Chemotherapy and metastatic breast cancer

How it works

Chemotherapy uses drugs known as “cytotoxics” to kill cancer cells or disrupt their growth. Chemotherapy can be used to control or slow the growth of metastatic breast cancer, relieve symptoms and improve quality of life.  

Chemotherapy may be used to treat people with metastatic breast cancer that do not have hormone receptors on the breast cancer cells, including triple negative or HER2 receptor-positive, hormone receptor-negative metastatic breast cancers. It may also be used for people who have hormone receptor-positive metastatic breast cancer that has stopped responding to hormone-blocking therapies or to treat metastatic breast cancer that is growing quickly, especially in the liver or lungs.

How it's given

Chemotherapy is most commonly delivered by intravenous (IV) infusion – known as a “drip” – or in tablet form. Often used on their own for metastatic breast cancer, chemotherapy drugs may also be given in combination with other medicines.

Many different types of chemotherapy are available, and your doctor and cancer nurse will be able to explain the possible benefits and side effects of the drugs to you.  

Side effects

Chemotherapy works by targeting fast-growing cells. Unfortunately, while these include cancer cells, there are also fast-growing cells in other areas of the body, such as the hair, nails, bone marrow and digestive system. This is why side effects including low blood counts and hair loss may occur with chemotherapy. Not everyone has significant side effects, and most side effects stop when the treatment stops. 

Chemotherapy will be given as long as it is effective in treating the cancer and not causing too many side effects. For some people chemotherapy can be effective in controlling the cancer for a long time.

It is important that you talk to your medical oncologist and cancer nurse if you are concerned about any side effects that you experience. Read more about Managing symptoms and  side effects

Common types

Some of the common chemotherapy drugs used to treat metastatic breast cancer include: 

• taxanes (e.g. paclitaxol) 
• eribulin (Halaven)  
• anthracyclines (e.g doxorubicin) 
• platinum agents (e.g carboplatin)  
• capecitabine (Xeloda)  
• vinorelbine (Navelbine) 
• gemcitibine (Gemzar). 

Central venous access 

Ports and PICCs 

Chemotherapy drugs are commonly given intravenously – injected or dripped into a vein through a cannula (thin plastic tube) inserted into your arm or hand. Because you may be having chemotherapy regularly over a period of time, there are options that can make this easier. 

A central venous access device, also known as a port-a-cath, infusaport or simply a “port” is one option. It provides access via a very slender, flexible tube that feeds directly into one of the major veins near the heart. A port is implanted under the skin in the chest wall or, less commonly, the arm, and it can stay in place for as long as you need it. The procedure to insert a port can be done in the radiology department under local anaesthetic or in surgery under general anaesthetic. 

An alternative to a port is a peripherally inserted central catheter line, which is also called a PICC. A PICC is inserted into a vein in the arm near the elbow and travels into a larger vein near the heart. Central catheters are generally inserted under local anaesthetic in the radiology or outpatient department. The procedure usually takes about 30 minutes, and you will then need a chest X-ray to check that the PICC is correctly positioned. A PICC can be used in hospital settings or at home and can stay in place for weeks or months if needed. 

Both a port and a PICC can be used for giving chemotherapy drugs, blood transfusions and antibiotics when needed and taking blood for tests, so there’s no need to find a suitable vein each time for blood collection. 

The advantage of having a port or PICC line is that it can spare your veins from the frequent “needle sticks” associated with chemotherapy and blood tests. It can also spare your veins and blood vessels from the irritating effects of intravenous medications, which over time can make your veins sore, scarred and no longer be usable for access.

A port – because it is under the skin – is less susceptible to infection and does not require dressings. As it is not visible, other than a minor swelling under the skin, it is also less intrusive than a PICC line.