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NCCN Guidelines for Patients



Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017


Chemotherapy and HER2 treatment What to expect

What to expect

Preparing for chemotherapy

Before starting 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. You may

also have to change what you drink and eat. If you

smoke, it’s important that you stop.

Receiving chemotherapy

All chemotherapy drugs for stage III breast cancer

are liquids that are injected into a vein. The injection

may be one fast shot or may be a slow drip called

an infusion. The drugs can be injected directly into a

vein or through a catheter surgically placed in your

chest or arm. Trastuzumab and pertuzumab are also

liquids given by infusion.

You will need to go to a chemotherapy center

to receive treatment. How long your visit will be

depends on which drugs you will get. It can take a

few minutes or a few hours to finish a dose.

If you have HER2-positive breast cancer, you should

be treated with chemotherapy and HER2 antibodies

for at least 9 weeks before surgery. However, it is

ideal that your finish chemotherapy before surgery.

Side effects

Side effects are unplanned physical or emotional

reactions to treatment. Side effects differ among

women. Some women have many side effects. Other

women have few. Some side effects can be very

serious. 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 follicles, 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 neuropathy is numbness or tingling

of nerves in the hands and feet. Some types of

chemotherapy, such as anthracyclines, can cause

damage to the heart. Anthracyclines include

doxorubicin and epirubicin.

Premenopause is the time in life during which

menstrual periods occur. Menopause is the point

in time when periods completely stop. If you are in

premenopause, chemotherapy may cause periods

to stop short term or completely. However, don’t

depend on chemotherapy for birth control. You could

still become pregnant and your baby could have

birth defects. Use birth control but not birth control

with hormones (eg, “the pill”). Talk to your doctors for

more information.

HER2 antibodies

You may have a mild flu-like response to the first

dose of trastuzumab that includes fever, chills,

headache, muscle aches, and nausea. This response

is less common with the second and third doses.

Other side effects may include damage to the heart

and rarely to the lungs.

Common side effects of pertuzumab are diarrhea,

nausea, and feeling tired and weak. Less common

side effects include skin rash, low white blood

cell counts, and mouth sores. It is not yet clear

if pertuzumab damages the heart, although

trastuzumab may do so.

Not all the side effects of chemotherapy and HER2

antibodies are listed here. Please ask your treatment

team for a complete list. If a side effect bothers you,

tell your treatment team. There may be ways to help

you feel better.