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, combining different drugs further increases their ability to kill cancer cells. Common drug combinations for the treatment of early and locally advanced breast cancer are listed below. Other combinations are also used.
| Chemotherapy drug combination |
Treatment cycle/Drug regimen |
AC: a combination of doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan)
|
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) and cyclophosphamide (Cytoxan) followed by paclitaxel (Taxol) |
Doxorubicin and cyclophosphamide are given for four cycles, followed by four cycles of paclitaxel. Paclitaxel is given by IV and can be given either weekly for 12 cycles or every two weeks for four cycles with growth factor injections to boost white blood cell count.
Dexamethasone (an anti-inflammatory steroid drug) is given before the paclitaxel to prevent an allergic reaction.
This regimen is given to both pre- and postmenopausal women whose cancer has spread to the lymph nodes.
|
AC—> Docetaxel: a combination of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan) followed by docectaxel (Taxotere)
|
This regimen is similar to AC—>Paclitaxel, except that docetaxel is used instead of paclitaxel.
For adjuvant treatment, docetaxel is given once every three weeks.
|
CAF (FAC/CAF): a combination of cyclophosphamide (Cytoxan), doxorubicin (Adriamycin) and 5-fluorouracil (Adrucil)
|
Usually, all are 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 one through 14 rather than through an IV. In this case, the cycle is every 28 days.
|
TAC: a combination of docectaxel (Taxotere), doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan)
|
Usually, all are given through an IV the first day, followed by 20 days of rest. The cycle is repeated six times.
This regimen is used for lymph node-positive cancer.
|
Cyclophosphamide (Cytoxan) and docetaxel (Taxotere)
|
Given through an IV on the first day, followed by 20 days of rest. This is repeated for a total of four cycles, every 21 days.
|
CMF: a combination of cyclophosphamide (Cytoxan), methotrexate (Rheumatrex) and 5-fluorouracil (Adrucil)
|
Given through an IV on days one and eight. Cyclophosphamide can be given through an IV on the first day and the eighth day, or as oral pills on days one 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.
|
If a tumor is HER2/neu-positive, trastuzumab (Herceptin) is included in the chemotherapy regimen. Trastuzumab is usually started with chemotherapy, and then continued for several months after chemotherapy. For more on trastuzumab, visit the Targeted Therapy section.
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. Figure 5.3 lists the most common chemotherapy drugs used alone or in combination to treat metastatic breast cancer. Although comprehensive, it is not meant to be exhaustive and does not include rarely used drugs or those no longer in use.
Figure 5.3: Chemotherapy Drugs for Metastatic Breast Cancer
|
Drug (abbreviation)
|
Trade Name
|
Capecitabine
|
Xeloda
|
Carboplatin
|
Paraplatin
|
Cisplatin
|
Platinol
|
Cyclophosphamide (C)
|
Cytoxan
|
Docetaxel
|
Taxotere
|
Doxorubicin (A)
|
Adriamycin
|
Epirubicin (E)
|
Ellence
|
5-Fluorouracil (5FU)
|
Adrucil, Effudex, Fluoroplex
|
Gemcitabine
|
Gemzar
|
| Ixabepilone |
Ixempra |
Liposomal Doxorubicin
|
Caelyx, Doxil, Evacet
|
Methotrexate (M)
|
Rheumatrex
|
Paclitaxel (T)
|
Taxol
|
Paclitaxel, albumin bound
|
Abraxane
|
Vinorelbine
|
Navelbine
|
Updated 08/24/09
