What is Neoadjuvant Chemotherapy?
Medicines administered to you before breast cancer surgery are known as neoadjuvant chemotherapy. They are generally given to reduce the size of a tumour or shrink it.
Duration of Neoadjuvant Chemotherapy
The duration and concentration of the chemotherapeutic medicine depend on the aggressiveness of the tumour and is usually given for 3 to 6 months intravenously in an outpatient setting. Treatment cycles may be every three weeks or more frequently depending on your situation. Some chemotherapy drugs can be administered orally without the need for IV infusion.
Expectations Before Neoadjuvant Chemotherapy
- Your doctor may undertake the following steps before the therapy:
- Your doctor may order a biopsy of your breast tumour to test the characteristics of your breast cells.
- Your doctor may order placement of a radio-opaque clip in your tumour. The purpose of this is to locate a tumour after neoadjuvant chemotherapy and to test the level of shrinkage of your tumour. The chip is removed after the surgery.
Advantages of Neoadjuvant Therapy
- Survival rates are higher
- Facilitates breast conservation
- Improved response in patients
- Prevents the spread of a tumour to the nearby lymph nodes
- Lowers the risk of recurrence of breast cancer after surgery and recovery
Breast Conservation Therapy
Preserving the breast involves the administration of neoadjuvant chemotherapy to shrink a tumour to prevent the need for a mastectomy (breast removal). If the chemotherapy works, a lumpectomy (surgical removal of the cancerous lump) followed by radiation therapy will be done to treat the breast cancer.
Side Effects of Neoadjuvant Chemotherapy
Drugs to treat only cancer cells without affecting the normal cells are challenging researchers today. Chemotherapy medicines have certain side effects on different cells of your body which may include:
- Gastrointestinal effects such as nausea
- Hair loss
- Damage to blood cells
- Mouth sores
- Changes in the menstrual cycle
- Damage to the heart
- Premature menopause
Neoadjuvant Chemotherapy Regimens
The combination of drugs your doctor administers during neoadjuvant chemotherapy depends on various factors. One such factor is if your breast tumour is HER2 positive. HER2 is a Human Epidermal Growth Factor Receptor 2 gene. This gene is necessary for normal multiplication of your breast cells. Mutations in this gene result in breast cancer.
If you are HER2 positive, the cancer is aggressive, and treatment often involves many side effects, particularly damage to the heart. Talk to your doctor to learn how to minimise these effects. Neoadjuvant hormone therapy may be helpful in cases of HER2 positive patients.
Pathologic Response
This is a pathological test of your tumour cells during surgery to indicate the amount of tumour tissue left after chemotherapy.
In some cases, there may be complete shrinkage of the tumour. This is called a pathological complete response (pCR).
A biopsy of your sentinel node is also performed after neoadjuvant chemotherapy during surgery. This is to check the spread of tumour cells to nearby lymph nodes.
Am I the Right Candidate for Neoadjuvant Chemotherapy?
Your doctor may recommend neoadjuvant chemotherapy if:
- You have inflammatory breast cancer
- You have high-grade tumours
- The size of your tumour is large
- Your breast cancer cells are HER2 positive
- You have triple-negative breast cancer
- If you have metastatic breast cancer (already spread to the lymph nodes)
Safety Measures During Neoadjuvant Chemotherapy?
Neoadjuvant chemotherapy and adjuvant chemotherapy (chemotherapy after surgery) involve similar side effects which can be managed effectively by following these steps:
- Talk to your doctor about proper storage of medicines (if you are given oral medicines)
- In the case of vomiting, dispose of your vomitus in a separate plastic bag using gloves if necessary
- Do not allow your body fluids to meet any other person
- Avoid pregnancy during chemotherapy
- If you feel tired you should rest instead of working
- Perform light exercises such as walking
- Accept help from your family members to perform household works such as cleaning
- Eat a well-balanced diet
