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Doctors use certain medications to help prevent breast cancer or, in combination with other therapies, to fight it and treat it. The kinds of drugs you'll take depend on what stage your cancer has reached, whether it responds to hormones like estrogen, whether you're resistant to any medications or treatments, and how well you tolerate the ones prescribed. Chemotherapy is the tried-and-true standard, but several newer drug treatments may also be helpful.

Chemotherapy combats cancer with drugs that work by killing all fast-growing cells, not only cancer cells but also those in your hair follicles and immune system. A combination of three or four drugs is often more effective than any single one. A woman's overall health is also important in determining what type of chemotherapy is best for her. The medications may be taken in pill form or through an IV (a tube inserted into a vein). An IV treatment, which lasts about two hours, often includes antinausea medications along with the chemo drugs. The treatment is painless, and you can usually relax in a reclining chair and read or chat while receiving it.

A typical course of chemotherapy might involve treatments every other week (to allow time for recovery in between) for three to six months, depending on the stage of your cancer and the other treatments you're receiving. Chemo may also be used before surgery. This is called neoadjuvant chemotherapy and is used to shrink a large tumor that otherwise cannot be removed completely by surgery. It's also used to shrink large tumors so they can be removed by lumpectomy rather than mastectomy.

Chemotherapy is notorious for causing nausea and vomiting. Some cancer patients even start to experience anticipatory nausea before their chemo appointments. But many of these side effects can be treated, and some can be prevented entirely. Today's antinausea medications are more sophisticated and effective than those used even a few years ago: They can sometimes make you feel better and boost your appetite. Let your doctor know if you continue to feel nauseated; there are new drugs that can help control this even in highly sensitive patients. Discuss other things you can do to get relief as well, such as eating frequent, small, non-spicy meals, learning and practicing self-hypnosis, and having a few crackers every time you wake from sleep.

The most serious side effect of chemotherapy is suppression of your immune system, which can greatly increase the risk of serious infection. Chemo lowers your levels of red and white blood cells and platelets, an effect that's likely to make you tired and lower your immunity. It's very important to wash your hands carefully and often and, if possible, avoid being around sick people while you're undergoing chemo. You may be given drugs called colony-stimulating factors, which can improve your blood-cell count and thus give you more energy. The exhaustion and nausea are at their worst shortly after you have a treatment, but within a day or so the nausea will often subside; it's the ever-present fatigue that many women find most debilitating.

Exercising daily, getting lots of rest and frequent naps, and avoiding stress and unnecessary chores can help you cope. "There are many things that can be done to counter cancer-related fatigue, starting with a search for treatable physical factors, like low thyroid or blood count, and learning to recognize and respect one's limits," writes Dr. Wendy S. Harpman, the author of After Cancer: A Guide to Your New Life. "Many patients try to keep life as normal as possible, and in the process, they overdo it."

Other common side effects of chemotherapy are hair loss, sores in the mouth, changes in the skin, and menstrual irregularities. Whether you have these problems may depend on which drugs you're given or the dosage and length of treatment.

The three most common chemo regimens are CMF (cytoxan, methotrexate, and 5Fluorouracil), AC (adriamycin and cytoxan) and AC followed by Taxol, now produced synthetically but originally derived from the bark of yew trees. Once used only to treat advanced breast cancer and ovarian cancer, Taxol is now approved for treatment of early breast cancer. All patients receiving adriamycin-based therapy should have a special heart evaluation called a MUGA scan before starting therapy to assess for underlying heart disease. High doses of adriamycin can cause heart damage, so the dosage must be carefully monitored by your doctor.

Generally, adriamycin-based regimens cause hair loss, which can occur not only on your head, but on other parts of your body. CMF regimens can cause hair loss, too, but not always. Many women cut their hair short or buy a wig before starting chemo to help them cope with losing their hair.

Other serious side effects are possible but rare. For example, some women experience premature menopause or, more rarely, develop acute myeloid leukemia. Chemotherapy may infrequently lead to kidney or bladder problems, too. Some drugs can cause peripheral neuropathy, a nerve-related condition that may make your hands or feet feel tingly, weak, or numb. Consult with your oncologist if you develop any of these symptoms.

In some women, the female hormone estrogen can increase the growth of breast cancer cells. Certain hormone medications function by lodging in the receptors of the harmful cells so that the estrogen can't get to the cells and feed the tumor.

One of these drugs, Tamoxifen/Nolvadex has been used for more than 20 years in the treatment of known breast cancers. More recently, over the past five or ten years, it's been used for prevention of new breast cancers. In terms of treatment, tamoxifen can improve a woman's ten-year survival by 5 to 11 percent. For prevention, tamoxifen decreases the risk of developing breast cancer in the same breast or the other breast by 50 percent.

Its rare but serious side effects include uterine cancer, blood clots, and cataracts. If you take tamoxifen, the American Cancer Society recommends that you get a yearly pelvic exam to screen for uterine cancer. In many women, the drug also causes such menopause-like symptoms as hot flashes, weight gain, and mood swings. Tamoxifen shouldn't be taken in conjunction with hormone replacement therapy.

Tamoxifen has proven to only be effective for five years, but researchers are hopeful that a new drug will take over where tamoxifen leaves off. In a study of over 5,000 women published in the October 9, 2003 issue of the New England Journal of Medicine, the drug letrozole, when given after a five-year course of tamoxifen, reduced the risk of subsequent breast tumors by 40 percent. Women in the study all had estrogen-sensitive breast cancer. Half were given a dummy pill and half were given letrozole. After the researchers saw how well the drug performed, they decided to stop the study early so that women taking the dummy pill would be able to take it as well.

Though the new drug seems promising, researchers caution that the long-term side effects of letrozole aren't known. Some side effects of the drug that are already known are increased risk of osteoporosis, pain in the joints and bones, hot flashes, and night sweats.

Still another new drug, anastrozole, shows even more promise. In a study of 9,300 women over five years, researchers found that anastrozole reduced the recurrence of tumors by 70 percent, compared to tamoxifen's 50 percent. It also had a lower associated risk of strokes, blood clots and uterine cancers than tomoxifen. Women on anastrozole did have a higher risk of osteoporosis, but researchers said drugs can be prescribed to reduce that risk.

Drugs like arimidex and megestrol acetate -- known as aromatase inhibitors -- can be useful for women with hormone-receptive cancers that don't respond to tamoxifen. In fact, in two studies reported at the Second European Breast Cancer Conference in October 2000, an aromatase inhibitor marketed under the name Femara was more effective than tamoxifen in slowing the progression of breast cancer. Exemestane is a new drug in this class, recently approved for women who were not helped by anti-estrogen therapy. If these medications don't work, progestins or androgens may be used, but they may cause undesirable side effects such as fluid retention or excessive body hair. Another drug, goserelin (Zoladex ), blocks the ovaries and creates a chemical menopause, which shuts down estrogen production.

One of the most exciting advances in cancer therapy may be the ability to fight cancer with substances that act as "guided missiles," seeking out and destroying cancer cells. These are molecules known as monoclonal antibodies, which are synthesized proteins that can carry chemo medications or radiation directly to cancer cells in order to destroy them. Researchers are also experimenting with ways to arm these molecular "destroyers" with toxins or radioactive particles that are released directly into the cancer cells when the missile hits home. Unlike regular chemotherapy, this therapy targets only harmful cells, and so promises to be much less toxic and debilitating to patients.

In some forms of aggressive breast cancer, cancerous cells go out of control and produce too much of a protein called HER2/neu, which is thought to give the signal for cells to multiply. Monoclonal antibodies are designed to latch onto the surface of those cells and make it impossible for the cells to keep reproducing. So far, one such drug, trastuzumab (brand name Herceptin), has been approved for the treatment of metastasized breast cancer; others are being studied. Government studies released in April 2005 found that women who took Herceptin along with chemotherapy were only half as likely to see a recurrence of their cancer than women who received chemotherapy alone. "These are truly life-saving results in a major disease," Dr. JoAnne Zujewski, a leading researcher for the National Cancer Institute, said in a statement released by the National Institutes of Health.

About 5 percent of people who take Herceptin have suffered serious heart problems, especially when it was combined with other cancer medications, so the drug may not be a good choice for anyone at risk for heart disease. It also produces some flu-like symptoms and breathing problems in some women, and a few women may experience severe allergic reactions, but otherwise the drug has relatively few side effects.

In February 2008, the FDA approved the use of Avastin (bevacizumab) for the treatment of breast cancer. Avastin is used in conjunction with regular chemotherapy and works by preventing the formation of blood vessels that feed tumors. It is already approved for the treatment of lung and colon cancers.

A new class of drugs may shrink tumors by preventing the formation of blood vessels that are necessary to a cancer's growth. An aggressive cancer in particular needs to grow lots of small blood vessels in order to spread. Two drugs from this category that are currently under study are Endostatin and Angiostatin. Another class of drugs, called biphosphonates, is currently used to treat osteoporosis but is being explored as a possible cancer medication because this drug group strengthens bones, including bones to which cancer has metastasized. One of these drugs, clodronate, may prevent the spread of breast cancer to the bones and organs.

No alternative remedies have been proven to cure cancer, but some, such as acupuncture, may help you feel better and recover faster from the side effects of conventional drugs. Some people report that smoking marijuana eases the nausea and vomiting resulting from chemotherapy. The Institute of Medicine under the National Academy of Sciences reported that the drug may be appropriate for patients not helped by antinausea medications. It's best to check the laws in your state. In some areas marijuana is available for medical purposes.

In 2000, doctors at the University of California at San Francisco began several studies of the effectiveness of Chinese herbs on the chemo side effects of nausea, vomiting, and fatigue. The UCSF researchers -- one of whom did extensive research on Herceptin -- are also studying whether some seven Tibetan herbal combinations are safe and can shrink cancer tumors.

-- Ann Lane is a freelance writer based in San Francisco.

References

First published July 20, 1999
Last updated March 12, 2008
Copyright © 1999 Consumer Health Interactive

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