Key points
- Chemotherapy is a systemic treatment inhibiting the growth of cancer cells that may have metastasised to other areas of the body.
- It may be given in the neo-adjuvant, adjuvant or palliative care setting.
- Prognostic testing is available to determine the benefit of chemotherapy for patients.
- Decisions about chemotherapy are discussed at a multi-disciplinary meeting.
What is chemotherapy?
Chemotherapy disrupts the cycle of cell production and inhibits the growth of cancer cells throughout the body. It is typically used as an adjuvant treatment for women considered at high risk of metastatic disease based on factors such as nodal status, tumour size, grade and receptor status.
Chemotherapy can be given at different stages of treatment:
- Neo-adjuvant chemotherapy:
- Inflammatory breast cancer
- Larger, or locally advanced breast cancers, to reduce tumour size prior to surgery.
- Highly proliferative (high grade) breast cancers
- Patients with possible genetic features, such as BRCA, may also be offered neoadjuvant chemotherapy whilst waiting for genetic results, as these will impact on decisions about surgery.
- Stage 2 or 3 triple negative breast cancer (TNBC) or HER2+ breast cancer. - Adjuvant chemotherapy: given post-surgery to destroy any microscopic cancer cells remaining in the body and reduce the risk of recurrence. Some women who have had neo-adjuvant chemotherapy may also continue to have adjuvant chemotherapy following surgery.
- Chemotherapy for advanced breast cancer (ABC): chemotherapy is given to relieve symptoms and prolong survival.
The rate of neoadjuvant chemotherapy in breast cancer is increasing. Around 35% of patients will have neoadjuvant and/or adjuvant chemotherapy. This means most people with breast cancer do not have chemotherapy.
Chemotherapy is usually administered in three-weekly cycles via IV infusion, although some IV drugs are given weekly or fortnightly. Certain chemotherapy drugs are given orally. Adjuvant treatment may last from four to six months, but can last longer, depending on the combination of drugs used.
Chemotherapy is uncommon in patients with receptor-positive tumours. They should be considered for endocrine therapy once they've completed chemotherapy. Patients with HER2+ breast cancer have a higher risk of recurrence than HER2- cancers and will typically undergo a 12-month cycle of trastuzumab (Herzuma) to lower this risk.
Patients who have chemotherapy may experience a range of acute and longer term side effects. Their specialist oncology team will provide patients with advice and strategies to manage these. The patient, whānau and primary care team will be provided with detailed information about how to arrange rapid review with the oncology team should patient experience severe side effects or complications.
Chemotherapy regimens for breast cancer in New Zealand
| Name | Brand name(s) | Class | How it works | Breast cancer use | Typical regimen | Used with | Administration |
| Docetaxel | DBL Docetaxel Docetaxel Sandoz Taxotere | Taxanes | Inhibit the microtubule structures that help the cancer cells divide and multiply | Early node-positive breast cancer
Early HER2+ breast cancer Advanced breast cancer resistant to anthracycline chemotherapy Advanced breast cancer (second-line treatment) | One dose every 21 days | Capecitabine
Doxorubicin Cyclophosphamide Trastuzumab Carboplatin | IV infusion |
| Paclitaxel | Taxol Paclitaxel Ebewe | Taxanes | Inhibit the microtubule structures that help the cancer cells divide and multiply | Early node-positive breast cancer
Early HER2+ breast cancer Advanced breast cancer Advanced HER2+ breast cancer (first-line treatment) | One dose every 21 days | Doxorubin
Cyclophosphamide Tastuzumab | IV infusion |
| Nab-paclitaxel (not currently funded) | Abraxane | Taxanes | Inhibit the microtubule structures that help the cancer cells divide and multiply | Advanced breast cancer resistant to anthracycline chemotherapy | One dose every 21 days | IV | |
| Doxorubicin | Adriamycin
Arrow-Doxorubicin Doxorubicin Ebewe | Anthracyclines | Antitumour antibiotics that block growth by interfering with DNA | Advanced breast cancer
Early breast cancer | One dose every 21 days | Taxanes
Cyclophosphamide Cisplatin 5-fluorouracil | IV infusion |
| Doxorubicin hydrochloride | Caelyx | Anthracyclines | Antitumour antibiotics that block growth by interfering with DNA | Advanced breast cancer in women for whom an anthracycline would be considered
| One dose every four weeks | IV infusion | |
| Epirubicin | Epirubicin Ebewe Pharmorubicin | Anthracyclines | Antitumour antibiotics that block growth by interfering with DNA | Early node-positive breast cancer Advanced breast cancer | One dose every 21 days | Usually given alongside other cytotoxic drugs | IV infusion |
| Cyclophosphamide | Endoxan
Cytoxan | Alkylating agents | Target cancer cells in the resting phase of the cell cycle, and attach to DNA to prevent replication of the cancer cells | One dose daily
One dose twice weekly | Tablet taken orally IV infusion | ||
| Carboplatin | DBL carboplatin
Ebewe | Alkylating agents | Target cancer cells in the resting phase of the cell cycle, and attach to DNA to prevent replication of the cancer cells | Advanced breast cancer | IV infusion | ||
| Cisplatin | DBL Cisplatin
| Alkylating agents | Target cancer cells in the resting phase of the cell cycle, and attach to DNA to prevent replication of the cancer cells | IV infusion | |||
| Fluorouracil | 5-fluorouracil (5FU) Fluorouracil Ebewe DBL Fluorouracil Fluorouracil Accord | Antimetabolites | Target cells at specific times during the cell cyle to prevent cell division | Advanced breast cancer | IV infusion | ||
| Capecitabine | Brinov
| Antimetabolites | Target cells at specific times during the cell cyle to prevent cell division | Advanced breast cancer resistant to anthracycline chemotherapy
| One tablet twice daily for two weeks | Docetaxel | Tablet taken orally |
| Vinorelbine | Navelbine
| Vinka alkaloid | Inhibit the action of microtubules to stop breast cancer cells dividing, causing cell death | Advanced breast cancer (second-line treatment) | IV infusion | ||
| Gemcitabine | DBL Gemcitabine
Gemzar | Antimetabolites | Target cells at specific times during the cell cyle to prevent cell division | Advanced breast cancer resistant to anthracycline chemotherapy (first-line treatment) | Two doses within a 21-day cycle | Paclitaxel | IV infusion |
| Methotrexate | Trexate DBL Methotrexate Onco Methotrexate Ebewe | Antimetabolites | Target cells at specific times during the cell cyle to prevent cell division | Early node-positive breast cancer | Two doses within a 21-day cycle | Cyclophosphamide Fluorouracil | IV infusion |
