Dr. Terpenning shares the medications that are commonly used to treat women with breast cancer.
Read the full transcript »
Which Drugs Are Commonly Used To Treat Breast Cancer? Dr. Marilou Terpenning: There are several chemotherapy regimens that are used, and regimens are made up of drugs. So, let me go through the regimens for you that are commonly used for breast cancer treatment. For early stage breast cancer treatment, early stage meaning lymph node negative breast cancer. We often use four courses of chemotherapy with two different regimens. One is Adriamycin and Cytoxan; one is Taxotere and Cytoxan. The latter regimen has become widely popular. Let me discuss each one of those when I finish giving you the other regimens. For the people who have lymph node positive breast cancer or more high risk breast cancer, we often use combinations of regimens, either TAC which is Taxotere, Adriamycin, and Cytoxan. So, all three drugs are given, or ACT, either given every 21 days or in a dose-dense every 14-day manner in which four cycles of AC are followed by four cycles of either Taxol or Docetaxel (Taxotere). So, let me go through those regimens. Those are the most commonly used regimens in the country for adjuvant therapy of breast cancer. I would point out that for women who are HER2 positive, we add Herceptin to dose-dense ACT, or we follow some of the other regimens with a year of Herceptin. Adriamycin is a longstanding drug used in treatment of breast cancer, which is coming out of use, and there’s a quite controversy about whether or not it should still be continued to use. Many of us still continue to use that drug, and it’s a solid drug. It has side effects that include nausea, vomiting, pink tears and pink urine after you immediately receive it. It will cause hair loss. The nausea, vomiting is well mitigated by using anti-nausea medications but there’s nothing which will stop the hair loss. It will depress the production of white blood cells and used to be given with a bone marrow boosting drugs, which is Neupogen or Neulasta, in order to be able to be given safely to avoid too low a white count and infection. In a few percent of women, it has the effect of weakening the heart muscle if it is used over certain dose limits. The heart function is to be monitored during treatment and afterwards to make sure that there’s no toxicity that’s present from the use of the Adriamycin. Adriamycin is used for many other cancers as well, widely for Hodgkin’s disease, for non-Hodgkin’s lymphoma and is part of curative intent treatment for those cancers. So, it’s a drug that’s used for many cancers, not just breast cancer. We have a lot of experience with it. Cytoxan is used, and that’s a drug that’s used in multiple breast cancer regimens. It’s given intravenously also, and it too can cause hair loss and nausea, vomiting. Again, the latter is prevented by using medications. Cytoxan is actually inactive when it’s given; it becomes active in your liver and gets excreted through your kidneys down into your bladder. If it sits in your bladder too long, it can irritate the bladder. So, we always have our women drink lots of fluids in the few days after chemotherapy, so they are urinating freely to prevent that problem. It’s a rare complication. I have only seen it a handful of times in over 30 years. Rarely Cytoxan can affect the heart, also much more rarely than Adriamycin. Taxotere is a drug; Docetaxel is its generic name. It is a drug that’s being used increasingly frequently. Taxotere is again given intravenously. It too causes hair loss. It too causes depression of the blood counts, again prevented with Neupogen or Neulasta. It too can cause nausea, vomiting. It can also cause some other side effects. It can cause some changes in the nail beds; it can cause some darkening of the nail beds. Rarely, it can cause loss of nails, which is uncomfortable for women. It can also cause sometimes numbness or tingling in the hands and feet. It could also cause some inflammation of the intestines; make a woman have abdominal discomfort and diarrhea and loss of appetite