Assoc. Prof. Yaowanuch Kongdan, M.D., Mathuros Sukvanich, M.D.
Chemotherapy is a cancer treatment that uses drugs to destroy cancer cells. It plays a crucial role in treating breast cancer, whether it's in the early stages, advanced stages, or metastatic stages.
Objectives of Chemotherapy:
Shrinking the tumor before surgery (neoadjuvant chemotherapy): Chemotherapy can help reduce the size of the tumor before surgery, making the surgery easier, increasing the chances of breast-conserving surgery, and reducing the risk of needing a complete mastectomy. The tumor's response to chemotherapy can also help predict the patient's prognosis.
Eliminating residual cancer cells after surgery (adjuvant chemotherapy): This involves administering medication after surgery. Chemotherapy can help eliminate any remaining cancer cells, reduce the chance of cancer recurrence, and increase the chances of a complete cure.
Treating metastatic cancer: For cancer that has spread to other organs of the body, chemotherapy is an important method for inhibiting cancer growth and spread.
Types of Chemotherapy:
Single-agent chemotherapy: Using a single chemotherapy drug for treatment.
Combination chemotherapy: Using multiple chemotherapy drugs together for treatment, which can increase the effectiveness of destroying cancer cells and reduce the risk of drug resistance.
Sequential chemotherapy: Administering chemotherapy in a specific sequence, where each set of drugs is given in a planned order, such as giving drug set A followed by drug set B.
Chemotherapy combined with other drugs: Using chemotherapy in conjunction with other medications, such as targeted therapy or immunotherapy, to enhance treatment effectiveness.
Chemotherapy Regimens Used in Breast Cancer Treatment:
Combination Chemotherapy:
AC Regimen: Adriamycin (Doxorubicin) 60-75 mg/m² + Cyclophosphamide 600-750 mg/m² administered every 21 days for a total of 4 cycles.
EC Regimen (Epirubicin and Cyclophosphamide): Epirubicin 100 mg/m2 + Cyclophosphamide 600 mg/m2 every 21 days, 4-6 times
TC Regimen (Docetaxel and Cyclophosphamide): Docetaxel (Taxotere) 75 mg/m2 + Cyclophosphamide: 600 mg/m2 every 21 days, 4-6 times
FAC Regimen: Fluorouracil (5-FU) 500 mg/m2 + Adriamycin (Doxorubicin) 50 mg/m2 + Cyclophosphamide 500 mg/m2 every 21 days, 6 times
FEC Regimen: Fluorouracil (5-FU) 500 mg/m2 + Epirubicin 100 mg/m2 + Cyclophosphamide 500 mg/m2 every 21 days) 75 mg/m2 every 21 days, 6 times
TAC Regimen: Docetaxel (Taxotere) 75 mg/m2 + Adriamycin (Doxorubicin) 50 mg/m2 + Cyclophosphamide 500 mg/m2 every 3 weeks, 6 times
CMF Regimen: Cyclophosphamide 600 mg/m2 + Methotrexate 40 mg/m2 + Fluorouracil (5-FU) 600 mg/m2 every 28 days, 6 times
Sequential chemotherapy
AC Regimen followed by T: Adriamycin (Doxorubicin) 60-75 mg/m2 + Cyclophosphamide 600-750 mg/m2 every 3 weeks for 4 doses followed by Paclitaxel (Taxol) 175 mg/m2 every 3 weeks for 4 doses
AC with weekly T: Adriamycin (Doxorubicin) 60-75 mg/m2 + Cyclophosphamide 600-750 mg/m2 every 3 weeks for 4 doses followed by Paclitaxel (Taxol) 80 mg/m2 every 12 doses
Dose-Dense AC with T: Adriamycin (Doxorubicin) 60-75 mg/m2 + Cyclophosphamide 600-750 mg/m2 every 2 weeks for 4 doses followed by Paclitaxel (Taxol) 175 mg/m2 every 12 weeks for 17 doses 4. FEC followed by T: Fluorouracil (5-FU) 500 mg/m2 + Epirubicin 100 mg/m2 + Cyclophosphamide 500 mg/) 100 mg/m2 every 21 days for 3 cycles, followed by Docetaxel (Taxotere) 100 mg/m2 + Cyclophosphamide: 600 mg/m2 every 21 days for 3 cycles
Chemotherapy with other drugs
Chemotherapy + HER2-targeted drugs: For HER2-positive breast cancer, chemotherapy with HER2-targeted drugs such as Trastuzumab, Pertuzumab may be used.
Chemotherapy + immunotherapy: In some cases, chemotherapy may be used in combination with immunotherapy. In triple negative breast cancer, such as Pembrolizumab
For example:
AC followed by T: Adriamycin (Doxorubicin) 60-75 mg/m2 + Cyclophosphamide 600-750 mg/m2 every 3 weeks for 4 doses, followed by Paclitaxel (Taxol) 80 mg/m2 every week for 12 doses, and Herceptin (Trastuzumab) 8 mg/kg (first dose) then 6 mg/kg (subsequent doses) every 3 weeks for 1 year
TH (Paclitaxel and Herceptin): Dosage: Paclitaxel every week for 12 weeks and Herceptin every 3 weeks for 1 year
TCHP chemotherapy regimen: Docetaxel (Taxotere) 75 mg/m2 + Carboplatin AUC 6+ Trastuzumab (Herceptin) Dose: 8 mg/kg (first dose) followed by 6 mg/kg (subsequent doses) + Pertuzumab (Perjeta) every 3 weeks for 6 doses and give Trastuzumab (Herceptin) 6 mg/kg for 1 year
TCH chemotherapy regimen: Docetaxel (Taxotere) 75 mg/m2 + Carboplatin AUC 6+ Trastuzumab (Herceptin) Dose: 8 mg/kg (first dose) followed by 6 mg/kg (subsequent doses) every 3 weeks for 6 doses and give Trastuzumab (Herceptin) 6 mg/kg for 1 year
Chemotherapy regimen with Pembrolizumab for breast cancer Triple-Negative: Pembrolizumab (Keytruda) Dosage: 200 mg every 3 weeks Paclitaxel (Taxol) 80 mg/m2 every week for 12 weeks + Carboplatin AUC 5-6 every 3 weeks
Side effects of chemotherapy
Chemotherapy can cause different side effects in different people. Common side effects include fatigue, nausea and vomiting, hair loss, reduced immunity, diarrhea or constipation, and changes in skin and nails.
Care for yourself during chemotherapy
Maintain good hygiene: Wash your hands frequently and avoid contact with people who are sick to reduce the risk of infection.
Eat a healthy diet: Choose a well-balanced, nutritious diet with a balanced diet, protein, and a balanced diet to boost your immune system and restore your body.
Get enough rest: Getting enough rest will give your body the energy it needs to fight off disease and restore itself.
See your doctor as scheduled: Follow your doctor's appointments and instructions strictly.
Inform your doctor immediately if you have any unusual symptoms.
Conclusion
Chemotherapy plays an important role in the treatment of breast cancer, even though it can have unwanted side effects. But with proper self-care and following the doctor's advice, patients can effectively and safely get through the treatment.
Namarak Hospital is pleased to provide comprehensive breast cancer consultation and treatment. You can contact us for more information and make an appointment through the channels listed on our website.
Note: The information in this article is for general knowledge purposes only. It cannot be used as a substitute for the advice of a specialist doctor. You should consult a doctor for advice and treatment that is appropriate for your physical condition and disease.
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