Chemotherapy
Introduction

Early aggressive chemotherapy therapy controls micrometastases, reduces tumor bulk and allows for more limited procedures for local control

Combination chemotherapy with Adriamycin-based regimens are commonly used. Tumor response rates are seen in 80% of patients. About 10% of patients will have a complete response with chemotherapy.

While in some respects there is little a patient can do to improve their outcome besides endure treatment, it turns out that the time of day at which chemotherapy is administered appears to be an important factor in optimizing long term outcome. This is because cancer cells and normal body cells have different cycles of division and resting. Get your Adriamycin at 5 am and your body cells will get less impact than the cancer cells.

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Factors

1. Biological

  • Tumor mass (primary and number of lymph nodes)
  • Metastasis
  • Hormone receptor status
  • Histological grade
  • Age
  • Menopausal status
  • Oncogene expression/amplification

2. Non-Biological

  • Timing of initation of therapy
  • Dose intensity

Chemotherapy Algorithm

Response
No Response
  • Mastectomy
  • Chemotherapy
  • Assess for high dose chemotherapy
  • Radiation Therapy
  • Radiation Therapy
  • Chemotherapy
  • Reassess for mastectomy
-- figure courtesy "The Breast Cancer Survivor Manual" page 91