Chemotherapy for breast cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the way cancer cells grow and divide but they also affect normal cells.

You usually have chemotherapy in a chemotherapy day unit. Most drugs are given into a vein (intravenously), but some are given as tablets.

The nurse gives you the chemotherapy drugs into a vein by injection or as a drip (infusion). It can be given through:

• a cannula – a short, thin tube put into a vein in your arm or the back of your hand
• a central line – a long, thin tube inserted into a vein in your chest
• a PICC line put into a vein in the arm and threaded through to a vein in the chest
• an implantable port (portacath) that is put into a vein, with an opening (port) under the skin on your chest or arm.

Chemotherapy is often given as a few sessions of treatment. Each session takes a few hours. After the session, you have a rest period of a few weeks. The chemotherapy and the rest period is called a cycle of treatment.

The length of a cycle depends on the chemotherapy drugs you are taking. Most cycles are 1 to 3 weeks. Your cancer doctor or specialist nurse will tell you how many cycles you need.

Different chemotherapy drugs affect cancer cells in different ways. This is why a combination of drugs is often used. For early breast cancer, the combination often includes drugs called:

• anthracyclines – such as epirubicin and doxorubicin (Adriamycin^®)
• taxanes – such as docetaxel (Taxotere^®) and paclitaxel (Taxol^®).

These drugs are commonly used in combination with other chemotherapy drugs, including fluorouracil and cyclophosphamide.

Some commonly used combinations include:

• FEC – fluorouracil (5FU), epirubicin and cyclophosphamide
• FEC-T– FEC followed by docetaxel
• AC – doxorubicin (Adriamycin) and cyclophosphamide
• EC – epirubicin and cyclophosphamide
• TC – docetaxel and cyclophosphamide
• carboplatin and paclitaxel
• EC-T – epirubicin and cyclophosphamide followed by docetaxel
• EC-P – epirubicin and cyclophosphamide followed by paclitaxel
• FEC-P – fluorouracil (5FU), epirubicin and cyclophosphamide followed by paclitaxel (carboplatin may sometimes be added to this combination).

Your cancer doctor may offer you a choice of chemotherapy treatments. If so, you will be given more information to help you decide.

If you have HER2 breast cancer, you may have a targeted therapy called trastuzumab with your chemotherapy.

Sometimes the targeted therapy drug pertuzumab (Perjeta^®) is given in combination with trastuzumab and chemotherapy. The combination may be used before surgery if there is a high risk of the cancer coming back.

Anthracycline chemotherapy drugs are not usually given at the same time as trastuzumab because they can both affect the heart. Your cancer doctor or specialist nurse can give you more information about this.

Macmillan is here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.
• Visit our chemotherapy forum to talk with people who have had chemotherapy, share your experience, and ask an expert your questions.