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Breast Cancer Chemotherapy

Most women need chemotherapy when they have advanced breast cancer. And it's likely to be easier to handle than in the past. "Our aim is to keep the cancer under control for as long as possible with as few side effects as possible," says Virginia Borges, MD, of the University of Colorado-Denver School of Medicine.

Unless you have an urgent condition, like serious liver problems or trouble breathing, you'll probably get one drug at a time. "A combination of drugs will get you a faster response, but not one that lasts longer," Borges says.

There are several chemo drugs your doctor may choose from, depending on your particular case. Some are pills. Others you get through an IV tube in your arm. Talk with your doctor about what you prefer.


Hormonal Therapy for Breast Cancer

If your cancer is sensitive to hormones such as estrogen, you may need to take hormonal therapy. There are various types of these drugs that you and your doctor may choose from. They can lower the amount of estrogen your body makes so it's not available to fuel your breast cancer.

There are different types of hormonal therapies for breast cancer:

Tamoxifen and toremifene (Fareston) block estrogen from stimulating cancer cell growth. Doctors call these drugs "SERMS," which stands for selective estrogen receptor modulators.

Letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) stop the body from making estrogen in women who have gone through menopause.

Fulvestrant (Faslodex) counters estrogen throughout the body, not just in cancer cells. You get it by injection. It's approved for use in postmenopausal women with advanced breast cancer who have already tried tamoxifen or toremifene.

Goserelin (Zoladex) and leuprolide (Lupron) stop the ovaries from producing estrogen. Doctors may consider these drugs, along with other hormone drugs, in women who have not yet been through menopause. After stopping these drugs, the ovaries may or may not make estrogen again.

Targeted Therapies for Breast Cancer

There are drugs that target specific proteins related to cancer.

Everolimus (Afinitor) targets a protein called mTOR, and palbociclib (Ibrance) targets a protein called CDK 4/6. They are approved to treat advanced breast cancer in women after menopause if:

  • Their breast cancer is sensitive to estrogen. Doctors call this “ER-positive.” Most breast cancers are ER-positive.
  • Their cancer is not sensitive to the HER2 protein. Your doctor may call this “HER2-negative” breast cancer. Most breast cancers are HER2-negative.
A Treatment Option If Hormone Therapy Stops Working

A Treatment Option if Hormone Therapy Stops Working

For women living with advanced HR+, HER2-negative breast cancer after menopause who have already received certain other medicines that have failed for their cancer, AFINITOR® (everolimus) Tablets plus Aromasin®* (exemestane) is proven to help DOUBLE the time without cancer growth vs exemestane alone.**

*Aromasin is a registered trademark of Pfizer, Inc.
**The median progression-free period was 7.8 months with AFINITOR + exemestane vs 3.2 months with exemestane alone. Data have not shown an increase in overall survival.

Important Safety Information

Patients should not take AFINITOR if they are allergic to AFINITOR or to any of its ingredients. Patients should tell their health care provider before taking AFINITOR if they are allergic to sirolimus (Rapamune®) or temsirolimus (Torisel®).

AFINITOR can cause serious side effects, such as lung or breathing problems, infections, or kidney failure. Some of these side effects can be severe and can even lead to death. Your health care team may have ways to help manage side effects that do occur. It's important to talk with your doctor or nurse about side effects you experience and the best ways to manage them. Serious side effects include:

Lung or Breathing Problems: Patients should tell their health care provider right away if they have any of these symptoms: new or worsening cough, shortness of breath, chest pain, difficulty breathing, or wheezing.

Infections: AFINITOR may make patients more likely to develop an infection, such as pneumonia, or a bacterial, fungal, or viral infection. Viral infections may include reactivation of hepatitis B in people who have had hepatitis B in the past. Patients may need to be treated as soon as possible. Patients should tell their health care provider right away if they have a temperature of 100.5°F or above, have chills, or do not feel well. Symptoms of hepatitis B or infection may include the following: fever, chills, skin rash, joint pain and inflammation, tiredness, loss of appetite, nausea, pale stools or dark urine, yellowing of the skin, or pain in the upper right side of the stomach.

Angioedema: Patients who take an angiotensin-converting enzyme (ACE) inhibitor medicine during treatment with AFINITOR are at a possible increased risk for a type of allergic reaction called angioedema. Talk with your health care provider before taking AFINITOR if you are not sure if you take an ACE inhibitor medicine. Get medical help right away if you have trouble breathing or develop swelling of your tongue, mouth, or throat during treatment with AFINITOR.

Kidney Failure: Patients taking AFINITOR may develop kidney failure. Patients should have tests to check their kidney function before and during their treatment with AFINITOR.

Delayed Wound Healing: AFINITOR can cause incisions to heal slowly or not heal well. Call your health care provider right away if your incision is red, warm, or painful; if you have blood, fluid, or pus in your incision; if your incision opens up; or if your incision swells.

Before taking AFINITOR, tell your health care provider about all your medical conditions, including if you:

  • Have or have had kidney problems
  • Have or have had liver problems
  • Have diabetes or high blood sugar
  • Have high blood cholesterol levels
  • Have any infections
  • Previously had hepatitis B
  • Are scheduled to receive any vaccinations. You should not receive a live vaccine or be around people who have recently received a live vaccine during your treatment with AFINITOR. If you are not sure about the type of vaccine, ask your health care provider
  • Have other medical conditions
  • Are pregnant or could become pregnant. AFINITOR can cause harm to your unborn baby. You should use effective birth control while using AFINITOR and for 8 weeks after stopping treatment. Talk to your health care provider about birth control options while taking AFINITOR
  • Are breastfeeding or plan to breastfeed. You and your health care provider should decide if you will take AFINITOR or breastfeed. You should not do both

Tell your health care provider about all of the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Using AFINITOR with certain other medicines can cause serious side effects. Keep a list of medicines you take and show it to your health care provider when you get a new medicine. Especially tell your health care provider if you take St John's wort (Hypericum perforatum), medicines that weaken your immune system (your body's ability to fight infections and other problems), or medicines for:

  • Fungal infections
  • Bacterial infections
  • Tuberculosis
  • Seizures
  • Heart conditions or high blood pressure

If you are taking any medicines for the conditions listed above, your health care provider might need to prescribe a different medicine or your dose of AFINITOR may need to be changed. Tell your health care provider before you start taking any new medicine.

Common Side Effects

The most common side effect of AFINITOR in treating advanced hormone receptor-positive, HER2-negative breast cancer was mouth ulcers and sores (67%). Tell your health care provider if you have pain, discomfort, or open sores in your mouth. Your health care provider may tell you to use a special mouthwash or mouth gel that does not contain alcohol, hydrogen peroxide, iodine, or thyme.

Other common side effects of AFINITOR include:

  • Infections (50%)
  • Rash (39%)
  • Feeling tired (36%)
  • Diarrhea (33%)
  • Loss of appetite (30%)
  • Nausea (29%), vomiting (17%)
  • Weight loss (25%)
  • Cough (24%), shortness of breath (21%)
  • Abnormal taste (22%)
  • Headache (21%)
  • Pain in arms and legs (9%), back (14%), joints (20%)
  • Swelling of arms, hands, feet, ankles, face, or other parts of the body (19%)
  • Nose bleeds (17%)
  • Fever (15%)
  • Constipation (14%)
  • High blood glucose (14%)
  • Difficulty sleeping (13%)
  • Feeling weak (13%)
  • Itching (13%)
  • Dry mouth (11%)
  • Hair loss (10%)

Tell your health care provider if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of AFINITOR. For more information, ask your health care provider or pharmacist. Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call 1-800-FDA-1088.

Please see full Prescribing Information for AFINITOR, including Patient Information.

AFINITOR is a prescription medicine used to treat advanced hormone receptor-positive, HER2-negative breast cancer, along with the medicine exemestane, in postmenopausal women who have already received certain other medicines for their cancer.

The brands listed are the trademarks or register marks of their respective owners and are not trademarks or register marks of Novartis.

Novartis Pharmaceuticals Corporation
East Hanover, New Jersey
(c) 2015 Novartis
6/15 AFB-1110888

6/15 AFB-1110888