NCCN Guidelines for Patients
Stages I and II Breast Cancer, Version 1.2014
Chemotherapy/HER2 inhibitors Chemotherapy regimens
Recommended drugs for before
or after surgery
Some chemotherapy drugs kill cancer cells by
damaging their DNA (
disrupting the making of DNA. Other drugs interfere
with cell parts that are needed for making new cells.
Many chemotherapy drugs work when cells are in
an active growth phase. During the active growth
phase, cells grow and divide to form a new cell.
Chemotherapy drugs that disrupt the growth phase
work well for cancer cells that are growing and
dividing quickly. Other chemotherapy drugs work
whether cells are in a growth or resting phase.
HER2 inhibitors used for stages I and II breast
cancer include trastuzumab (Herceptin
). HER2 inhibitors are taken with
chemotherapy if the cancer is HER2 positive. They
are a type of targeted therapy.
Targeted therapy stops the action of molecules that
start the growth of cancer cells. Trastuzumab works
by attaching to HER2 receptors—like a key into a
lock—to stop the start of cell growth. Pertuzumab
works like trastuzumab but attaches to a different part
of the receptor. These two drugs also attract immune
cells that help to kill the cancer cells.
Chemotherapy drugs differ in the way they work, so
often more than one drug is used. A combination
regimen is the use of two or more chemotherapy
drugs. Chemotherapy is given in cycles of treatment
days followed by days of rest. Giving chemotherapy
in cycles gives your body a chance to recover after
receiving chemotherapy. The cycles vary in length
depending on which drugs are used.
The recommended regimens for HER2–negative
and positive tumors are listed in the charts on the
following pages. They are divided by “preferred” and
“other” regimens by NCCN experts based on how
well they work, side effects, and treatment schedules.
Some regimens are only used in very specific
circumstances. Please talk with your doctor about
which regimen is best for you.