Chemotherapy for secondary breast cancer

Chemotherapy uses anti cancer drugs (cytotoxic drugs) to destroy cancer cells. The drugs circulate in the bloodstream around the body. Your specialist may suggest either chemotherapy or hormone therapy when you are diagnosed with secondary breast cancer. You are likely to have chemotherapy in any of the following situations

• Your cancer is oestrogen receptor negative
• Your cancer is in the liver or lung
• You have already had hormone therapy

If your breast cancer is oestrogen receptor negative (ER -ve) your specialist may suggest chemotherapy as soon as your secondary cancer is diagnosed. This is because hormone therapy is less likely to help you.

If your cancer responded to hormone treatment in the past, it may well do again. But sometimes, after you have had a few different types, breast cancer stops responding to it so well. Then your doctor may offer chemotherapy.

You usually have chemotherapy as a series of treatments a few weeks apart. Each round of treatment is known as a chemotherapy cycle. After each cycle you have a break for about 3 or 4 weeks. The exact schedule of treatment depends on the drugs you are having.

Your complete treatment may last several months. Although you may take some chemotherapy drugs as tablets or capsules, treatment is also often given as injections into the bloodstream. Most people can have treatment as an outpatient, going home after the injections. But sometimes you may need to spend a day or two in hospital. Again, this depends on the particular drugs that you have.

In many circumstances, the drugs used to treat secondary breast cancer are the same as those used to treat primary breast cancer. There is information about these drugs in the main chemotherapy for breast cancer section of CancerHelp UK.

The drugs used most often for secondary breast cancer at the moment are

• Docetaxel (Taxotere)
• Vinorelbine
• Capecitabine (Xeloda)
• Paclitaxel (Taxol)
• Gemcitabine (Gemzar)

There is information about these drugs in the cancer drug section of CancerHelp UK. The drugs may be used in combination – for example, gemcitabine and taxol, or capecitabine and docetaxel. 

A biological therapy called trastuzumab (Herceptin) is also used for secondary breast cancer and may be given alongside chemotherapy. There is information about biological therapies for secondary breast cancer in this section of CancerHelp UK.

A new type of paclitaxel called Abraxane is licensed in Europe for breast cancer that has spread, and has not responded to its first treatment. The tiny particles of paclitaxel are held in a protein based preparation. Abraxane is used if the cancer is not suitable for treatment with anthracycline chemotherapy (for example, epirubicin). In trials, Abraxane worked better for these patients than conventional paclitaxel. The Scottish Medicines Consortium (SMC) issued guidance in April 2010 which means that Abraxane can be used in the NHS in Scotland for women whose treatment is no longer working and are not suitable for anthracycline chemotherapy. It has not been approved for use yet in England, Wales and Northern Ireland. A drug called eribulin mesylate was licensed in 2011 in the UK for secondary breast cancer. NICE have said that eribulin should not be available within the NHS in England and Wales because the benefit is not enough for the amount it costs.

Chemotherapy has some general side effects. The drugs kill cancer cells because they divide quickly. Your blood cells also divide rapidly, so chemotherapy can lower the number of healthy white blood cells, red blood cells and platelets you have. This can mean you

• Are more likely to get infections
• May be more tired than usual
• Can be prone to nosebleeds and other bleeding problems

If you develop a temperature above 38°C or think you have an infection, it is very important to contact the hospital immediately. You may need urgent treatment with antibiotics. Your doctor or chemotherapy nurse will give you an emergency number to phone if you need to. There is detailed information about the effect of chemotherapy on your blood cells in the main chemotherapy section of CancerHelp UK.

Tiredness (fatigue) is the most common side effect for people having chemotherapy. It may continue for some months after your treatment ends. How quickly you get back to normal will depend on your general health, on the amount of treatment you've had, and on other treatments you have had.

Other side effects of chemotherapy for secondary breast cancer can include

• Feeling sick (nausea) and being sick
• Hair loss or thinning
• Sore mouth
• Diarrhoea
• Sore eyes – they may feel as if they have grit in them. Let your doctor or breast care nurse know, as eyedrops can help.

You can use the links above to go to pages in the cancer drugs section that tell you about coping with the side effects. Side effects may seem hard to bear at the time. But most disappear when your treatment ends.

There are books and booklets about chemotherapy, some of which are free. Look at our breast cancer reading list. There is more information about chemotherapy generally in the main chemotherapy section of CancerHelp UK.  If you want to know more about chemotherapy, talk to your doctor or the nurses involved in your treatment.  Many hospitals now have special chemotherapy nurses to support chemotherapy patients.