Chemotherapy

Chemotherapy in early invasive breast cancer typically lasts 3 to 6 months. Each cycle of treatment is usually 2 to 3 weeks long, and the total number of chemotherapy rounds can range from 4 to 8. Treatment plans are tailored to your individual needs, considering the cancer type, stage, and your overall health.

Timing of Chemotherapy

Chemotherapy isn’t always given in the same order for everyone. Sometimes it’s used before surgery to shrink a tumor and make surgery easier. Other times, it’s used after surgery to lower the risk of cancer coming back. Here’s what you need to know about both approaches.

Preoperative chemo is given before surgery to help shrink the tumor and determine if additional treatment is needed after surgery. Someone who needs a mastectomy may become a candidate for a lumpectomy if the tumor shrinks enough with treatment.

This approach is often used when:

• The tumor is too large to remove right away
• Many lymph nodes are involved
• The cancer is inflammatory breast cancer
• The cancer is HER2+ or triple negative

Preoperative chemo has a few goals:

• Lower the risk of cancer returning in the future (recurrence)
• Shrink the tumor so it can be removed more easily
• Kill any hidden cancer cells that aren’t visible on scans
• Guide future treatment—if the tumor doesn’t respond well to chemo before surgery, your care team might consider a different strategy afterward

Postoperative chemo is given after surgery to reduce the chances that breast cancer comes back.

Even when surgery removes all visible signs of cancer, microscopic cancer cells can sometimes remain. These leftover cells may be too small to see on imaging or even under a microscope—but they can still pose a risk down the line.

That’s where postoperative chemo comes in:

• It works as a precautionary step, targeting any stray cancer cells
• It can help lower the risk of recurrence, especially in higher-risk cases

Your doctor may recommend postoperative chemotherapy based on your specific cancer type, stage, and other personal risk factors.

Some chemo medicines used to treat MBC are:

• Doxorubicin (Adriamycin^®)

• Docetaxel (Taxotere^®) or Paclitaxel (Taxol^®)

• Capecitabine (Xeloda^®)

You’ll be monitored (checked) every few months to see if the cancer is responding to treatment. If the first chemotherapy drug (or combination of drugs) stops working and the cancer begins to grow again, a second or third drug can be used.

The use of each chemotherapy drug (or combination of drugs) for metastatic breast cancer is called a “line” of treatment. For example, the first chemotherapy used is called the “first-line” treatment and the second is called the “second-line” treatment.

With each line of treatment, it becomes less likely the cancer will shrink. And if the cancer does shrink, it’s often controlled for a shorter period of time with each new drug. It’s common to get multiple lines of chemotherapy regimens over the course of treatment for metastatic breast cancer.