Medication Therapies

Cancer cells grow and divide faster more quickly than normal cells. Chemotherapy, or "chemo," targets the division and function of fast-growing cells to kill them. Other treatments work in different ways.⁴⁴

Medication categories are:

• Chemotherapy
• Hormonal therapies
• Antibody-based therapy
• Targeted therapies

Chemo may be given as a pill. It may also be given through an IV line into the bloodstream. It is usually given in cycles of treatment . After each cycle, there is a recovery time. The timing of cycles can vary. They can be once a week or every second, third, or fourth week. You may receive one medication at a time or a combination.

Chemo affects people in different ways. It destroys both cancer and healthy cells. The destruction of normal cells may cause side effects. These side effects may be severe enough to stop treatment. Sometimes, treatment must be stopped before the full course can be completed. The side effects will depend on:

• The type of chemotherapy you are getting
• The dose of chemotherapy you are getting
• Your type of cancer
• Your stage of cancer
• How healthy you are before treatment

The most common side effects of chemotherapy include:

• Fatigue (feeling tired)
• Alopecia (hair loss)
• Easy bruising and bleeding due to the killing of blood clotting cells
• Infection due to the killing of white blood cells that fight infection
• Anemia (low red blood cell counts)
• Nausea and vomiting
• Appetite changes
• Constipation or diarrhea
• Mouth and throat sores

To find out more about chemotherapy, the specific medication, and ways to manage all of the side effects, go to the website of the National Cancer Institute.

Hair loss can occur. This may happen on the scalp, face, arms, legs, underarms, and pubic area. This is known as alopecia. In most cases, hair will grow back after treatment. Many people use scarves, caps, hats, or wigs during hair loss. Your team will guide you so that you can prepare in advance. You may want to cut your hair short. You could also be fitted for a wig. Wigs are usually covered by insurance.

Hormonal therapy fights breast cancers that use hormones to grow, like estrogen or progesterone. These drugs help slow the tumor's growth and ultimately kill it. Tamoxifen is one common hormone therapy drug that can be used in both premenopausal and postmenopausal women. Tamoxifen is an example of a selective estrogen receptor modulator (SERM).

Aromatase inhibitors decrease the amount of estrogen made by tissues other than the ovaries. They block the enzyme needed to make estrogen. They are effective only in postmenopausal women. Examples of aromatase inhibitors include:

• Anastrozole
• Letrozole
• Exemestane

Antibodies are proteins produced by immune cells. These cells are called B-lymphocytes or B-cells. Antibodies stick to foreign molecules (antigens) that enter the body. This tells the body that the object is foreign. It marks it for destruction. Some therapies can help antibodies stick to cancer cells.

Targeted therapies attack certain parts of cancer cells. They also attack other cells that help cancer cells grow. Some breast cancer cells have certain genetic mutations. For these cells, targeted medications may be a treatment option. Examples include trastuzumab and pertuzumab. These may block growth signals to receptors on the cell surface. These medications may also be combined with chemo.

Immunotherapy is a form of cancer treatment. It uses the power of the body's own immune system to prevent, control, and eliminate cancer. This treatment may be used for people with advanced triple-negative breast cancer. Triple-negative breast cancers tend to grow and spread quickly. There are limited treatments available for this type of breast cancer.

To find out more about immunotherapy, visit the website of the National Cancer Institute.

Cool Cap Technology

Chemotherapy kills all fast-growing cells, including hair cells. The damage to the hair follicle causes the hair to fall out (alopecia). Cooling the scalp reduces the amount of medication in the scalp. This can reduce hair loss in 65 percent of breast cancer patients.⁴⁵

Scalp cooling has been used since the late 1970s. Caps may be frozen to very low temperatures then placed on the head. They may be worn before, during, and after chemotherapy treatment. Other techniques use a machine that cools and circulates fluid through a cap.