NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
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.
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 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
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.