The Chemotherapy Drugs

Many of the drugs used to treat early breast cancer and locally advanced breast cancer are different than those used to treat metastatic breast cancer.

Chemo Drugs for Early & Locally Advanced Breast Cancer

The most effective drugs for the treatment of early and locally advanced breast cancer are:

• Cyclophosphamide (Cytoxan)
• Doxorubicin (Adriamycin) or Epirubicin (Ellence)
• 5-Fluorouracil (5FU)
• Methotrexate (Matrex)
• Paclitaxel (Taxol) or Docetaxel (Taxotere)

Although each of these drugs is effective on its own, research has shown that combining different drugs further increases their ability to kill cancer cells. Frequently used drug combinations for the treatment of early and locally advanced breast cancer are listed below. Other combinations are also used, depending on the situation.

• AC: a combination of doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan).
  This combination is given through an IV on the first day, followed by 20 days of rest. This is repeated four times every 21 days. AC can also be given in a two-week cycle (see below).
• AC—>Paclitaxel: a combination of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan) and paclitaxel (Taxol).
  This regimen is for both pre- and postmenopausal women whose cancer has spread to the lymph nodes. It involves four doses of AC followed by four doses of paclitaxel. Paclitaxel is given by IV and can be given either every three weeks or in a dose-dense manner every two weeks (with growth factor injections to boost white blood cell count) [17]. Dexamethasone (an anti-inflammatory steroid drug) is given before the paclitaxel to prevent an allergic reaction.
• AC—> Docetaxel: a combination of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan) and docectaxel (Taxotere).
  Usage is similar to AC—>Taxol, except that docetaxel is used instead of paclitaxel. Though the effectiveness of docetaxel is still being studied, this combination is increasingly popular. For adjuvant treatment, docetaxel should only be given once every three weeks, rather than every two weeks.
• CAF (FAC/CAF): a combination of cyclophosphamide (Cytoxan), doxorubicin (Adriamycin) and 5-fluorouracil (Adrucil).
  All are usually given through an IV the first day. One is given on the eighth day, followed by 20 days of rest. The cycle is repeated six times. Sometimes the cyclophosphamide is given orally on days 1 through 14 rather than through an IV. For oral cytoxan, the cycle is every 28 days.
• Chemotherapy with CMF: a combination of cyclophosphamide (Cytoxan), methotrexate (Rheumatrex) and 5-fluorouracil (Adrucil).
  This combination is given through an IV on days 1 and 8. Cyclophosphamide can be given intravenously on day 1 and 8 or as oral pills on days 1 through 14, followed by two weeks of rest. The cycle is repeated six times. If oral cyclophosphamide is used, the cycle is 28 days; for IV cyclophosphamide the cycle is 21 days.
• TAC: a combination of docectaxel (Taxotere), doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan).
  For lymph node-positive cancer. All are usually given through an IV the first day, followed by 20 days of rest. The cycle is repeated six times.
• Cyclophosphamide (Cytoxan) and docetaxel (Taxotere). This combination is given through an IV on the first day, followed by 20 days of rest. This is repeated four times every 21 days.

Chemotherapy Drugs for Metastatic Breast Cancer

Some of the same drug combinations used to treat early breast cancer are also used to treat metastatic cancer. However, single drugs are also used in treatment. Six of the most commonly used are:

Capecitabine (Xeloda)
Docetaxel (Taxotere)
Doxorubicin (Adriamycin)
Paclitaxel (Taxol)
Vinorelbine (Navelbine)
Gemcitabine (Gemzar)

A list of chemotherapy drugs used to treat metastatic breast cancer can be found in Figure 5.3. Although comprehensive, it is not meant to be exhaustive and does not include rarely used drugs or those no longer in use.

Updated 07/28/08

Going Through Chemotherapy

Side Effects of Chemotherapy