Chemotherapy for secondary breast cancer
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. The drugs are carried in the blood and can reach cancer cells anywhere in the body.
Chemotherapy may be used as a first treatment for secondary breast cancer that is growing quickly, or is in the liver or lungs. It is also given if the cancer does not respond to hormonal therapy (ER negative).
If you’ve already had a chemotherapy drug before, a different drug or drugs will be used.
Research trials are looking at different combinations of chemotherapy drugs and chemotherapy in combination with targeted therapy drugs. Your cancer specialist may discuss this with you and invite you to take part in a clinical trial.
Chemotherapy drugs commonly used to treat secondary breast cancer are:
You may have a drug on its own or a combination of drugs.
A drug called paclitaxel albumin (Abraxane®) is similar to paclitaxel. It is sometimes used after other chemotherapy drugs have been tried.
A new drug called eribulin (Halaven®) is licensed for women who have already had two other courses of chemotherapy for secondary breast cancer.
But it has not been approved by the National Institute for Health and Care Excellence (NICE) or by the Scottish Medicines Consortium (SMC). As a result, eribulin is not widely available.
Another new drug called T-DM1 is a combination of the targeted therapy medicine Herceptin and a chemotherapy drug called emtansine. In T-DM1, the emtansine is attached to the Herceptin. This drug may be given in a clinical trial.
Your cancer specialist will explain which type of chemotherapy is appropriate for you and will discuss the benefits and side effects with you.
Our section on chemotherapy has more information. We also have more information about individual drugs and drug combinations.
How chemotherapy is given
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Chemotherapy drugs can be given into a vein (intravenously), as injections or drips (infusions), or as tablets or capsules to take at home.
Intravenous chemotherapy is usually given through a small tube (cannula) in your arm. Occasionally it’s given through a soft plastic tube called a central or a PICC line. A central line is put into a vein in your chest and a PICC line is put into a vein in the bend of your arm.
You’ll usually have your treatment in the chemotherapy day unit. Some chemotherapy drugs can be taken as tablets or capsules at home.
Your chemotherapy will be given to you as a series of treatments known as cycles. You may have drugs weekly or every three weeks and the complete course of treatment may take several months.
Your doctor or nurse will explain how many cycles of treatment are planned for you and how you’ll be given your chemotherapy.
Chemotherapy drugs may cause unpleasant side effects, but these can usually be well-controlled with medicines and will usually go away once treatment has finished. Not all drugs cause the same side effects and some people may have very few. You can talk to your doctor or nurse about what to expect from the treatment that’s planned for you.
The main side effects are described here as well as some ways to reduce or control them.
We can send you further information about many of the side effects mentioned here.
We met a lot of other ladies in the same position as myself, some of them a lot sicker than I was, some of them less. We turned it into a positive experience.
Risk of infection (neutropenia)
Chemotherapy can temporarily reduce the number of white blood cells which help fight infection. If the number of your white blood cells is low you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
you develop a high temperature - this may be over 37.5° C (99.5°F) or over 38°C (100.4°F) depending on the hospital’s policy. Follow the advice that you have been given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you feel shivery and shaky
you have any symptoms of infection such as a cold, sore throat, cough, passing urine frequently (urine infection), or diarrhoea.
If necessary you’ll be given antibiotics to treat an infection.
You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally treatment may need to be delayed if the number of your white cells is still low.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
Anaemia (reduced number of red blood cells)
Chemotherapy may reduce the number of red bloods cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia, and can make you feel very tired and lethargic.
Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can take.
You’re likely to become tired and have to take things slowly.
Try to pace yourself and save your energy for things that you want to do or that need doing. Balance rest with some physical activity - even going for short walks will help increase your energy levels.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. If it doesn’t improve you can ask to see a dietitian.
Chemotherapy can cause mouth problems such as a sore mouth, mouth ulcers or infection. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening.
Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems. They can give you mouthwashes, medicines and gels to help.
Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows. Others may only experience partial hair loss or thinning. It depends on what chemotherapy drugs you are having.
Your doctor or nurse can tell you more about what to expect. You’ll be given advice on looking after your scalp.
Our section on coping with hair loss has lots of helpful tips on how to deal with hair loss.
Increased risk of blood clots
Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain.
Blood clots can be very serious so it’s important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information about blood clots.
It’s not advisable to become pregnant while having chemotherapy, as the drugs may harm the unborn baby. It’s important to use effective contraception during your treatment.
Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in vaginal fluid.