Chemotherapy Treatment Options

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This may be your first treatment for metastatic disease, or you may be coming back for a fourth try or more. Fortunately, there are many different options with good response rates. So there's always the chance that you will respond to a new treatment. Just because you didn't respond well to one chemotherapy plan doesn't mean you won't do better with another. We give a brief overview of your options below. If you want more information, visit our more comprehensive chemotherapy section.

Single-drug therapy

Doctors often recommend that you take only one chemotherapy drug before trying a combination. This is because you can get significant benefits with fewer side effects.

You may be prescribed single-drug therapy with:

  • A taxane: Taxotere (chemical name: docetaxel), Taxol (chemical name: paclitaxel), or Abraxane (chemical name: albumin-bound or nab-paclitaxel)
  • Adriamycin (chemical name: doxorubicin) or a similar drug, such as Doxil (chemical name: doxorubicin)
  • Xeloda (chemical name: capecitabine)
  • Navelbine (chemical name: vinorelbine)
  • Gemzar (chemical name: gemcitabine)

Here are some things to consider when deciding which of these drugs to take:

  • More women have their cancer shrink or disappear when taking Taxotere, Taxol, or Abraxane than when taking Adriamycin. Response rates with taxanes average around 30%, and range between 15% and 60%. These drugs also cause less nausea, vomiting, and mouth sores than Adriamycin.
  • For some women, however, Adriamycin may be effective but the taxane drugs are not.
  • A large study found that Taxotere was more effective than Taxol in treating advanced breast cancer. But Taxotere caused more side effects.
  • Data suggest that Abraxane works better than Taxol with fewer side effects. Two studies that have recently been completed show that Abraxane given weekly at a lower dose is also effective and is associated with fewer side effects. Research combining Abraxane and Herceptin is in process too.
  • Taxotere or Taxol, given weekly in relatively low doses, is very effective and is associated with fewer side effects (such as low blood counts, hair loss, and nerve problems) than when given every three weeks. Abraxane is also given once a week and does not require pre-treatment with steroids.
  • Navelbine and Gemzar each can be used to help keep the tumor and its symptoms under control without causing too many side effects (including less hair loss). The response rate is 20% to 40%, and if there is a response it lasts about eight months.

Combination therapy

The ideal combination chemotherapy regimen:

  • attacks all the different kinds of cells in the breast cancer (cancer is made up of different kinds of cells that may respond differently to any one drug)
  • uses drugs that work well together, without overlapping benefits or side effects
  • keeps the cancer cells from figuring out how to protect themselves from the particular chemotherapy (developing resistance)
  • has an acceptable level of side effects

If you have never had chemotherapy before, your medical oncologist might recommend one of a number of chemotherapy combinations:

  • AT—Adriamycin (chemical name: doxorubicin) and Taxotere (chemical name: docetaxel)
  • AC ± T—Adriamycin with cyclophosphamide, with or without Taxol (chemical name: paclitaxel) or Taxotere
  • CMF—cyclophosphamide, methotrexate, and fluorouracil ("5-FU" or 5-fluorouracil)
  • CEF—cyclophosphamide, epirubicin (similar to Adriamycin), and fluorouracil
  • FAC—fluorouracil, Adriamycin, and cyclophosphamide
  • TAC—Taxotere, Adriamycin, and Cytoxan (chemical name: cyclophosphamide)
  • CAF—cyclophosphamide, Adriamycin, and fluorouracil
  • GET—Gemzar (chemical name: gemcitabine), epirubin, and Taxol
  • Avastin (chemical name: bevacizumab) and either Taxol or Abraxane

If the cancer progresses

If the cancer progresses while you are taking Adriamycin, consider these findings when choosing your next treatment:

  • Taxotere appears to be more effective for metastatic disease than Taxol.
  • Abraxane was found to be easier to tolerate than Taxol because it does not require pre-treatment with steroids.
  • Another study found that Taxotere combined with Xeloda was more effective than Taxotere alone.
  • Gemzar plus Taxol worked better than Taxol alone, a study found.

If the cancer is resistant to both Adriamycin and a taxane, most doctors would next recommend one of the following approaches, in no particular order:

  • Xeloda (chemical name: capecitabine)
  • Navelbine (chemical name: vinorelbine)
  • Gemzar (chemical name: gemcitabine)
  • CMF—cyclophosphamide, methotrexate, and fluorouracil ("5-FU" or 5-fluorouracil).
  • Ixempra (chemical name: ixabepilone) was approved by the FDA in October 2007 to treat cancers that are resistant to treatment with anthracyclines, taxanes (Taxotere, Taxol and Abraxane) and Xeloda. Ixempra may also be given in combination with Xeloda.

If none of these treatments work, another option is the combination of Mitomycin (chemical name: mutamycin) and vincristine (brand names: Oncovin, Vincasar PES, Vincrex).

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