For many women diagnosed with breast cancer, the disease doesn't make them feel ill. It's the treatment -- surgery, radiation, and, most of all, chemotherapy. Coping with side effects that range from nausea and fatigue to mouth sores and premature menopause can make four, six, or eight months of treatment seem like a lifetime.
And for many women, side effects can linger long after breast cancer treatment is over. What's more, some, such as low blood counts or nausea and vomiting so extreme they can't be controlled, can delay the next treatment, possibly making it less effective.
Triple-negative breast cancer (TNBC) is defined as the absence of staining for estrogen receptor, progesterone receptor, and HER2/neu. TNBC is insensitive to some of the most effective therapies available for breast cancer treatment including HER2 -directed therapy such as trastuzumab and endocrine therapies such as tamoxifen or the aromatase inhibitors. Combination cytotoxic chemotherapy administered in a dose-dense or metronomic schedule remains the standard therapy for early-stage TNBC. A...
As scientists research new treatments for breast cancer, they're also studying new "treatments for the treatments," new ways to prevent or reduce some of the most debilitating side effects of cancer therapies.
New Drug Controls Nausea One of the most common (and awful) side effects of many types of chemotherapy is nausea and vomiting. It leaves many women exhausted, dehydrated, and sometimes so distressed that they want to stop chemotherapy altogether. Some women are so affected by chemotherapy nausea that, even years later, they find themselves searching for a bathroom or a bucket at the mere sight of their oncologist.
Now, a new drug is helping many more women get through chemotherapy nausea-free. Emend, approved by the FDA in 2003, works differently than many of the other standard anti-nausea medications used with chemotherapy. It blocks "substance P," a chemical substance that transmits nausea and vomiting signals to the brain. It's effective at staving off "delayed-onset" nausea, which hits 24 to 48 hours after a chemotherapy dose and can last as long as five days. In studies, Emend kept about 20% more patients nausea-free for up to five days following chemotherapy.
In late 2004, Memorial Sloan-Kettering Cancer Center in New York made Emend part of its standard regimen of drugs for women undergoing breast cancer chemotherapy. "It's very well tolerated and very effective," says Andrew Seidman, associate attending physician in the Breast Cancer Medicine Service at Sloan-Kettering.
"It doesn't replace other anti-nausea drugs, but rather works well in combination with them. With these other medications alone, patients still had the potential for breakthrough nausea two or three days after treatment. Since we've made the change, I think we're doing an even better job at managing nausea."
Sick and Tired: Tackling Fatigue Almost everyone undergoing breast cancer treatment feels some fatigue. It often builds up over the course of treatment, so while you start out thinking "This isn't so bad; I still have plenty of energy," by the end of chemotherapy and radiation you may feel lucky if you can get out of bed.
Some treatment-related fatigue, doctors say, is almost inevitable. "Chemotherapy does cause collateral damage to normal tissues, and the broad tissue damage is one source of this fatigue," says Mark Pegram, MD, director of the Women's Cancer Program at the Jonsson Comprehensive Cancer Center at UCLA. "Until we have more targeted therapies that don't damage normal tissues as much as chemotherapy does, we will have to try to manage fatigue as best we can."