Remember to discuss all medical issues with your medical team. There are many kinds of chemotherapy regimens and your medical team may recommend a different regimen for your particular situation.
One theory you will often hear or read is that Metaplastic Breast Cancer is chemotherapy-resistant. There is no definitive study which proves MpBC tumors are chemotherapy-resistant. However, MpBC patients do have higher recurrence rates and recurrences often happen in a shorter time frame. Because MpBC is often triple negative (not always) many oncologists will offer the standard treatment for triple negative breast cancer as their first line of defense. Here is a comprehensive list of chemo regimens. Please keep in mind that the specific combinations of chemo given can vary. New studies often allow doctors to offer newer and better regimens.
Depending on your personal situation you may be offered anyone of these chemotherapy regimens.
Chemotherapy can be given at different times in the treatment process. If chemotherapy is given after your surgery it is referred to as adjuvant. In this case the chemotherapy is regarded as an insurance policy for the patient. The tumor has been removed and in theory the cancer could be completely gone. However, micro cancer cells, invisible to the naked eye, may have broken off or been left behind. Chemotherapy is designed to be delivered throughout the body (hence the phrase “Systemic”) and track down any stray cancer cells and kill them. One benefit to having surgery first is that you know the cancer has been removed quickly, but you don’t know if the chemo was effective.
Chemotherapy can also be given before undergoing a surgical procedure. This is called neoadjuvant chemotherapy. Recently, studies have indicated some benefit to patients using neoadjuvant treatments so recommending this form of chemo is on the rise. Occasionally the tumor will be too large or dispersed for surgery. The chemotherapy is used to shrink the tumor(s) so that the surgeon has a better chance of removing all of the disease during surgery. With neoadjuvant chemotherapy the doctor will also be able to see if the tumor responds to the treatment and allow for adjustments to be made in the drugs being used.
Chemotherapy drugs are often work more effectively when used in combination. AC-T, FEC, and TAC are all combinations used with breast cancer. In the U.S. it is common for women with MpBC to be offered the AC-T chemotherapy regimen while in Europe many metaplastic patients will be offered FEC.
The overall plan for your chemotherapy treatment is called the “regimen.” The regimen is broken up into individual “cycles.” A cycle can be every three weeks, every two weeks, every week or every day. Normally your regimen will include anywhere from 3 to 8 cycles. The timing of the chemotherapy cycle will be determined by your oncologist who will consider your individual tumor and general health before creating a plan for you.
It is not uncommon for MpBC patients to be offered dose dense ACT chemotherapy. ACT refers to the drugs Adriamycin, Cytoxan and Taxol. With ACT a patient is often given 8 cycles. A cycle is a full dose of the treatment. With ACT, the adriamycin is given with the cytoxin together in four cycles and the taxol is given alone for four cycles.
The ACT regimen can be given in a three week cycle meaning the patient receives a dose every three weeks. However, studies have suggested a benefit to some patients if the doses are taken closer together. When the regimen is given every two weeks it is called dose dense. The AC portion of the treatment is most often given using the dose dense method. However, Taxol can be offered in two week (dose dense) cycles or in a weekly cycle with a lower dose. Normally it takes 2-3 hours for AC to be administered and 3-4 hours for taxol on treatment days.
The taxol may be given in weekly doses if the individual patient needs an easier regimen to minimize the most common side effect, neuropathy. If neuropathy becomes and issue sometimes the doctor will shorten the number of treatments to limit the potentially permanent damage to your nerve endings. This is not an entirely uncommon occurrence.
FEC is a common chemo regimen offered to MpBC patients in Europe. FEC stands for the drugs fluorouracil (which is also known as 5FU) epirubicin and cyclophosphamide. In this regimen the drugs are all given during the same session. This regimen usually includes between 4-6 cycles given three weeks apart. The FEC treatment can take as little as an hour.
Like AC-T and FEC the TC regimen is named for the drugs involved, Taxotere and Cytoxan. The TC regimen is normally given in 4 cycles three weeks apart. The drugs are given on the same day with the Taxotere drip taking about an hour and the Cytoxan taking between 30-60 minutes.
Chemo can be delivered in many different ways but is often given by IV. Some women chose to have a port-a-cath or mediport implanted in order to facilitate the delivery without having to endanger the health of the veins in their arm. You may want to investigate this option but it is not necessary to have a port to receive chemo treatments. Chemo can also be given using an IV through your veins. Keep in mind that these drugs are very caustic and can damage the veins in your arms over time.
Whether you use a port or your veins for the delivery of chemo you will probably have a drip to control the speed of delivery. Most infusion centers will have machines designed to help control the delivery of your treatment. The nurses are skilled in setting the machines to allow for the precise timing of your treatment. The machines are electric but can be unplugged to allow you to get up from your seat during treatment in case you want to stretch your legs or visit the restroom.
Thankfully chemo therapy, while difficult for many, is not as bad as it has been in years past. Many new drugs have been found that can help reduce the side effects of chemo. These drugs are often given before a cycle begins. Anti-emetics, steroids and anti-histamines are common drugs administered in a saline drip before chemo is given. Anti-emetics are intended to help with nausea, steroids like dexamethasone and anti-histamines like Benadryl will help protect you from an allergic reaction to the chemo. Your nurse will explain to you what drugs you are given before your first cycle. Don’t hesitate to ask your nurse about every drug prescribed and be sure to tell them (and your doctor) about any side effects so your dose can be altered or additional precautions can be taken. These pre-meds are great for keeping you from having allergic reactions and from vomiting but they come with their own side effects, which can impact your health and how you feel as well.
Cancer cells are abnormal cells that quickly replicate themselves spreading throughout the body if they are allowed to grow unchecked. Chemo drugs work by attacking quickly dividing cells in the body that is why it is so effective against cancer. However, other cells in your body grow quickly as well, like hair and nail cells, bone marrow cells and the cells in the lining of your intestines. While the chemo is attacking the fast growing cancer cells it is also attacking these other fast growing but normal cells in your body. This is where many of the side effects of chemo come from.
For More general information on Chemotherapy: