Chemotherapy for Breast Cancer
Chemotherapy (chemo) uses anti-cancer drugs that may be given intravenously (injected into your vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body.
Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area (called intrathecal chemotherapy).
When is chemotherapy used for breast cancer?
Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended.
After surgery (adjuvant chemotherapy)
Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can't be seen, even on imaging tests. These cells are considered microscopic because they can’t be seen by the naked eye. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back. Sometimes it is not clear if chemotherapy will be helpful. There are tests available, such as Oncotype DX, that can help determine which women will most likely benefit from chemo after breast surgery. See Breast Cancer Gene Expression Tests for more information.
Before surgery (neoadjuvant chemotherapy)
Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed, have many lymph nodes involved with cancer, or are inflammatory breast cancers .
If after neoadjuvant chemo, cancer cells are still found when surgery is done (also called residual disease), you might be offered more chemotherapy (adjuvant chemotherapy) to reduce the chances of the cancer coming back (recurrence).
Some other reasons you might get neoadjuvant chemo:
- By giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesn’t shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that might have spread but can't be seen by the naked eye or on imaging tests. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.
- Some people with early-stage cancer who get neoadjuvant chemo might live longer if the cancer completely goes away with that treatment. This can be seen most often in women who have triple-negative breast cancer or HER2-positive breast cancer.
- Getting chemo before surgery can also give some people extra time to get genetic testing or plan reconstructive surgery.
Keep in mind that not all women with breast cancer are good candidates for neoadjuvant chemo.
For metastatic breast cancer
Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
Chemotherapy drugs used for breast cancer
In most cases, chemo has the greatest effect when more than one drug is used at a time. Often, combinations of 2 or 3 drugs are used. Doctors use many different combinations, and it's not clear that any particular drug combination is the best.
Adjuvant and neoadjuvant chemo drugs
- Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
- Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
- 5-fluorouracil (5-FU) or capecitabine (Xeloda)
- Cyclophosphamide (Cytoxan)
- Carboplatin (Paraplatin)
Chemo drugs for breast cancer that has spread (metastatic breast cancer)
- Taxanes: Paclitaxel (Taxol), docetaxel (Taxotere), and albumin-bound paclitaxel (Abraxane)
- Ixabepilone (Ixempra)
- Eribulin (Halaven)
- Anthracyclines: Doxorubicin (Adriamycin), liposomal doxorubicin (Doxil), and epirubicin? (Ellence)
- Platinum agents (Cisplatin, carboplatin)
- Vinorelbine (Navelbine)
- Capecitabine (Xeloda)
- Gemcitabine (Gemzar)
- Antibody drug conjugates (Ado-trastuzumab emtansine [Kadcyla], Fam-trastuzumab deruxtecan [Enhertu], Sacituzumab govitecan [Trodelvy])
Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.
For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo. (See Targeted Therapy for Breast Cancer for more information about these drugs.)
How is chemotherapy for breast cancer given?
Chemo drugs for breast cancer are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctor’s office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
There are many different kinds