Chemotherapy and Targeted Therapy

Just as everyone has their own individual diagnosis of breast cancer, everyone has their own prescription for treatment. There are standards of care that your doctors will recommend based on your diagnosis, medical history and treatments available. These are always changing which is both exciting and confusing. Make sure that you have a care team that you trust and that is up to date on recent breast cancer breakthroughs.

Some good general information about Chemotherapy and specific drugs used can be found here.

Good information regarding Targeted Therapy can be found here.

Blood tests are required before each chemotherapy session. If your blood work values are outside of the norm it could affect your treatment program.

My Experience
Chemotherapy and targeted therapy were combined. Both chemotherapy and targeted therapy may be given intravenously (infusion) or by mouth (pill). I received my chemo and targeted drugs intravenously.

Being diagnosed with triple positive IDC that had invaded the lymphatic system (verified by armpit node biopsy), it was recommended that I receive neoadjuvant therapy – chemo before surgery. This consisted of 12 weeks of Taxol, Herceptin & Perjeta, immediately followed by 8 weeks of Adriamycin & Cytoxan. Taxol was a weekly infusion. Herceptin and Perjeta were added every third week. After 12 weeks of THP, AC was given every 2 weeks.

The morning of my first infusion, I went to the hospital to have a Smart Port placed in my chest. This was used for my chemotherapy as well as blood draws. I never liked the way the small disc felt right under my skin (it was a bulge that you could see through fitted clothes) but I definitely liked using it for chemo. It wasn’t too uncomfortable when accessed and it saved my arm veins from collapsing due to toxicity of drugs and repeated needle pokes.  EMLA cream was recommended to numb the skin prior to port access. I never used it. I think my baby boys (now teenagers) pregnancy/delivery increased my pain tolerance! Port access felt similar to getting a shot and EMLA cream application required a bit of preplanning, which I’m not good at. Ask your doctor about EMLA to learn more.

Taxol, Herceptin, Perjeta

Taxol (paclitaxel) – Premeds prior to Taxol infusion took 60 minutes. Taxol infusion itself was also 60 minutes.

  • Decadron, a steroid to help control acute nausea and vomiting
  • Pepcid, an antihistamine that also helps nausea
  • Benadryl, which prevents allergic reactions and makes you very sleepy.

Herceptin (trastuzumab) & Perjeta (pertuzumab) immediately follow Taxol. No additional  premeds. The initial dose of each of these targeted therapies took 90 minutes. After that, 30 minutes each.

The first infusion day is the longest because your care team slows the drip so they can make sure you don’t have any adverse reactions to the infusion. Other than some sleepiness and hair thinning, I didn’t have any major side effects from THP. See what I did to minimize side effects and avoid neuropathy.

Adriamycin & Cytoxan

For most, Adriamycin (doxorubicin) & Cytoxan (cyclophosphamide) are a stronger chemotherapy cocktail than the aforementioned THP. Adriamycin is nicknamed the “red devil” because of it’s deep red color and it’s nasty side effects.  Unlike the other drugs given by IV, my Adriamycin was personally administered by a nurse using 3 large syringes full of the stuff over 15 minutes (I made sure to look away).  Cytoxan followed via IV for 30 minutes.

Premeds I was given as part of my infusion included

  • Decadron steroid
  • Aloxi anti-nausea premed
  • Emend anti-nausea premed that works in your body for 3 days

I was told to take Claritin for 3 days, beginning the morning of chemo, in order to ease bone pain caused by Neulasta.  Also take Tylenol the day of Neulasta. Neulasta is a shot given the day following AC which stimulates growth of new white blood cells.  I had the option to return to the cancer center for the Neulasta shot or to use the on-body injector (Neulasta Onpro) which was supposed to deliver the drug dose at appropriate time (24 hours after chemo). I tried Neulasta Onpro after my first AC infusion but my injector failed and I ended up back at the center for a shot anyway! I just scheduled the shot for subsequent infusions.

Take home medication included Decadron pills, Ativan & Compazine. Take home nurse advice (always listen to the nurses):

  • Drink 12 cups of water/day
  • Urinate every hour during the day (Cytoxin is hard on the bladder)
  • Flush the toilet twice (pink pee for a while from “red devil”)
  • Wash hands before eating
  • Vaseline w/cotton gloves/socks at night (dry cracked skin)
  • Senokot – stool softener, daily
  • Miralax – powder, take in water, as needed (try after Senokot)

See what I did to minimize side effects and avoid neuropathy.