Breast Cancer High-Dose Chemotherapy, Hormonal and Biological Therapy

by National Cancer Institute

(Page 8 of 9)

High-Dose Chemotherapy

In breast cancer treatment clinical trials, researchers at NCI and other health institutions are testing high-dose chemotherapy to find out if it is better than standard chemotherapy. They are trying to learn if higher doses of drugs can prevent or delay the spread or return of breast cancer better than standard doses of drugs, and which type of treatment helps patients live longer.

Patients who receive high-dose chemotherapy are at great risk of suffering life-threatening side effects because the treatment damages their bone marrow and they no longer are able to produce needed blood cells. To help repair the damage done by high doses of drugs, the treatment includes peripheral blood stem cell transplantation and/or bone marrow transplantation.

Peripheral Blood Stem Cell Transplantation

Peripheral blood stem cell transplantation involves the removal of a certain type of blood cell (stem cell) from a patient's blood. Stem cells are immature cells from which all blood cells develop as they are needed. Stem cells are able to divide and form more stem cells (copies of themselves) or they can become fully mature red blood cells (erythrocytes), platelets, and white blood cells (leukocytes).

The removed stem cells are frozen and stored while the patient is treated with high-dose chemotherapy. After chemotherapy ends and the drugs are gone from the body, the stem cells are returned to the patient through a vein. The healthy stem cells can then begin to grow and produce all types of blood cells the patient needs to survive.

Bone Marrow Transplantation

Bone marrow is the sponge-like material found inside bones that produces blood cells. Autologous bone marrow transplantation is used in breast cancer treatment. In this procedure, some of a patient's own healthy bone marrow is removed with a needle before treatment begins. The bone marrow is then frozen and stored while the patient is treated with high-dose chemotherapy. Several days after the treatment ends and the drugs are gone from the body, the healthy bone marrow is given back to the patient through a vein. The healthy bone marrow can then begin to produce blood cells that the patient needs to survive. Peripheral blood stem cells and bone marrow transplantation may be used together as part of high-dose chemotherapy.

It hasn't been proven yet whether high-dose chemo-therapy is better than standard chemotherapy, or which breast cancer patients need this treatment. It is best to have high-dose chemotherapy at an established transplant center or medical institution conducting a clinical trial. Some health insurance plans pay for some of the costs of peripheral blood stem cell or bone marrow transplantation.

POSSIBLE PROBLEMS: There are major risks involved with high-dose chemotherapy. Talk with your doctor about possible complications and severe side effects, and whether this would be an appropriate treatment for your type and stage of breast cancer.

Hormonal Therapy

Hormonal therapy is used to prevent the growth, spread, or recurrence of breast cancer. If lab tests show that your tumor depended on your natural hormones to grow, it will be described as estrogen-positive or progesterone-positive in the lab report. This means that any remaining cancer cells may continue to grow when these hormones are present in your body. Hormonal therapy can block your body's natural hormones from reaching any remaining cancer cells.

• You may be given a hormone drug. One of the most common drugs used for hormonal therapy for breast cancer is tamoxifen.
• You may have surgery to remove both ovaries that produce natural hormones.

Research has proven that hormonal therapy can extend the lifespan of a breast cancer patient who has cancer cells that depend on hormones to grow. Tamoxifen has been used for nearly 20 years to treat patients with advanced stage breast cancer. Now it is being used also as additional treatment for early stage disease after breast cancer is removed by surgery. Clinical trials show that taking tamoxifen as part of the treatment for breast cancer helps to reduce the chances of recurrence in the treated breast and of new cancer developing in the other breast.

Tamoxifen is taken daily by mouth as a pill. Your oncologist will decide on the dose and length of treatment according to current research findings. Like chemotherapy, hormonal therapy affects cells throughout your body. Studies have shown that there is some increased risk for cancer of the uterus. Blood clots have been reported in the veins of a small percentage of patients who take tamoxifen along with chemotherapy. These risks, however, are much lower than the benefits received from tamoxifen.

Of course, you will have frequent blood tests and physical exams while you are on hormonal therapy. Be sure your gynecologist and primary care doctor know you are taking this drug. You should have yearly pelvic exams while taking tamoxifen, and you should notify your doctor about any unusual bleeding or pain.

POSSIBLE PROBLEMS: Side effects could include hot flashes, nausea, vaginal spotting (small amounts of blood), or increased fertility in younger women. Less common side effects include depression; vaginal itching, bleeding, or discharge; loss of appetite; eye problems; headache; and weight gain.

QUESTIONS TO ASK YOUR MEDICAL ONCOLOGIST ABOUT HORMONAL THERAPY What benefit might I get from hormonal therapy? Which would be better for me, hormone medication or surgery to remove my ovaries? Why? What drug will I be taking? How will I know it is working? What are the side effects and how can I manage them? What side effects should I report to you? How long will I be on hormonal therapy? Will I need followup care? What if I don't have hormonal therapy?

Biological Therapy

Your own immune system is your body's natural defense against diseases, including cancer. Your immune system also defends your body against infections and other side effects of cancer treatment. A strong immune system detects the difference between healthy cells and cancer cells, and it can get rid of those that become cancer. The immune system can be strengthened and improved by new biological therapies. These treatments are designed to repair, stimulate, or increase your body's natural ability to fight infections and cancer.

Medical researchers are looking at many types of biological therapies that use and boost the substances produced naturally by the body's own cells. They are also creating new substances that can imitate or help the body's natural immune system to work against infection and disease. These are being used in clinical trials with chemotherapy and radiation therapy.

POSSIBLE PROBLEMS: Biological therapies may produce side effects such as rashes or swellings at the site where shots are given; flu-like symptoms, including fever, chills and fatigue; digestive tract problems; or allergic reactions.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.