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Debbie Bajrovic
Oncology Pharmacist
Mount Hospital Pharmacy
 Adjuvant
therapy is any treatment given
after primary surgery.
 Neo-Adjuvant therapy is any treatment given
before primary surgery.
 Therapy can include:
hormonal therapy
the targeted drug Trastuzumab (Herceptin)
radiation therapy
or a combination of treatments
 Stage
of the cancer (size/position)
 Grade of the cancer (how closely the
tumour cells resemble normal cells)
 Your age
 Menopausal status
 Whether lymph nodes are effected
 HER2 status
 Hormone receptor status
 Use
of anti-cancer (cytotoxic) drugs to
destroy cancer cells
 Usually administered intravenously as an
 Treatment can take a number of hours
 Treatment cycles can be weekly, fortnightly
or three weekly depending on the drugs used
 There is a rest period between cycles to let
your body recover from side effects
 A complete course is likely to take 4-6
 Fluorouracil
 Epirubicin (Epi)
 Cyclophosphamide (Cyclo)
 Docetaxel (Taxotere)
 Carboplatin (Carbo)
 Doxorubicin (Dox)
 Paclitaxel (Taxol)
 Trastuzumab
(Herceptin) – tests are done
to see if you are HER 2 +ve (overexpress
HER 2)
 If you are HER 2 +ve you will be given
Herceptin with your chemotherapy.
 Treatment may start immediately with
chemotherapy or be delayed a few weeks
 When chemotherapy finishes you will
continue to have Herceptin for a total of
52 weeks.
Hormonal therapies only work in women whose
cancer cells have receptors for oestrogen and/or
progesterone on their surface. ER+ or PR+
 Hormonal therapy deprives the cancer of the
hormone oestrogen which many breast cancers
need to grow.
 They are given after chemotherapy to reduce
the chance of the cancer coming back.
 Tamoxifen blocks oestrogen activity in the body
 Letrozole(Femara), Exemestane(Aromasin) and
Anastrozole(Arimidex) stop the body from
making oestrogen
 Goserelin (Zoladex)
 Patients
may be offered a choice of
chemotherapy treatments, as different drug
combinations can cause different side
 Some patients may be offered to go on a
clinical trial.
 Clinical trials are carried out to compare
different types of therapy, to improve
effectiveness and reduce side effects.
 Chemotherapy
drugs are often used in
combination. These are called chemotherapy
regimens or protocols.
(5-FU, Epirubicin, Cyclophosphamide x 6)
 FEC-D(T) (FEC x 3- Docetaxel x 3)
 AC-T(H) (Doxorubicin, Cyclo x 4 – Taxol x 4)
 TAC (Docetaxel, Doxorubicin, Cyclo x 6)
 TCH (Docetaxel, Carboplatin, Herceptin x 6)
 TC (Docetaxel, Cyclophosphamide x 4)
 Pre-meds
are given prior to chemotherapy to
help reduce hypersensitivity reactions and
side effects.
 They are given orally and intravenously
starting the day before chemotherapy or just
prior to chemotherapy
 Antiemetic's, steroids, antihistamines and
pain killers are used.
 Mostly to prevent nausea, fluid retention and
 They can cause headaches and constipation
 Dexamethasone
– steroid used to prevent
nausea and fluid retention. Given IV just
prior to chemotherapy and orally up to three
days after. Sometimes taken twice a day
starting the day before chemotherapy
 Kytril – (Granisetron) given IV just prior to
chemotherapy and orally in the morning on
days 2 and 3
 Phenergan – (Promethazine) given IV just
prior to chemotherapy to help prevent an
allergic reaction
 Panadol – (Paracetamol) for pain and fever
 Maxolon
– (Metoclopramide, 10mg) used for
breakthrough nausea and vomiting. 1-2
tablets up to 4-6 hourly.
 Stemetil – (Prochlorperazine, 10mg) 1 tablet
every 4 to 6 hours for breakthrough
 Stemetil Suppositories – (Prochlorperazine)
25mg rectally every 12 hours.
 Ativan – (Lorazepam, 1mg) – 1 tablet placed
under the tongue every 4 to 6 hours if
needed for breakthrough nausea.
Neutropenia - reduced numbers of white blood
cells which can lower resistance to infection
- can begin 7 days after treatment
and reaches its lowest point 10-14 days after
- WBC usually increase steadily and
return to normal before your next cycle.
- Contact your doctor if your
temperature goes above 38 C or if you suddenly
feel unwell
o Neulasta – Injection given 24 hours after
chemotherapy which stimulates the level of
white blood cells (neutrophils). This can allow
frequent dosing of chemotherapy and diminish
tumour regrowth.
 Bruising
or bleeding – reduced numbers of
platelets which help the blood to clot
- contact your doctor if
you have unexplained bruising or bleeding such
as nosebleeds or bleeding gums
 Anaemia
– low red blood cell count
- may make you feel tired or
Nausea or vomiting
 Diarrhoea/Constipation
 Tiredness or fatigue
 Hair Loss – usually starts 2 -3 weeks after you
start your chemotherapy. Thinning of the
eyelashes, eyebrows and other body hair may
also occur. Hair loss is temporary.
 Sore mouth and ulcers – your mouth may become
sore or dry. Drink plenty of fluids, clean teeth
regularly with a soft brush, floss daily. Use
mouthwashes regularly (half a teaspoon of salt
or bicarbonate of soda in a glass of water)
 Taste
 Irritation of the bladder – cyclophosphamide
 Pink urine – Doxorubicin/Epirubicin
 Skin changes
 Sensitivity to the sun – use sunscreen/hat
 Fluid retention
 Nail changes
 Allergic reactions
 Pain in joints or muscles
 Numbness or tingling in hands and feet
 Flu-like
 Diarrhoea
 Headaches
 An allergic reaction
 Cardiotoxicity – usually mild and reversible
 Hot
 Vaginal dryness or itching
 Loss of libido
 Psychological effects
 Joint aches or pains