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30

NCCN Guidelines for Patients

®

:

Breast Cancer – Metastatic (STAGE IV), Version 2.2017

3

Treatment guide

Hormone receptor–negative cancers

Hormone receptor–negative cancers

These cancers lack hormone receptors that trigger

cell growth. Thus, in general, endocrine therapy

does not help. Thus, chemotherapy and targeted

therapy are used to treat hormone receptor–negative

cancers.

The information in this section also applies to

endocrine refractory cancers. These cancers didn’t

improve during 3 back-to-back endocrine regimens.

Chemotherapy is the next option.

Chemotherapy

The types of chemotherapy differ in the way they

treat cancer. Some kill cancer cells by damaging

their DNA or by disrupting the making of DNA. Others

interfere with cell parts that are needed for making

new cells. Thus, no new cells are made to replace

dying cells. The four types of chemotherapy used to

treat metastatic breast cancer are listed in

Guide 4

.

Some chemotherapies work when cells are in an

active growth phase.

See Figure 10.

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 in any growth or resting phase.

What to expect

. 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.

Most chemotherapy for metastatic breast cancers are

liquids that are injected into a vein. Some are made

as pills to be swallowed. 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.

Chemotherapy is given in cycles of treatment

days followed by days of rest. The cycles vary in

length depending on which drugs are used. Giving

chemotherapy in cycles gives your body a chance to

recover after receiving chemotherapy.

You will need to go to a chemotherapy center

to receive the drugs. 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 of

chemotherapy. You may be given drugs to fight

nausea and vomiting. To learn more, read the

NCCN Guidelines for Patients ® : Nausea and Vomiting.

You

may also get a shot of (peg-)filgrastim under your

skin. This medicine increases the number of white

blood cells to normal levels.

The reactions to chemotherapy 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 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.