Specific Drug Information

Chemotherapy drugs differ in their chemical structure, their relationship to another drug, and how they act in an each person's body. Although the goal of using them is the same--to eliminate breast cancer cells from the body--knowing how each drug works is important in predicting side effects and determing which drug(s) work best for you. The following descriptions of specific drugs used for breast cancer may increase your awareness of side effects and general concerns related to the use of each drug.

If you need to contact the Breast Care Center about a question or concern about your chemotherapy, call 415-353-7070. During clinic hours Monday through Friday, the triage nurse will return your call. After 5 p.m. or on weekends, an on-call doctor will return your call.

1. "AC" or Doxorubicin (Adriamycin®), Cyclophosphamide (Cytoxan®)

How do these drugs work?

These chemotherapy drugs prevent division of DNA and growth of cancer cells and may also injure normal cells that grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen) platelets (which help blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Nausea, vomiting
Hair loss
Metallic taste (when Cytoxan® is given)
Mouth sores and throat irritation
Fatigue
Premature menopause (stopping of menstrual periods, which is often permanent)

Less common side effects with your type of chemotherapy

ADRIAMYCIN®

Sensitivity to sunlight
Skin and tissue damage may occur to the area in which Adriamycin? is given, if the drug leaks out of the vein into the tissue
Dry skin and blistering to areas previously treated by radiation
Heart muscle weakness (also called cardiomyopathy)
Watery, sore eyes
Skin rash and itching

CYTOXAN®;

Bladder bleeding and irritation
Nasal stuffiness, sneezing, watery eyes (when Cytoxan® is given)
Dizziness, confusion, agitation
Yellowing of skin and/or eyes

As with any drug, other side effects that were not mentioned may occur.

General concerns

Report vomiting or nausea that is not relieved with anti-nausea medication
If you have a fever of 101° F (38.3° C) with or without chills, or chills alone, call the nurse immediately. If you cannot reach the nurse or on-call doctor (after hours), go to an emergency room
Report nose bleeds, gum bleeds, or any unusual bruising
Avoid direct sunlight. Wear sunscreen and sunglasses for protection
Ask your nurse about special mouth rinses to prevent mouth sores
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you

Other concerns with your AC chemotherapy

ADRIAMYCIN®

Your urine may turn pink or red up to 2-3 days after the drug is given to you. This is not blood and is not harmful.
Report to the nurse immediately any redness, swelling, or discomfort along the injection site.
Report chest discomfort or pain.

CYTOXAN®

Drink 8-10 glasses of fluid each day for two days after your treatment. Urinate often (about every 2 hours while awake). Drinking fluids and urinating often will help prevent any bladder irritation.
Report nasal stuffiness while getting the drug.
Immediately report blood in urine or painful urination.

2. Capecitabine (Xeloda®)

How does this drug work?

Xeloda®is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines. It is a "prodrug" meaning that it is broken down and activated in your body to the active drug called fluorouracil (5-FU). Xeloda® is taken by mouth for 2 or 3 weeks every month.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Hand-foot reaction: skin on palms of hands or soles of feet may be dry, cracked, red, numb, painful or swollen
Fatigue or tiredness

Less common side effects with your type of chemotherapy

Nausea, vomiting
Diarrhea
Mouth sores
Hair loss (rare)
Sun sensitivity

As with any drug, other side effects that were not mentioned may occur

General concerns

Report nausea or vomiting that is not relieved by anti-nausea medication
If you have a fever of 101° F (38.3° C) with or without chills, or chills alone, call the nurse immediately. If you cannot reach the nurse or on-call doctor (after hours), go to an emergency room.
Report nose bleeds, gum bleeds, or any unusual bruising
Report hand-foot reactions
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you

Other concerns with your type of chemotherapy

To prevent hand-foot reaction, do not wear tight fitting shoes or perform activities that may place pressure on your hands or feet. You may also use creams on your hands and feet.

3. Carboplatin (Paraplatin®)

How does this drug work?

Paraplatin® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding.
Nausea/vomiting
Fatigue or tiredness

Less common side effects with your type of chemotherapy

Drug reaction: difficulty breathing, shortness of breath, flushing, low blood pressure
Hair loss (rare)
Numbness or tingling in hands and feet

As with any drug, other side effects that were not mentioned may occur

General concerns

Report vomiting or severe nausea not relieved by anti-nausea medication
If you have a fever of 101° F (38.3° C) with or without chills, or chills alone, call the nurse immediately. If you cannot reach the nurse or on-call doctor (after hours), go to an emergency room.
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable

4. Cisplatin (Platinol®)

How does this drug work?

Platinol® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Nausea/vomiting
Numbness or tingling of the hands and feet
Fatigue or tiredness

Less common side effects with your type of chemotherapy

Mouth sores
Diarrhea
Ringing in your ears
Drug reaction (rare): difficulty breathing, shortness of breath, flushing, low blood pressure
Hair loss (rare)

As with any drug, other side effects that were not mentioned may occur

General concerns

Report vomiting or severe nausea not relieved by anti-nausea medication
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any changes in your hearing or ringing in your ears
Report any muscle cramps or pain

Other concerns with your type of chemotherapy

Platinol® may cause a decrease in your kidney function. You may get intravenous fluid hydration before and after your treatment to decrease the risk of kidney problems. Make sure you drink lots of fluids around the time of your treatment; usually the day before, the day of and the day after chemotherapy.
Platinol® may cause a decrease in potassium and/or magnesium levels. If this occurs, you may get potassium and/or magnesium replacement either intravenously or orally.

5. "CMF" or Cyclophosphamide (Cytoxan®), Methotrexate (MTX), Fluoracil (Adrucil®, 5-FU)

How do these drugs work?

These are "chemotherapy" drugs that destroy cancer cells and may also kill normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Nausea, vomiting, and diarrhea
Hair thinning and hair loss
Mouth and throat irritation and sores
Irritation of the eyes
Metallic taste and taste changes in general
Skin reactions: rash, itchy skin, discoloration
Fingernail splitting or darkening
Watery or dry eyes, eye discomfort
Menopause symptoms - hot flashes, dry vaginal mucosa
Fatigue

Less common side effects with your type of chemotherapy

CYTOXAN®

Bladder bleeding and irritation
Nasal stuffiness, sneezing, watery eyes (when Cytoxan® is given)
Dizziness, confusion, agitation
Yellowing of skin and/or eyes

METHOTREXATE

Sensitivity to light
Difficulty breathing
Swelling of legs and feet
Yellowing of skin and/or eyes
Liver irritation and increased liver function tests

ADRUCIL®

Sensitivity to light
Mild depression
Difficulty with balance and walking
Rare blood clots causing chest pain, heart attack, or stroke

As with any drug, other side effects that were not mentioned may occur

General concerns

Report vomiting or nausea that is not relieved with anti-nausea medication.
Immediately report any fevers of 101° or higher, with or without chills.
Report nose bleeds, gum bleeds, or any unusual bruising.
Report more than 5 watery stools a day.
Avoid direct sunlight. Wear sunscreen and sunglasses for protection.
Ask your nurse about special mouth rinses to prevent mouth sores.
Ask your doctor about a birth control method for you.
Report any symptoms which are unusual for you.

Other concerns with your CMF chemotherapy

CYTOXAN®

Should be taken on an empty stomach.
Drink 8-10 glasses of fluid each day for two days after your treatment. If you are taking Cytoxan® by mouth, take the pill in the morning and continue drinking fluids for as long as you are taking the drug. Urinate often (about every 2 hours while awake). Drinking fluids and urinating often will help prevent any bladder damage.
Report nasal stuffiness while getting the drug.
Immediately report blood in urine or painful urination.

METHOTREXATE

Do not take aspirin-containing products, NSAIDs (Advil®, Motrin®), sulfa drugs, or alcohol while getting methotrexate.
Report to your nurse, doctor, or pharmacist if you are taking anticoagulants or blood-thinners.
Report pain or difficulty with urination.
Report any dry cough, shortness of breath, or chest pain.

ADRUCIL®

Report any balance or movement difficulty.
Report any chest pain, dizziness, or changes in vision to your physician or nurse.

6. Docetaxel (Taxotere®)

How does this drug work?

Taxotere® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines. It is similar to another drug called Taxol®.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Nausea, vomiting
Hair loss
Rash
Bloating, weight gain, swelling
Tingling of the hands and feet

Less common side effects with your type of chemotherapy

Drug reaction: difficulty breathing, shortness of breath, flushing, low blood pressure
Mouth sores
Irregular heart beat
Muscle ache
Skin damage may occur to the area in which Taxotere is given, if the drug leaks out of the vein into the tissue
Shortness of breath, fluid in the lungs
Excessive tearing

As with any drug, other side effects that were not mentioned may occur

General Concerns

To help prevent a drug reaction from occurring, you will be given medication before receiving Taxotere®. However, if you experience any difficulty breathing, lightheadedness, or other changes during the Taxotere® infusion, report symptoms immediately.

Report vomiting or nausea that is not relieved with your anti-nausea medication.
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any shortness of breath especially during the infusion of Taxotere®.

7. Liposomal Doxorubicin (Doxil®)

How does this drug work?

Doxil® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines. Doxil® has the same active drug as doxorubicin (Adriamycin®). But Doxil® is different from Adriamycin® because it is made with a layer of fat (liposome) around it, so it is called liposomal doxorubicin. The liposome protects Doxil® from being broken down by the body so about 90% of the drug can reach the cancer cells. Doxil® is an anthracycline chemotherapy and is similar to epirubicin (Ellence®).

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Irritate skin on hands and feet; skin can be red, dry, and/or painful and can crack, peel, and/or swell
Mouth sores
Sensitivity to sunlight

Less common side effects with your type of chemotherapy

Nausea, vomiting
Diarrhea or constipation
Skin damage may occur to the area in which Doxil® is given, if the drug leaks out of the vein into the tissue
Drug reaction: difficulty breathing, shortness of breath, flushing, low blood pressure

As with any drug, other side effects that were not mentioned may occur

General Concerns

Report vomiting or nausea that is not relieved with anti-nausea medication
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any shortness of breath especially during the infusion of Doxil®.

Other concerns with your Doxil® chemotherapy

Infusion reaction may occur with your first Doxil® treatment. You will not need any medications to prevent the reaction. The infusion time for the first Doxil dose will be longer, over 60 minutes. If you tolerate the treatment well, you will receive subsequent treatments over 30 minutes.
Your urine may turn pink or red up to 2 days after the drug is given to you. This is not blood and is not harmful.
Report to the nurse immediately any redness, swelling, or discomfort along the injection site.
Report chest discomfort or pain.
Doxil® may rarely cause heart muscle weakness (also called cardiomyopathy). Your doctor may periodically monitor your heart function by having you get an echocardiogram.
To prevent hand-foot reaction, do not wear tight fitting shoes or perform activities that may place pressure on your hands or feet. You may also use creams on your hands and feet.

8. Epirubicin (Ellence®)

How does this drug work?

Ellence® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines. Ellence® is an anthracycline chemotherapy and is similar to doxorubicin (Adriamycin®) and liposomal doxorubicin (Doxil®).

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Hair loss
Nausea and vomiting
Mouth sores
Premature menopause (stopping of menstrual periods, which is often permanent)

Less common side effects with your type of chemotherapy:

Diarrhea
Fatigue
Skin damage may occur to the area in which Ellence® is given, if the drug leaks out of the vein into the tissue
Heart muscle weakness (also called cardiomyopathy)

As with any drug, other side effects that were not mentioned may occur

General Concerns

Report vomiting or nausea that is not relieved with anti-nausea medication
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable

Other concerns with your Ellence® chemotherapy

Your urine may turn pink or red up to 2 days after the drug is given to you. This is not blood and is not harmful.
Report to the nurse immediately any redness, swelling, or discomfort along the injection site.
Report chest discomfort or pain.
Ellence® may cause weakness of your heart muscle, especially if you have received other anthracycline chemotherapy in the past. You may receive another intravenous medication called dexrazoxane (Zinecard®) before each Ellence® treatment. Zinecard® is given to protect your heart from potential problems caused by anthracycline chemotherapy. Your doctor may periodically monitor your heart function by having you get an echocardiogram.

9. Gemcitabine (Gemzar®)

How does this drug work?

Gemzar® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Nausea/vomiting
Swelling of hands, feet or lower legs
Rash
Fatigue or tiredness

Less common side effects with your type of chemotherapy

Hair loss
Diarrhea
Flu-like symptoms: fever, chills, headache, muscle or joint pain, fatigue

As with any drug, other side effects that were not mentioned may occur

General concerns

Report vomiting or severe nausea
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable

Other concerns with your type of chemotherapy

Flu-like symptoms will usually go away on their own. You may take Tylenol® if needed. If you have a fever, you should report this immediately.

10. Ixabepilone (Ixempra™)

How does this drug work?

Ixempra™ is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Hair loss
Numbness or tingling of the hands and feet
Muscle ache

Less common side effects with your type of chemotherapy:

Drug reaction: difficulty breathing, shortness of breath, flushing, low blood pressure
Nausea, vomiting
Diarrhea or constipation
Mouth sores
Rash

As with any drug, other side effects that were not mentioned may occur

General Concerns

To help prevent a drug reaction from occurring, you may be given medication before receiving Ixempra™. However, if you experience any difficulty breathing, lightheadedness, or other changes during the Ixempra™ infusion, report symptoms immediately.

Report vomiting or nausea that is not relieved with anti-nausea medication.
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any shortness of breath especially during the infusion of Ixempra™.

Other concerns with your type of chemotherapy

There may be drug interactions between Ixempra™ and some antibiotics and other medications. It is important that you tell your doctor all medications that you are currently taking before you start Ixempra™.

11. Paclitaxel (Taxol®)

How does this drug work?

Taxol® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines. It is a "taxane" chemotherapy similar to Abraxane® and Taxotere®.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Hair loss
Rash
Bloating, weight gain, swelling
Numbness or tingling of the hands and feet

Less common side effects with your type of chemotherapy

Drug reaction: difficulty breathing, shortness of breath, flushing, low blood pressure
Nausea, vomiting
Diarrhea
Mouth sores
Muscle ache
Skin damage may occur to the area in which Taxol® is given, if the drug leaks out of the vein into the tissue
Irregular heart beat

As with any drug, other side effects that were not mentioned may occur

General Concerns

To help prevent a drug reaction from occurring, you will be given medication before receiving Taxol®. However, if you experience any difficulty breathing, lightheadedness, or other changes during the Taxol® infusion, report symptoms immediately.

Report vomiting or nausea that is not relieved with anti-nausea medication.
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any shortness of breath especially during the infusion of Taxol®.

12. Protein-Bound Paclitaxel (Abraxane®)

How does this drug work?

Abraxane® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair follicles, cells that line the mouth, stomach, and intestines. Abraxane® is bound to a protein called albumin which decreases the potential for drug reactions. It is a "taxane" chemotherapy similar to Taxol® and Taxotere®.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen and help against feeling tired), and platelets (which cause blood to clot). A low number of these cells may lead to infection, anemia, and bleeding
Hair loss
Numbness or tingling of the hands and feet
Feeling tired or weak

Less common side effects with your type of chemotherapy

Nausea, vomiting
Diarrhea
Swelling of hands, feet, or lower legs
Mouth sores
Muscle ache
Cough, shortness of breath

As with any drug, other side effects that were not mentioned may occur

General Concerns

Report vomiting or nausea that is not relieved with anti-nausea medication
If you have a fever of 101° F (38.3° C) with or without chills, or chills alone, call the nurse immediately. If you cannot reach the nurse or on-call doctor (after hours), go to an emergency room.
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you
Report any swelling which is uncomfortable
Report any shortness of breath

13. Temozolomide (Temodar®)

How does this drug work?

Temodar® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines. Temodar® is taken by mouth on an alternating schedule of one week on treatment and one week off treatment.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Fatigue or tiredness
Headache
Nausea, vomiting

Less common side effects with your type of chemotherapy

Constipation or diarrhea
Rash
Mouth sores

As with any drug, other side effects that were not mentioned may occur

General concerns

Report nausea or vomiting that is not relieved by anti-nausea medication
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you

14. Vinorelbine (Navelbine®)

How does this drug work?

Navelbine® is a "chemotherapy" drug that prevents cancer cell division and may also injure normal cells which grow fast such as blood cells, hair, cells that line the mouth, stomach, and intestines. It is known as a "vinca" type of chemotherapy and inhibits the cell spindle which is necessary for cell division and growth.

Common side effects

Lowers number of white blood cells (which fight against infection), red blood cells (which carry oxygen), and platelets (which helps blood clot). A low number of these cells may lead to infection, anemia, and bleeding
Skin damage may occur to the area in which Navelbine® is given, if the drug leaks out of the vein into the tissue
Constipation
Hair thinning
Numbness, tingling or weakness in hands or feet
Fatigue or tiredness
Temporary soreness of the shoulders, back, and thigh (known as myalgia) may occur.

Less common side effects with your type of chemotherapy

Nausea, vomiting

As with any drug, other side effects that were not mentioned may occur

General concerns

Report vomiting or severe nausea lasting more than 1 day
Immediately report any fevers of 101° or higher, with or without chills
Report nose bleeds, gum bleeds, or any unusual bruising
Ask your doctor about a birth control method for you
Report any symptoms which are unusual for you

Other concerns with your type of chemotherapy

Report to the nurse immediately any redness, swelling, or discomfort along the injection site.
To prevent constipation, eat high fiber foods such as whole-grain cereal, bran, raw vegetables, and fruits. Drink plenty of fluids. Take a stool softener as needed. Ask your nurse about additional medications to prevent constipation.