Chemotherapy for secondary breast cancer

Chemotherapy uses anti cancer drugs (cytotoxic drugs) to destroy cancer cells. The drugs circulate in the bloodstream around the body. Your specialist may suggest either chemotherapy or hormone therapy when you are diagnosed with secondary breast cancer. You are likely to have chemotherapy in any of the following situations

• Your cancer does not have many receptors for oestrogen so hormone therapy is not likely to work well
• Your cancer is in the liver or lung
• You have already had hormone therapy and it is no longer controlling the cancer

If your breast cancer is oestrogen receptor negative (ER -ve) your specialist may suggest chemotherapy as soon as your secondary cancer is diagnosed. This is because hormone therapy is less likely to help you.

If your cancer responded to hormone treatment in the past, it may well do again. But sometimes, after you have had a few different types, breast cancer stops responding to it so well. Then your doctor may offer chemotherapy.

You usually have chemotherapy as a series of treatments a few weeks apart. Each round of treatment is known as a chemotherapy cycle. After each cycle you have a break for about 3 or 4 weeks. The exact schedule of treatment depends on the drugs you are having.

Your complete treatment may last several months. Although you may take some chemotherapy drugs as tablets or capsules, treatment is more often given as injections into the bloodstream. Most people can have treatment as an outpatient and go home after the injections and drips. But sometimes you may need to spend a day or two in hospital. Again, this depends on the particular drugs that you have.

In many situations, the chemotherapy drugs for secondary breast cancer are the same as those used for primary breast cancer. There is information about these drugs in the main chemotherapy for breast cancer section.

The drugs used most often for secondary breast cancer at the moment are

• Docetaxel (Taxotere)
• Vinorelbine (Navelbine)
• Capecitabine (Xeloda)
• Paclitaxel (Taxol)
• Gemcitabine (Gemzar)

You can use the links above to go to information about these drugs. The drugs may be used in combination – for example, gemcitabine and taxol, or capecitabine and docetaxel. 

Other drugs that doctors sometimes use include

• Epirubicin (Pharmorubicin)
• A new type of paclitaxel called Abraxane
• Eribulin mesylate

Biological therapies called trastuzumab (Herceptin) and lapatinib (Tyverb) are also used to treat secondary breast cancer. You may have them alongside chemotherapy. There is information about biological therapies for secondary breast cancer in this section.

Chemotherapy has some general side effects. The drugs kill cancer cells because they divide quickly. Your blood cells also divide rapidly, so chemotherapy can lower the number of healthy white blood cells, red blood cells and platelets you have. This can mean you

• Are more likely to get infections
• May be more tired than usual
• Can be prone to nosebleeds and other bleeding problems

If you develop a temperature above 38°C or think that you have an infection, it is very important to contact the hospital immediately. You may need urgent treatment with antibiotics. Your doctor or chemotherapy nurse will give you an emergency number to phone if you need to. There is detailed information about the effect of chemotherapy on your blood cells in the main chemotherapy section.

Tiredness (fatigue) is the most common side effect for people having chemotherapy. It may continue for some months after your treatment ends. How quickly you get back to normal will depend on various factors including

• Your general health
• The amount of treatment you've had
• Other treatments you have had

Other side effects of chemotherapy for secondary breast cancer can include

• Feeling sick (nausea) and being sick
• Hair loss or thinning
• A sore mouth
• Diarrhoea
• Sore eyes – they may feel as if they have grit in them. Let your doctor or breast care nurse know, as eyedrops can help.

You can use the links above to go to pages in the cancer drugs section that tell you about coping with the side effects. Side effects may seem hard to bear at the time. But most of them disappear when your treatment ends.

If you want to know more about chemotherapy, you can talk to your doctor or the nurses involved in your treatment. There is general information in the main chemotherapy section. You can also contact the Cancer Research UK nurses. 

There are books and booklets about chemotherapy, some of which are free. Look at our breast cancer reading list.  

If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.