2.7 Chemotherapy & Targeted Therapy

2.7.1 What is Chemotherapy?

Chemotherapy is a systematic breast cancer treatment that uses medications to weaken and eliminate cancer cells (Lymphedema Working Group, 2012). Generally, you receive chemotherapy along with another treatment method, like surgery.

Chemotherapy can treat any stage of breast cancer (Lymphedema Working Group, 2012). In late-stage breast cancer, chemotherapy destroys and damages cancer cells. This treatment does the same thing for early-stage breast cancer, but in this case, it also reduces the chance of cancer recurrence.

2.7.2 Chemotherapy Drugs

Which chemotherapy medications you will receive depends on factors such as your cancer stage, cancer type, and overall health (Lymphedema Working Group, 2012). Chemotherapy treatment often uses more than one of these drugs simultaneously.

According to the Lymphedema Working Group, the following are the most common chemotherapy drug combinations:

• AC — adriamycin & cytoxan.
• AT — adriamycin & taxotere.
• CMF — cytoxan, methotrexate & fluorouracil.
• FAC — fluorouracil, adriamycin & cytoxan.
• CAF — cytoxan, adriamycin & flouracil (different doses than FAC). (Lymphedema Working Group, 2012)

2.7.3 Chemotherapy Port

A chemotherapy port is a small medical device implanted under the skin of either your chest or upper arm (Lymphedema Working Group, 2012). The purpose is to make it easier to receive regular doses of intravenous (directly into your bloodstream) chemotherapy drugs, take blood, and receive transfusions.

The implantation process happens in an outpatient clinic (Lymphedema Working Group, 2012). You will receive a local anesthetic for pain, and then an incision will be made in that area. The port is a small disk inserted under your skin with a tube attached. Said tube will be placed inside one of the veins by your neck.

After the chemotherapy port insertion, you can continue your normal activities, including bathing and swimming (Lymphedema Working Group, 2012). The port is not particularly noticeable; all you will see is a small bump.

2.7.4 What to Expect at The Treatment Centre

At the cancer treatment centre, you will get to know the healthcare team on the floor, such as the nurses (Lymphedema Working Group, 2012). To determine your chemotherapy dose, your healthcare team will record your height and weight; you can request a blind weight if that would be more comfortable for you. If you have not had a chemotherapy port implanted before, then you will have an IV inserted.

Before your medication administration, your healthcare team will assess your overall health, which can include:

• blood pressure,
• heart and respiratory rate,
• temperature,
• oxygen saturation,
• and general wellness (e.g., tired or nauseous) (Lymphedema Working Group, 2012).

Administering the medication by port or IV can take multiple hours (Lymphedema Working Group, 2012). You might also receive other chemotherapy or anti-nausea medications orally. Throughout the process, your healthcare team will be monitor you for any side effects of the medications, such as nausea, itching, and rash.

Although you can drive yourself to and from your appointments, having someone you know and trust drive you is recommended (Lymphedema Working Group, 2012).

Ultimately, chemotherapy can be an exhausting experience physically, emotionally, and spiritually, so make sure to take care of yourself during it.

2.7.5 Side Effects of Chemotherapy

Like with the other treatment methods, chemotherapy side effects can vary depending on the person and which drugs are used (CBCN, 2022).

According to the CBCN (2022), these are the most common side effects during chemotherapy treatment:

• cognitive impairment (chemo brain),
• hair loss,
• nausea and vomiting,
• fatigue,
• constipation or diarrhea,
• appetite loss,
• aches and pains,
• hands or feet numbness or tingling (peripheral neuropathy),
• low white blood cell count (neutropenia),
• low red blood cell count (anemia),
• low platelet count (thrombocytopenia),
• mouth sores (oral mucositis or stomatitis),
• bladder inflammation (cystitis),
• nail changes,
• and allergic reactions (CBCN, 2022).

Other potential long-term side effects include:

• early menopause,
• heart problems,
• and leukemia (CBCN, 2022).

Fortunately, the last two long-term side effects rarely occur (CBCN, 2022).

If you would like to learn more about chemotherapy, check out Video 12 (Canadian Cancer Society, 2020).

2.7.6 Questions to Ask About Chemotherapy

1. How long will I require chemotherapy?
2. Can I do just chemotherapy and no other treatments?
3. How successful is chemotherapy with my stage and type of breast cancer?
4. How will the chemotherapy medications be administered?
5. If I can take some chemotherapy medications orally, can I take all of them this way?
6. Do I need to do anything before starting my chemotherapy appointments (e.g., blood work)?
7. Who should I call if I have questions?
8. What are the side effects of the specific medications I am on?
9. Are there ways to decrease the side effects that I might experience?
10. If I lose my hair from chemotherapy, is there anything I can cover my head with (e.g., a wig)?
11. Are there any long-term side effects of chemotherapy?
12. What should I bring to my chemotherapy treatments?
13. Can I continue to go to work and complete my daily activities while receiving chemotherapy?
14. I have heard about others who have had breast cancer freeze their eggs; is this a good idea for me, too? (Lymphedema Working Group, 2012)

2.7.7 What is Targeted Therapy?

Targeted therapy targets cancer cell characteristics that cause the cancer to rapidly grow and change (Lymphedema Working Group, 2012). Unlike treatments like chemotherapy and radiation, targeted therapy harms less healthy cells.

2.7.8 Targeted Therapy Drugs

Which targeted therapy medications you will receive depends on what characteristic they are targeting (Canadian Breast Cancer Network [CBCN], 2022). Targeted therapy drugs are widely dependent upon tumour characteristics. The specific cancer treatment is customized for you and your tumour pathology, grade, stage, and characteristics (tumour receptor status, HER2/neu, ER/PR +/-, triple negative, etc.).

Targeted therapy categories and their corresponding drugs include:

• HER2 — block HER2 receptors (e.g., trastuzumab and lapatinib).
• HR+ — inhibits cancer cells’ estrogen or progesterone receptors (e.g., everolimus).
• BRCA — targets mutated BRCA 1 and BRCA2 genes (e.g., olaparib). (CBCN, 2022)

2.7.9 Side Effects of Targeted Therapy

Targeted therapy side effects depend on which medication you are taking (CBCN, 2022). Some common side effects include:

• fatigue,
• nausea,
• diarrhea,
• vomiting,
• and headache (CBCN, 2022).

For patients receiving trastuzumab specifically, there is an associated risk of developing congestive heart failure (Lymphedema Working Group, 2012). If you have any questions regarding the side effects of the specific medication prescribed, it is important to consult with your healthcare team.

If you would like more information about targeted therapy and how it differs from other cancer treatments, check out Video 13 (Cancer.Net, 2019).

2.7.10 Questions to Ask About Targeted Therapy

1. How is targeted therapy different from chemotherapy or radiation therapy?
2. How long will I require targeted therapy?
3. Can I self-administer targeted therapy treatments at home?
4. What are the side effects of targeted therapy? What signs should I watch out for?
5. Is it necessary for me to visit a clinic or hospital for testing to determine the effectiveness of the treatment?
6. Can I take all my other medications while I am taking targeted therapy medication?
7. Can I continue my daily activities while receiving targeted therapies? (Lymphedema Working Group, 2012)