticosteroids, such as dexamethasone (Hexadrol or Decadron). Corticosteroids reduce swelling in the part of the brain that controls nausea.
• Aprepitant (Emend), which prevents and controls nausea and vomiting by blocking the effects of a chemical in the brain. It is always used in combination with a serotonin antagonist and/or dexamethasone.
• Phenothiazines, such as Compazine and Phenergan. These medicines stop nausea and vomiting by reducing the activity of the central nervous system.
• Metoclopramide (Reglan), which increases the movements or contractions of the stomach and intestines. This decreases the amount of time it takes for the stomach contents to move through the digestive tract.
• Dimenhydrinate (Dramamine), which is often used to treat motion sickness. It relieves nausea by blocking motion signals to the brain.
• Benzodiazepines, which are medicines to reduce anxiety, such as lorazepam (Ativan) or alprazolam (Xanax). This medicine can help with both anxiety and nausea when used with other anti-nausea medicine.
• Antipsychotic medicine, such as haloperidol or olanzapine.

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.

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.

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.