How is chemotherapy given?

How is chemotherapy given?

In most cases (especially adjuvant and neoadjuvant treatment), chemo is most effective
when combinations of more than one drug are used. Many combinations are being used,
and it's not clear that any single combination is clearly the best. Clinical studies continue
to compare today's most effective treatments against something that may be better.
Some of 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 cyclophosphamide
· 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 HER2/neu positive
tumors

Other chemo drugs used to treat women with breast cancer include cisplatin, vinorelbine
(Navelbine®), capecitabine (Xeloda®), liposomal doxorubicin (Doxil®), gemcitabine
(Gemzar®), mitoxantrone, ixabepilone (Ixempra®), albumin-bound paclitaxel
(Abraxane®), and eribulin (Halaven®). The targeted therapy drugs trastuzumab and
lapatinib (Tykerb®) may be used with these chemo drugs for tumors that are HER2/neupositive
(these drugs are discussed in more detail in the "Targeted therapy for breast
cancer" section).
Doctors give chemo in cycles, with each period of treatment followed by a rest period to
give the body time to recover from the effects of the drugs. Chemo begins on the first day
of each cycle, but the schedule varies depending on the drugs used. For example, with
some drugs, the chemo is given only on the first day of the cycle. With others, it is given
every day for 14 days, or weekly for 2 weeks. Then, at the end of the cycle, the chemo
schedule repeats to start the next cycle. Cycles are most often 2 or 3 weeks long, but it
varies according to the specific drug or combination of drugs. Some drugs are given more
often. Adjuvant and neoadjuvant chemo is often given for a total time of 3 to 6 months,
depending on the drugs that are used. Treatment may be longer for advanced breast
cancer and is based on how well it is working and what side effects the patient has.
Dose-dense chemotherapy: Doctors have found that giving the cycles of certain chemo
agents closer together can lower the chance that the cancer will come back and improve
survival in some women. This usually means giving the same chemo that is normally
given every 3 weeks (such as AC → T), but giving it every 2 weeks. A drug (growth
factor) to help boost the white blood cell count is given after chemo to make sure the
white blood cell count returns to normal in time for the next cycle. This approach can be
used for neoadjuvant and adjuvant treatment. It can lead to more side effects and be
harder to take, so it isn’t for everyone.