chemotherapy - Breast Cancer Research Centre WA
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Transcript chemotherapy - Breast Cancer Research Centre WA
Debbie Bajrovic
Oncology Pharmacist
Mount Hospital Pharmacy
Adjuvant
therapy is any treatment given
after primary surgery.
Neo-Adjuvant therapy is any treatment given
before primary surgery.
Therapy can include:
chemotherapy
hormonal therapy
the targeted drug Trastuzumab (Herceptin)
radiation therapy
or a combination of treatments
Stage
of the cancer (size/position)
Grade of the cancer (how closely the
tumour cells resemble normal cells)
Your age
Menopausal status
Whether lymph nodes are effected
HER2 status
Hormone receptor status
Use
of anti-cancer (cytotoxic) drugs to
destroy cancer cells
Usually administered intravenously as an
outpatient
Treatment can take a number of hours
Treatment cycles can be weekly, fortnightly
or three weekly depending on the drugs used
There is a rest period between cycles to let
your body recover from side effects
A complete course is likely to take 4-6
months
Fluorouracil
(5-FU)
Epirubicin (Epi)
Cyclophosphamide (Cyclo)
Docetaxel (Taxotere)
Carboplatin (Carbo)
Doxorubicin (Dox)
Paclitaxel (Taxol)
Trastuzumab
(Herceptin) – tests are done
to see if you are HER 2 +ve (overexpress
HER 2)
If you are HER 2 +ve you will be given
Herceptin with your chemotherapy.
Treatment may start immediately with
chemotherapy or be delayed a few weeks
When chemotherapy finishes you will
continue to have Herceptin for a total of
52 weeks.
Hormonal therapies only work in women whose
cancer cells have receptors for oestrogen and/or
progesterone on their surface. ER+ or PR+
Hormonal therapy deprives the cancer of the
hormone oestrogen which many breast cancers
need to grow.
They are given after chemotherapy to reduce
the chance of the cancer coming back.
Tamoxifen blocks oestrogen activity in the body
Letrozole(Femara), Exemestane(Aromasin) and
Anastrozole(Arimidex) stop the body from
making oestrogen
Goserelin (Zoladex)
Patients
may be offered a choice of
chemotherapy treatments, as different drug
combinations can cause different side
effects.
Some patients may be offered to go on a
clinical trial.
Clinical trials are carried out to compare
different types of therapy, to improve
effectiveness and reduce side effects.
Chemotherapy
drugs are often used in
combination. These are called chemotherapy
regimens or protocols.
FEC
(5-FU, Epirubicin, Cyclophosphamide x 6)
FEC-D(T) (FEC x 3- Docetaxel x 3)
AC-T(H) (Doxorubicin, Cyclo x 4 – Taxol x 4)
TAC (Docetaxel, Doxorubicin, Cyclo x 6)
TCH (Docetaxel, Carboplatin, Herceptin x 6)
TC (Docetaxel, Cyclophosphamide x 4)
Pre-meds
are given prior to chemotherapy to
help reduce hypersensitivity reactions and
side effects.
They are given orally and intravenously
starting the day before chemotherapy or just
prior to chemotherapy
Antiemetic's, steroids, antihistamines and
pain killers are used.
Mostly to prevent nausea, fluid retention and
allergy
They can cause headaches and constipation
Dexamethasone
– steroid used to prevent
nausea and fluid retention. Given IV just
prior to chemotherapy and orally up to three
days after. Sometimes taken twice a day
starting the day before chemotherapy
Kytril – (Granisetron) given IV just prior to
chemotherapy and orally in the morning on
days 2 and 3
Phenergan – (Promethazine) given IV just
prior to chemotherapy to help prevent an
allergic reaction
Panadol – (Paracetamol) for pain and fever
Maxolon
– (Metoclopramide, 10mg) used for
breakthrough nausea and vomiting. 1-2
tablets up to 4-6 hourly.
Stemetil – (Prochlorperazine, 10mg) 1 tablet
every 4 to 6 hours for breakthrough
Stemetil Suppositories – (Prochlorperazine)
25mg rectally every 12 hours.
Ativan – (Lorazepam, 1mg) – 1 tablet placed
under the tongue every 4 to 6 hours if
needed for breakthrough nausea.
Neutropenia - reduced numbers of white blood
cells which can lower resistance to infection
- can begin 7 days after treatment
and reaches its lowest point 10-14 days after
chemotherapy.
- WBC usually increase steadily and
return to normal before your next cycle.
- Contact your doctor if your
temperature goes above 38 C or if you suddenly
feel unwell
o Neulasta – Injection given 24 hours after
chemotherapy which stimulates the level of
white blood cells (neutrophils). This can allow
frequent dosing of chemotherapy and diminish
tumour regrowth.
Bruising
or bleeding – reduced numbers of
platelets which help the blood to clot
- contact your doctor if
you have unexplained bruising or bleeding such
as nosebleeds or bleeding gums
Anaemia
breathless
– low red blood cell count
- may make you feel tired or
Nausea or vomiting
Diarrhoea/Constipation
Tiredness or fatigue
Hair Loss – usually starts 2 -3 weeks after you
start your chemotherapy. Thinning of the
eyelashes, eyebrows and other body hair may
also occur. Hair loss is temporary.
Sore mouth and ulcers – your mouth may become
sore or dry. Drink plenty of fluids, clean teeth
regularly with a soft brush, floss daily. Use
mouthwashes regularly (half a teaspoon of salt
or bicarbonate of soda in a glass of water)
Cryotherapy
Taste
changes
Irritation of the bladder – cyclophosphamide
Pink urine – Doxorubicin/Epirubicin
Skin changes
Sensitivity to the sun – use sunscreen/hat
Fluid retention
Nail changes
Allergic reactions
Pain in joints or muscles
Numbness or tingling in hands and feet
Flu-like
symptoms
Diarrhoea
Headaches
An allergic reaction
Cardiotoxicity – usually mild and reversible
Hot
flushes
Vaginal dryness or itching
Loss of libido
Psychological effects
Joint aches or pains