Medication / systemic therapy

Adjuvant therapy / chemotherapy

Adjuvant therapy takes place after the surgical removal of breast cancer. It is an addition to surgery that aims to eradicate potential micrometastases within the body. It reduces the likeliness that cancer might come back, and it increases the healing and the survival rate.

How is adjuvant therapy carried out?

During adjuvant therapy, so-called cytostatics are administered, which stop the growth of the tumor cells or cause them to die. However, healthy cells that proliferate often are also frequently targeted, e.g., cells of the hair, mucous membrane and blood-building bone marrow. Subject to the type of chemotherapy, different side effects can occur. Thanks to modern supportive therapy, many of these side effects can be reduced or prevented.

Adjuvant therapy is an outpatient treatment that is undergone in several cycles, with pauses of 1-3 weeks between each cycle.

A thorough and attentive care is imperative during adjuvant therapy in order to detect and treat side effects early enough.

What you can do during adjuvant therapy

What you can do to reduce side effects of the adjuvant chemotherapy:

Alcohol and nicotine

  • no smoking
  • alcohol only in small amounts

Diet

  • no one-sided diet or fasting
  • only healthy food rich in vitamins; generally, you can eat what you like
  • drink 2 liters (0.53 gal.) every day

Physical activity

  • sports activities can improve the course of the disease, quality of live and the immune system
  • adequate sports activities are walking, hiking, swimming or jogging slowly

Body and mind

Please listen to your body and decide what is good and important to you. To cure you of cancer requires time to heal, physically and psychologically. In case you cannot deal with the stress on your own, an experienced psycho-oncologist may be able to help you cope with your new situation and develop strategies to reduce social and psychological stress.

Neoadjuvant therapy / chemotherapy

Neoadjuvant (primary) therapy includes all kinds of medication to treat breast cancer prior to surgery. It is also called neoadjuvant chemotherapy.

When is neoadjuvant therapy indicated?

Neoadjuvant therapy is used to treat

  • locally advanced breast cancer
  • breast cancer that is inoperable
  • inflamed breast cancer

By undergoing neoadjuvant therapy, many patients can avoid a mastectomy and conserve the breast.

The evaluated efficacy of the neoadjuvant therapy gives us important information about the further development of the therapy and therapy options. Although there may be no visible tumor residues after neoadjuvant therapy, subsequent surgery is necessary.

Palliative chemotherapy

If breast cancer has spread and built metastases, the disease is chronic and curing it is not possible anymore. In order to control breast cancer as long as possible and, thus, sustain and improve the quality of life, patients undergo palliative chemotherapy that does not cure cancer itself but does treat its impacts/symptoms. At this stage, it is very important that a confidential information exchange between patients, relatives and the medical team takes place about the patient´s state of health. As long as it is possible, patients´ individual needs and wishes have to be considered.

Criteria to choose a type of palliative chemotherapy

Criteria to choose a kind of palliative chemotherapy should reflect the patient´s expectation, health condition and dominant symptoms. Given cancer advances slowly, monotherapy (only one drug) is preferable because it causes less side effects. If a quick amelioration of symptoms is crucial, polychemotherapy, which is a combination of several cytostatics (inhibit the growth and proliferation of cells), is a valid choice.

What you can do during palliative chemotherapy

What you can do to support the palliative chemotherapy:

  • you can engage in sports activities and, thus, improve your quality of life and your immune system despite an advanced stage of cancer
  • recommended sports activities are walking, riding a bike, hiking and swimming
  • slight weight training is advised to strengthen the muscles
  • physical therapy as well as relaxation and breathing exercises may help

If possible, do not let cancer dominate you, but live your life actively. Do things that make you happy and spend time with people that mean a lot to you. An experienced psycho-oncologist may also be able to help you cope with your situation and reduce social and psychological stress.

Hormone blocking therapy

Tamoxifen

You have been diagnosed with hormone-sensitive breast cancer, whose growth is stimulated by the female hormone estrogen by binding cancerous cells. Tamoxifen blocks the binding of estrogen to the cancerous cells and, consequently, reduces cancer growth.

This kind of therapy is a long-term therapy over several years. It is crucial to take tamoxifen as long and regularly as your doctor advises you to do in order to reduce cancer growth permanently.

Please abide by the following instructions on how to take tamoxifen.

Dose: Take 20 mg once a day with a meal and a glass of water without chewing it.

Prior to therapy: ophthalmological examination (eye examination)

During therapy:

  • blood tests on a regular basis
  • gynecological examination once a year to determine changes of the endometrium (mucous membrane of the uterus)
  • ophthalmological examination (eye examination) in case of diminished vision
  • do not eat grapefruits or drink grapefruit juice
  • reduce alcohol consumption
  • do not take during pregnancy or the period of lactation

Possible side effects:

  • hot flashes
  • bone pain
  • edema (swellings due to liquid within your body)
  • vaginal discharge

Anastrozole (Arimidex®)

You have been diagnosed with hormone-sensitive breast cancer, whose growth is stimulated by the female hormone estrogen by binding cancerous cells. Anastrazole reduces the production of estrogen and, consequently, cancer growth.

This kind of therapy is a long-term therapy over several years. It is crucial to take anastrazole as long and regularly as your doctor advises you to do in order to reduce cancer growth permanently.

Please abide by the following instructions on how to take anastrazole.

Dose: 20 mg once a day with a glass of water without chewing it

Prior to therapy: bone density test

During therapy:

  • regular controls of bone density and renal (kidney) function
  • do not take in case of severe renal dysfunction (kidney dysfunction)
  • do not take in case of moderate/severe hepatic dysfunction (liver dysfunction)

Possible side effects:

  • hot flashes
  • sweating
  • joint pain
  • osteoporosis

Exemestane (Aromasin®)

You have been diagnosed with hormone-sensitive breast cancer, whose growth is stimulated by the female hormone estrogen by binding cancerous cells. Exemestane reduces the production of estrogen and, consequently, cancer growth.

This kind of therapy is a long-term therapy over several years. It is crucial to take exemestane as long and regularly as your doctor advises you to do in order to reduce cancer growth permanently.

Please abide by the following instructions on how to take exemestane.

Dose: 20 mg once a day with a glass of water without chewing it

Prior to therapy: bone density test

During therapy:

  • regular controls of bone density and hepatic (liver) function
  • do not take in case of severe renal dysfunction (kidney dysfunction)
  • do not take in case of moderate/severe hepatic dysfunction (liver dysfunction)

Possible side effects:

  • hot flashes
  • sweating
  • joint pain
  • nausea (rare)
  • tiredness
  • osteoporosis

Letrozole (Femara®)

You have been diagnosed with hormone-sensitive breast cancer, whose growth is stimulated by the female hormone estrogen by binding cancerous cells. Letrozole reduces the production of estrogen and, consequently, cancer growth.

This kind of therapy is a long-term therapy over several years. It is crucial to take letrozole as long and regularly as your doctor advises you to do in order to reduce cancer growth permanently.

Please abide by the following instructions on how to take letrozole.

Dose: 20 mg once a day with a glass of water without chewing with or after a meal

Prior to therapy: bone density test

During therapy:

  • regular controls of bone density and hepatic (liver) function
  • do not take in case of severe renal dysfunction (kidney dysfunction)
  • do not take in case of moderate/severe hepatic dysfunction (liver dysfunction)

Possible side effects:

 

  • hot flashes
  • sweating
  • joint pain/stiffness
  • tiredness
  • osteoporosis

Antibody therapy

Antibody therapy with trastuzumab

The surface of the breast cancer cells have a distinct feature (HER2) in 15-20% of women. HER2 is a receptor that causes cancerous cells to grow. In case of an overexpression of HER2, which means that its efficiency is higher resulting in more cell growth, there is another treatment option: the targeted attack on cancerous cells with an antibody.

Trastuzumab switches the HER2 receptor off and activates the immune system of our body in order to attack the cancerous cells. Trastuzumab antibody therapy begins together with chemotherapy and is administered every 3 weeks over 1 year.

Well-tolerated therapy

Antibody therapy is generally tolerated well. The first injections may cause symptoms similar to a flu because the immune system of our body is stimulated. The cardiac output can be affected in rare cases why an ultrasound examination of the heart (echocardiography) should take place every 3 months.