People commonly associate chemotherapy with intravenous (IV) cancer drugs in a hospital or doctor’s office. This has been the traditional nonsurgical method of treating cancer.
Due to recent advances in cancer treatments, oral chemotherapy pills have become more widely used for many types of cancer. There are a few that are approved for breast cancer, including capecitabine (Xeloda), which is often used to treat metastatic breast cancer.
Not all traditional chemotherapy drugs come in an oral form. Many chemotherapy medications, commonly prescribed to fight cancer are available as pills. Of these, capecitabine (Xeloda) is approved in oral form for breast cancer.
Cyclophosphamide (Cytoxan) is another type of oral chemotherapy that’s included as part of a combined treatment regimen called CMF (cyclophosphamide methotrexate fluorouracil).
Although most commonly administered intravenously for the treatment of breast cancer, methotrexate is another chemotherapy agent that’s available in pill form.
It’s important to know the difference between the various forms of oral medication prescribed to fight breast cancer, says Dr. Hannah Luu, California-based oncologist and CEO and founder of OncoGambit, an online service that creates personalized cancer treatment plans.
She outlines three categories of oral medications cancer patients may take as part of their treatment plan:
- chemotherapy pills
- antihormonal pills
- targeted therapy (precision medicine) pills
Each therapy works differently and serves a different purpose, and not every medication will be right for everyone. Which therapy is right for you will depend on various factors including the type and stage of cancer you’re fighting, and other health considerations.
In addition, many treatments known as “targeted therapies” may be prescribed orally.
Continue reading for an explanation of these medications and how they differ from “oral chemotherapy.”
Capecitabine, also known as Xeloda, is a type of chemotherapy often used to treat metastatic breast cancer.
It’s taken orally and is sometimes used alongside targeted therapy, or on its own once your body has stopped responding to other types of therapy. In some cases, it may also be used following radiation therapy.
When you take capecitabine, it’s still in its inactive form. Certain enzymes found in cancer cells then activate the medication and convert it to a compound called 5-fluorouracil, which is able to kill cancer cells by preventing them from dividing.
Like other types of chemotherapy, capecitabine is associated with several possible side effects, including:
- sores in the mouth and throat
- appetite loss
- changes in your menstrual cycle
- swelling, pain, and redness on the hands or feet, which can progress to blistering or broken skin (also known as hand-foot syndrome)
If you’re taking any blood thinners like warfarin, your doctor may need to monitor and adjust your dosage regularly, as capecitabine could interfere with these medications.
Additionally, capecitabine may not be suitable for everyone, including people who are pregnant and those with severe kidney or liver problems.
Cyclophosphamide, or Cytoxan, is a type of oral chemotherapy that can help treat breast cancer by blocking the growth of cancer cells in your body.
It’s used as part of CMF, a treatment regimen that combines three different chemotherapy drugs, including methotrexate and 5-fluorouracil, both of which are usually administered through an IV.
Some of the possible side effects of Cytoxan include:
- hair loss
- loss of appetite
- unintentional weight loss
- sores in the mouth or tongue
- changes in skin color
Cytoxan is not recommended for those with health conditions that block the flow of urine, as it could cause serious side effects. Additionally, women who are pregnant or breastfeeding should not use Cytoxan.
Chemotherapy (also called antineoplastic therapy) is a type of cancer treatment that works by killing fast-growing cells in your body to help prevent the growth and spread of cancer cells. It can be given as an oral medication or administered through an IV.
But because chemotherapy can kill both healthy and cancerous cells in your body, it can cause many side effects.
On the other hand, targeted therapy is a treatment that attacks cancer cells specifically by interfering with certain pathways that control their growth.
Unlike chemotherapy, targeted therapy is designed to only affect cancer cells, meaning that it’s less likely to harm the normal, healthy cells in your body. But targeted therapy pills do have side effects as well.
Furthermore, while chemotherapy kills off cancer cells that have already been produced, targeted therapy also works by preventing cancer cells from multiplying and spreading.
Targeted therapy can be administered orally or through an IV for the treatment of breast cancer. It’s often used alone or in combination with other cancer treatments, including chemotherapy.
Targeted therapies are created to attack specific parts of cancer cells to prevent cancer growth or to shrink existing tumors.
Each type of targeted therapy works a little differently, but all tend to interfere with the ability of cancer cells to grow, divide, repair, and communicate with other cells.
Here are some of the common types of targeted therapy:
- Monoclonal antibodies. These medications are often combined with toxins, chemotherapy drugs, and radiation. They attach to targets on the surface of cancer cells and deliver these substances, causing cancer cells to die without harming healthy cells.
- Small molecule inhibitors. These drugs generally target and inhibit specific pathways and processes that cause cancer cells to proliferate. They must be small enough to be able to enter the cell and interfere with proteins on both the inside and outside of the cell.
- Angiogenesis inhibitors. These drugs inhibit the formation of new blood vessels, which fuel the growth of cancer cells.
There are several different types of targeted therapies available for the treatment of breast cancer.
Trastuzumab (Herceptin) and pertuzumab (Perjeta) are the two most common monoclonal antibodies used to treat HER2-positive breast cancer. These medications are typically administered through an IV infusion and are used in combination with chemotherapy.
After chemotherapy has finished, treatment with medications like Herceptin generally continues every 3 weeks over a total period of 1 year.
Neratinib (Nerlynx) is another type of targeted therapy, which is taken orally and is designed to help prevent the recurrence of HER2-positive breast cancer for patients who’ve completed 1 year of Herceptin.
Other drugs like lapatinib (Tykerb/Tyverb) and tucatinib (Tukysa), both oral medications, and ado-trastuzumab emtansine (Kadcyla), which is administered through an IV, are also available for the treatment of advanced HER2-positive breast cancer.
Capecitabine (Xeloda) and cyclophosphamide (Cytoxan) are chemotherapy drugs approved and available in pill form for the treatment of breast cancer. In addition, targeted therapies may also be an option. Talk with your healthcare professional to determine the best solution for you.