Primary treatment for breast cancer usually includes surgery to remove the tumor.This can involve removing a portion of the breast or the entire breast. Before surgery, doctors may administer neoadjuvant therapy to shrink the tumor. After surgery, doctors may administer adjuvant therapy to kill any last traces of cancer remaining in the body and decrease the risk of the cancer returning. These treatments have some side effects, but significantly improve a woman's chances of survival. CDK 4/6 inhibitors are a class of drugs used in cancer treatment. This class of drugs are increasingly used in the adjuvant setting and are primarily used in hormone receptor-positive breast cancer.
Adjuvant and neoadjuvant therapy may consist of chemotherapy, radiation therapy, hormone therapy, and targeted therapy. Most of these treatments are systemic, meaning they target the entire body as opposed to a specific area where the cancer is located.
Chemotherapy is the use of drugs to treat rapidly growing cancer cells to destroy them. Chemotherapy is given orally, intravenously, or subcutaneously in cycles of treatment followed by recovery.
Radiation therapy is the only localized form of adjuvant therapy, meaning it targets one specific area of the body. It is usually given after surgery to kill any remaining cancer cells in the surrounding breast tissue. The most common type is called whole breast radiation. This is external beam radiation given 5 days a week over 4-7 weeks determined by the characteristics of a woman's tumor. In some cases, partial breast irradiation may be appropriate. This may involve a device in the surgery site to give radiation to a smaller area although this is increasingly being administered through external beam radiation. Partial breast radiation treatment usually lasts about one week. Radiation therapy is rarely used in the neoadjuvant setting.therapy usually lasts about one week.
Hormone therapy is effective in treating women whose tumors are positive for estrogen or progesterone receptors. This treatment prevents estrogen from activating the growth of cancer cells. It is usually given orally every day for five to ten years.
Some forms of breast cancer contain cells that overexpress the HER-2 protein, which causes cancer cells to grow rapidly. Targeted therapy attacks these cells and prevents them from stimulating cancer growth. It is given by infusion every one to three weeks for a year. Neoadjuvant targeted therapy for HER2 positive breast cancer is often a combination of trastuzumab and pertuzumab. The doctor may recommend a neoadjuvant regimen of docetaxel, carboplatin, trastuzumab, and pertuzumab, or docetaxel, trastuzumab, and pertuzumab. Adjuvant targeted therapy for HER2 positive breast cancer is often trastuzumab and pertuzumab.
Neoadjuvant therapy may be recommended in order to shrink a tumor before surgery so that less extensive surgery may be performed. Patients at high risk for cancer recurrence are most likely to need adjuvant therapy. Your doctor will consider the following factors to determine if you need adjuvant therapy.
Risk of recurrence increases with increasing primary tumor size.
Cancer that has spread to the lymph nodes is more likely to recur.
This refers to the difference between cancer cells and normal cells when examined under a microscope. Risk of recurrence increases with histologic grade.
This refers to the rate at which cancer cells divide and multiply. Cancer cells with high nuclear grade are high risk. This is sometimes referred to as proliferative capacity of the tumor.
Breast cancer tumors that do not have estrogen receptors (estrogen receptor negative) tend to grow more aggressively and have a higher risk of recurrence.
Tumors producing too much of the HER-2 protein grow more aggressively and are more likely to recur.
Chemotherapy destroys not only cancer cells, but also other rapidly dividing cells in the body. These include cells in the blood, mouth, hair, nails, and digestive tract. As a result, patients may experience the following side effects:
The side effects of hormone therapy (estrogen-blocking therapy) The side effects of hormone therapy/estrogen-blocking therapy can be similar to the symptoms of menopause. These side effects include nausea and hot flashes, This therapy also increases the risk of developing cataracts, uterine cancer, or a blood clot. Patients on aromatase inhibitors may experience osteoporosis, or loss of strength of the bones.
The side effects of targeted therapy. Rash is the most common skin change from targeted drugs. The risk of getting a rash and how bad it gets depends on the type and dose of the targeted drug. In most people, the rash is mild. Trastuzumab can also increase the risk of heart problems, so your doctor should monitor your cardiovascular health throughout treatment with this medication.
Radiation therapy may cause the skin to become dry, tender, red, and itchy in the area treated. Like a sunburn sometimes blistering and the side effect can be managed with topical moisturizers as instructed by the radiation oncologist. It may also cause severe fatigue that can increase as treatment progresses, and make the breast feel heavy and tight. In rare cases, radiation therapy may cause heart or lung damage.
The benefits of adjuvant and neoadjuvant therapy for breast cancer greatly outweigh the risks and side effects. Neoadjuvant therapy can shrink a tumor before surgery and increase the chances of a successful operation. Adjuvant therapy can reduce the risk of the cancer returning and increase the possibility of long-term survival. Here are some tips to manage the most common side effects you may experience.
It is extremely important to eat a healthy, well-balanced diet, exercise regularly, and effectively manage your stress while undergoing treatment.
Proper nutrition is extremely important while undergoing chemotherapy. Stay hydrated and eat a nutritious, high-protein diet.
It is extremely important to exercise on a regular basis on chemotherapy. This will give you energy, assist your immune system, help you maintain physical function, and make you feel better.
Maintaining a calm, positive mindset and reducing stress in your life is especially important while undergoing chemotherapy.
Neoadjuvant therapy can shrink a tumor before surgery and increase the chances of a successful operation. Adjuvant therapy can eliminate any last traces of the cancer in your body after primary treatment and reduce the risk of your breast cancer returning. Talk to your doctor about any concerns you may have about the treatments or their side effects.
It is important to maintain a good relationship with your doctor. You should listen to your doctor carefully and feel free to share any questions or concerns you have with him.
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