After surgery to remove early-stage breast cancer, chemotherapy often is given to destroy any breast cancer cells that may remain in the body and reduce the risk of the cancer coming back (recurrence). Doctors call chemotherapy given after surgery adjuvant chemotherapy.
A number of chemotherapy medicines, given alone or in combination, are used as adjuvant chemotherapy, including a class of medicines called taxanes and a class of medicines called anthracyclines.
A study has found that after 2005, there was a large increase in taxane chemotherapy and a decrease in anthracycline chemotherapy to treat breast cancer in the United States.
The study was published online on May 21, 2012 by the Journal of Clinical Oncology. Read the abstract of “Decline in the Use of Anthracyclines for Breast Cancer.”
Taxane chemotherapy medicines are:
- Taxol (chemical name: paclitaxel)
- Taxotere (chemical name: docetaxel)
- Abraxane (chemical name: albumin-bound or nab-paclitaxel)
Taxanes work by interfering with the ability of cancer cells to divide.
Anthracycline chemotherapy medicines are:
- Adriamycin (chemical name: doxorubicin)
- Ellence (chemical name: epirubicin)
- Doxil (chemical name: doxorubicin)
- daunorubicin (brand names: Cerubidine, DaunoXome)
- mitoxantrone (brand name: Novantrone)
Anthracyclines work by damaging cancer cells’ genes and interfering with their reproduction.
Like all chemotherapy medicines, anthracyclines may cause serious side effects, including heart damage, which can lead to heart failure. The risk of heart problems can be higher when other treatments that may cause heart damage – Herceptin (chemical name: trastuzumab), for example – are used at the same time as an anthracycline. Doctors also are concerned about a higher risk of leukemia in women who have been treated with Adriamycin. Because of these concerns, many doctors started using a combination of Herceptin and a taxane to treat HER2-positive breast cancer after surgery. These concerns are probably why there was a decrease in anthracycline use – most women diagnosed with HER2-positive breast cancer are now treated with a combination of Herceptin and a taxane chemotherapy medicine. Unlike anthracyclines, taxanes are not known to cause heart problems.
Still, for some women, especially women diagnosed with HER2-positive breast cancer with a high risk of recurrence, chemotherapy that includes an anthracycline may be a better option. Taxanes, while an acceptable option for women who can’t or don’t want to get anthracyclines, haven’t been shown to be as good as anthracyclines for treating HER2-positive early-stage breast cancer.
You and your doctor will consider several important factors when deciding on a chemotherapy regimen:
- The characteristics of the cancer: The cancer’s stage, hormone-receptor status, HER2 status, and lymph node status will influence the chemotherapy regimen your doctor recommends.
- Your age, menopausal status, and general health: Your doctor will take into account your age, general health, and menopausal status when recommending a chemotherapy regimen. If you have high blood pressure, are older than 60, and have a history of heart problems, your doctor will probably recommend a taxane chemotherapy rather than an anthracycline.
Deciding on the best chemotherapy regimen can be a bit of a balancing act. You want a combination that offers the most benefits with the least risks and side effects. It’s important to remember that while there are many standard chemotherapy regimens, each person’s treatment plan will be unique because each cancer is unique.
If you’ll be having chemotherapy to treat breast cancer, it’s a good idea to ask your doctor why a specific regimen is recommended for you. If your recommended regimen doesn’t include an anthracycline and you have no history of heart problems or high blood pressure, you might want to ask your doctor why. Together, you and your doctor will make the best decision for your unique situation.