I’ve discussed previously adjuvant therapy for breast cancer. There are two classifications for cancer treatments: adjuvant and neoadjuvant. Neoadjuvant therapy is treatment administered prior to primary therapy. This is usually done in cases where the tumor is inoperable or too large in its current state, and the desire is to shrink it prior to surgery. For example, the initial tumor size would require a mastectomy (total breast removal), but the patient desires a breast-conserving lumpectomy (where only the tumor and immediately surrounding tissue are removed). Administering chemotherapy first allows the patient the opportunity to possibly preserve her natural breasts and avoid the potentially unnecessary added pain of a mastectomy and subsequent (if pursued) breast reconstruction process, which is pretty intense. If the tumor does not respond favorably to the chemotherapy, the type of drug may be changed, dosage modified, treatment paused to go ahead and perform a more advanced surgery, then resume chemotherapy if indicated. There are numerous possibilities. It all depends on the individual case, stage, and type of cancer.
Neoadjuvant therapy currently only includes chemotherapy, as other forms of therapy such as hormonal therapy, targeted therapy (Herceptin/trastuzumab), and radiation are still reserved and administered post-surgically. There are clinical trials in the process to determine the therapeutic benefits of administering hormonal therapy and Herceptin in a neoadjuvant capacity.
So what side effects come with neoadjuvant therapy? The actual chemotherapy drugs used in neoadjuvant therapy are the same drugs used in adjuvant therapy. What distinguishes between the two therapy processes is the order in which treatments are administered. That being said, I’ll address the side effects of the general medicine classes.
Chemotherapy reactions are as varied as there are drugs to treat. Anticancer chemotherapy drugs work by killing rapidly dividing cells – all rapidly dividing cells. This includes some blood cells, which carry oxygen throughout the body, enable the blood to clot, and fight off infections, as well as hair follicle cells, which is why women’s hair, and sometimes eyelashes and eyebrows, fall out with the administration of chemotherapy. Other common side effects include the well-known vomiting, nausea, appetite loss, mouth sores, and diarrhea.
Oncologists or other doctors coordinating the patient’s care can prescribe medications to assist with symptom management. There are medications to suppress nausea and vomiting, stimulate appetite, stop diarrhea, etc. Doctors will routinely (often weekly to twice a week) monitor the patient’s blood cell counts; however, while receiving chemotherapy, patients are advised to avoid people who have colds, are sick, and crowds in general. My doctor’s advice was to avoid ‘foreign germs’ as much as possible – that meant it was okay to be around the people my body was accustomed to being around, but to avoid infrequent visitors and limit shopping excursions (something I was unsuccessful with because I had to get out to control complications with my depression that were caused by feeling so sick and being cooped up in the house all the time.) Drugs called anthracyclines, like Adriamycin, are notorious for causing heart problems. Patients who receive these drugs will often have their hearts monitored periodically for the remainder of their lives.
I underwent neoadjuvant therapy. My tumor was the size of an average woman’s fist. I wear a size 7 ring if that gives you an idea of the size of my hands, and it was the size of my fist. It took up more than 25% of my breast mass, close to the breast wall, and rock solid. It was like having a big rock in my breast. Seriously. It was invasive and aggressive and, at the time of diagnosis, surgery was not an option because the tumor was so large. Even after neoadjuvant therapy, with a very responsive tumor, I still opted for a bilateral mastectomy because of the severity of my cancer and my family history of the disease. I had 5 months of chemotherapy, followed by surgery, then radiation, then ultimately four more surgeries related to my cancer – three for breast reconstruction and a complete hysterectomy. I do not regret the decisions I made. I’m 31 and have no uterus, and no, I cannot birth any more children, but I have one precious little girl who is my world, and I’m alive to raise her. That is something no one can put a value on, for it is immeasurable.