Chemotherapy attempts to destroy cancer cells with drugs. The drugs are a systemic treatment, meaning they get into the bloodstream and affect the whole body. Chemotherapy can attack cells at the original cancer site and any cancer cells that may have spread to another part of the body.
Chemotherapy after surgery is called adjuvant therapy. (Neoadjuvant chemotherapy is chemotherapy before surgery). Depending on your node status, tumor size and type you may not require both chemotherapy and radiation therapy. Your medical oncologist or radiation oncologist will provide information on the benefits of radiation therapy after chemotherapy based on your particular case.
Chemotherapy is more effective in some cases than in others. It is important for you to understand the effectiveness of chemotherapy for your age group and cancer type. If you plan on becoming pregnant you will want to understand what effects chemotherapy may have on your fertility.
Chemotherapy is indicated in the following patients:
- Node positive patients (regardless of receptor status)
- HER2 +
- Young women under 40
Chemotherapy drugs are typically given in combination, two or three different drugs at the same time. These combinations are called regimens. You may want to ask your physician if you are eligible for more than one regimen and, if so, what are the pluses and minuses associated with each one (e.g., clinical outcomes, side effects). Again, your eligibility for different therapies will depend on your hormonal receptor status and other tumor factors.
In some cases, ONCOTYPE DX can be ordered for your tumor. This test evaluates the genes in your tumour and provides a recurrence score. This score indicates whether or not you would benefit from chemotherapy and greatly helps in your decision making as to whether or not you want to proceed with chemotherapy when you have an ER/PR + tumor that is NODE NEGATIVE.
The most commonly used drug combinations are:
- CMF: cyclophosphamide (Cytoxan®), methotrexate, and 5-fluorouracil (fluorouracil, 5-FU)
- CAF (or FAC): cyclophosphamide, doxorubicin (Adriamycin®), and 5-fluorouracil
- AC: doxorubicin (Adriamycin) and cyclophosphamide12
- EC: epirubicin (Ellence®) and cyclophosphamide
- TAC: docetaxel (Taxotere®), doxorubicin (Adriamycin), and cyclophosphamide
- AC → T: doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel
- (Taxol®) or docetaxel (Taxotere). Trastuzumab (Herceptin) may be given with the paclitaxel or docetaxel for HER2/neu positive tumors.
- A → CMF: doxorubicin (Adriamycin), followed by CMF
- CEF (FEC): cyclophosphamide, epirubicin, and 5-fluorouracil (this may be followed by docetaxel)
- TC: docetaxel (Taxotere) and cyclophosphamide
- TCH: docetaxel, carboplatin, and trastuzumab (Herceptin) for HER-2 positive tumors