Who Gets Chemotherapy?

Chemotherapy is used to treat all stages of breast cancer, including cancer that has come back in the breast area and breast cancer that has spread to other parts of the body (metastatic disease). Chemotherapy treatments are tailored specifically for each person's unique situation. When deciding on which chemotherapy medicines would be best for you, you and your doctor will take into account the stage and other characteristics of the cancer, such as hormone-receptor status and HER2 status. You'll also consider your menopausal status and any other treatments you've had.

Chemotherapy for early-stage disease

Early-stage breast cancer generally means cancer that is classified as:

• stage 0
• stage I
• stages IIA and IIB
• some stage III

(For more information on the specific characteristics of each cancer stage, visit the Breastcancer.org Stages of Breast Cancer page.)

Chemotherapy is used after surgery to remove the breast cancer to get rid of any cancer cells that may be left behind and to reduce the risk of the cancer coming back. In some cases, chemotherapy may be used before surgery to shrink the tumor so less tissue needs to be removed.

Each person's treatment plan will be different, but there are some general guidelines about who would benefit from chemotherapy:

• Chemotherapy is almost always recommended if there is cancer in the lymph nodes, regardless of tumor size or menopausal status.
• Doctors recommend more aggressive treatments for premenopausal women diagnosed with invasive breast cancer. Breast cancer in premenopausal women tends to be more aggressive, so chemotherapy is often part of the treatment plan.
• Chemotherapy may be recommended for some women diagnosed with early-stage breast cancer if the cancer is hormone-receptor-negative and HER2-positive. Both of these characteristics are associated with cancer that is more aggressive.
• The Oncotype DX test may help some women diagnosed with estrogen-receptor-positive breast cancer and their doctors decide if the cancer is likely to come back and if chemotherapy would offer benefits.
• Chemotherapy usually is NOT recommended for non-invasive, in situ cancers such as DCIS because they have very little risk of spreading to other parts of the body.

Chemotherapy for advanced-stage/metastatic disease

Advanced-stage breast cancer generally means cancer that is classified as:

• some stage III
• stage IV

Metastatic disease is breast cancer that has spread beyond the breast area and nearby lymph nodes to other parts of the body. Metastatic cancer is considered stage IV.

Chemotherapy is used to treat advanced-stage breast cancer by destroying or damaging the cancer cells as much as possible. Because chemotherapy medicines affect the entire body, chemotherapy is commonly used to treat advanced-stage breast cancer. Research has shown that newer chemotherapy medicines, such as:

• Taxol (chemical name: paclitaxel)
• Abraxane (chemical name: albumin-bound paclitaxel)
• Taxotere (chemical name: docetaxel)
• Adriamycin (chemical name: doxorubicin)
• Ellence (chemical name: epirubicin)

are helping women diagnosed with advanced-stage breast cancer live longer. Other chemotherapies used in metastatic breast cancer include Gemzar (chemical name: gemcitabine), Xeloda (chemical name: capecitabine), Navelbine (chemical name: vinorelbine), and Ixempra (chemical name: ixabepilone).

Each person's treatment plan will be different, but there are some general guidelines that doctors follow when using chemotherapy to treat advanced-stage breast cancer:

• If you've had chemotherapy before, your doctor may recommend using only one chemotherapy medicine at a time to treat advanced-stage disease. This way you get benefits with fewer possible side effects.
• In general, most chemotherapy medicines can be used until side effects become a problem or the medicine stops being effective.
• Some chemotherapy medicines seem to work better against cancer tumors when used in combination. So your doctor may recommend a combination of medicines for you because research has shown that combining treatments has contributed to a better overall prognosis for some advanced-stage cancers.
• If you've had chemotherapy before and the cancer came back or didn't respond, your doctor will likely recommend a different combination of medicines. There are many chemotherapy medicines and if one medicine or combination of medicines doesn't seem to be working, there is almost always something else you can try.

If the cancer is hormone-receptor-positive, your doctor may choose to use hormonal therapy before or after initiating chemotherapy.

If you have metastatic breast cancer and chemotherapy is part of your treatment plan, your doctor may use different tests to determine how well the chemotherapy is working and how you're handling the chemotherapy:

• Blood cell counts
• Blood tumor marker tests
• Bone scans
• Chest X-rays, or X-rays of other parts of the body
• MRI
• CT (CAT) scans
• PET scans