Adjuvant chemotherapy

updated 6-2020


Chemotherapy treatment is recommended in some patients. The individual risk of relapse is taken into account. The higher the chance of relapse, the higher the expected benefits of chemotherapy.

Classical criteria that we use to recommend chemotherapy are: tumor size, involvement of the axillary lymph nodes, hormone sensitivity (ER and PR), HER2 status, ki-67 (a marker of proliferation) and lymphovascular invasion. In addition, the age of the patient and her relevant medical history are taken into account.

Chemotherapy or cytostatics act on the genetic material of the cancer cell and thus prevent cell division and tumor growth. Since chemotherapy mainly works on rapidly dividing cells, it will also affect other rapidly dividing body cells and give rise to a number of side effects. Healthy body cells, however, have a greater capacity to recover and restore than cancer cells, such that the net effect of chemotherapy is a reduction in tumor volume and repair of damaged healthy cells.

Chemotherapy can be given 'adjuvant', which means that this treatment starts after the breast tumor has been surgically removed. On the other hand, chemotherapy can also be given 'neo-adjuvant', which means that one starts chemotherapy first and performs surgery in the second step.
The historical standard is adjuvant administration of chemotherapy. Previously, only patients with large, inoperable breast tumors were treated neoadjuvantly. The goal was to shrink the tumor, making surgery possible.

Today chemotherapy is increasingly being given neoadjuvant. Especially with regard to the triple negative (= hormone receptors negative and HER2 negative) and the HER2 positive tumors. This has a number of advantages, the most important of which are briefly mentioned here:

  1. The response to neoadjuvant chemotherapy is of prognostic importance. Patients in whom the tumor shrinks nicely or even disappears completely under chemotherapy have a better prognosis than patients in whom this is not the case. They are less likely to develop distant metastases and have better survival.
  2. There is also a therapeutic benefit. In patients who did not have a good response to neoadjuvant treatment, the therapy can be extended / modified, which may mean an additional chance of a cure.
  3. Chemotherapy can reduce the size of the tumor, which sometimes requires less extensive surgery, with all the associated benefits.

Several chemotherapy schedules exist. Depending on the type of breast cancer, the stage, the age of the patient and his relevant history, your physician will make a proposal regarding treatment. A classic schedule may look like this: 4 cycles of Epirubicin - Cyclophosphamide (administered once every 2 or 3 weeks) followed by 12 weekly administrations of Paclitaxel.

This treatment is usually administered intravenously (via an IV), although in recent years treatment with tablets has also been possible in some cases. The courses are repeated at regular intervals, eg. every 3-4 weeks, for a certain number of cycles (eg. 6).

The main side effects of chemotherapy are:

  • Nausea and vomiting
  • Bone marrow suppression and thus increased susceptibility to infection
  • Hair loss, nail abnormalities
  • Oral and eye mucosal inflammation
  • Local reactions at the injection site
  • Fatigue
  • Influence on fertility and menstruation
  • Cystitis and urine discoloration
  • Specific organ toxicity in relation to the heart, lungs, liver, kidneys, nervous system. This toxicity is very specific for a limited number of products.

Your doctor will always take this into account in function of your body surface area, your general condition and the underlying suffering. Sometimes it will be necessary to make dose reductions or to omit certain products from the schedule.