Chemotherapy

In our new blog series, we're taking a close look at breast cancer treatments   When it comes to finding better ways to treat breast cancer, it’s easy to think of the brand new ‘targeted’ drugs as the treatments of tomorrow. But there’s plenty of research into improving ‘cornerstone’ treatments – namely surgery, chemotherapy, and radiotherapy – that have been the basis of breast cancer treatment for decades, or even centuries.   Here, we’ll be looking into each of these treatments and how research is making sure they are as effective as possible, with thoughts from leading experts in the field  

Chemotherapy and breast cancer treatment
Chemotherapy can be used to treat both primary and secondary breast cancer, but the reasons in each case are different, In early breast cancer, the objective of any treatment is cure, to put it very simply. With chemotherapy, we aim to eradicate any breast cancer cells, wherever they may be in the body. In advanced disease however, things are different because the objective is to control the disease for as long as possible, whilst minimising the disruption to quality of life. This is an important consideration for people with secondary breast cancer – if you’re treating a patient but making a significant amount of their remaining life miserable, then perhaps you should think twice”. Whilst it is clearly a useful treatment, “chemotherapy has a bad reputation in the minds of the general public, without a shadow of a doubt”. There are some side-effects that a lot of breast cancer patients experience – tiredness, sickness, and hair loss being some of the most common – and others which are rarer but can be life-threatening. Research over the years has helped doctors find ways to control symptoms – for example, the development of anti-sickness medicines to combat nausea has improved quality of life for many patients, and has enabled more people to tolerate and benefit from chemotherapy.  
A bright idea from a dark history
What many people don’t know about chemotherapy is that these drugs came as a result of one the darkest periods of history – the Second World War. After a group of American sailors was exposed to the chemical weapon mustard gas during an attack on an Allied base in Italy in 1943, scientists were intrigued to find that many of them had fewer white cells in their blood. They guessed that if chemicals in mustard gas could kill normal healthy white blood cells, they might also be able to kill cancerous blood cells too. Trials started soon after, and sure enough, drugs based on mustard gas were found to be an effective treatment for blood cancers like leukaemia and lymphoma – and so modern cancer chemotherapy began. One of the drugs that were developed during this time was cyclophosphamide, which many breast cancer patients still receive today. Newer drugs have been developed – some from unusual sources, such as taxanes which were originally isolated from the bark of yew trees.
Making better decisions
 
What is next for chemotherapy?   For most people with primary triple negative or HER2-positive breast cancer, chemotherapy is considered to be an essential part of their treatment. However, the benefit is less clear-cut for people with hormone-positive breast cancer, so these patients are offered chemotherapy if there’s a high risk that their breast cancer might come back or spread in the future. Currently, this risk is calculated using features such as the size and the grade of the tumour, and whether the cancer has already spread to lymph nodes near the breast.



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