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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016

What to expect

Before chemotherapy, your doctor may ask you to

stop taking some of your medicines, vitamins, or both.

Some of these treatments can cause chemotherapy

to not work as well or may cause health problems

while on chemotherapy. Your doctor may ask you

to eat a healthy diet and drink lots of fluids. If you

smoke, it’s important that you stop.

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


All chemotherapy drugs for stages I and II breast

cancer are liquids that are injected into a vein. Only

cyclophosphamide is made in pill form, too. The

injection may be one fast shot of drugs into a vein or

may be a slow drip called an infusion. Chemotherapy

can also be given through a needle surgically placed

in the chest or the arm. Trastuzumab and pertuzumab

are given by infusion.

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.

You will need to go to a chemotherapy center to

receive the drugs. How long your visit will be depends

on what drugs you will get. It can take a few minutes

or a few hours to finish a dose of chemotherapy.

It takes about 90 minutes to get the first dose of

trastuzumab and about 30 minutes for later doses.

For pertuzumab, it takes about 60 minutes to get the

first dose and about 30 to 60 minutes for later doses.

During chemotherapy cycles, you may be given other

drugs to help you feel your best. You may be given

drugs to fight nausea and vomiting. You may also

receive an injection under your skin the day after

chemotherapy to increase the number of white blood

cells to normal levels. Some people give themselves

the injection while others return to the clinic for it.

Blood, heart, and other tests may be given to check

your health.

Side effects

The reactions to chemotherapy and HER2 inhibitors

differ among women. Some women have many side

effects. Other women have few. Some side effects

can be very serious while others can be unpleasant

but not serious.

Side effects of chemotherapy depend on the drug

type, amount taken, length of treatment, and the

person. In general, side effects are caused by the

death of fast-growing cells. These cells are found in

the hair follicle, gut, mouth, and blood. Thus, common

side effects of chemotherapy include low blood

cell counts, not feeling hungry, nausea, vomiting,

diarrhea, hair loss, and mouth sores.

Other side effects of chemotherapy may include

anxiety, fatigue, and peripheral neuropathy. Peripheral


Chemotherapy and HER2 inhibitors What to expect