Chemotherapy in Breast Cancer

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VivitraTM (Trastuzumab) is a highly biosimilar medicinal product of reference biologic. It is a humanized monoclonal anti-HER2 (Human epidermal growth factor receptor 2) antibody. It comprises of 1328-amino acids; glycoprotein.

Not all people have serious side effects, but side effects with VivitraTM (Trastuzumab) therapy are common. Your doctor will stop treatment if any serious side effects occur.

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Breast Cancer Treatment

Breast Cancer Drugs in India


Breast Cancer Drugs in India
  • BCS (Breast Conservative Surgery): Partial mastectomy, Lumpectomy- removes only a part of the breast.
  • Mastectomy: If just the breast is removed (and not lymph nodes under the arm) it is called a simple (or total) mastectomy. A simple mastectomy combined with an axillary lymph node dissection (discussed below) is called a modified radical mastectomy.
  • Skin-sparing mastectomy: For some women considering immediate reconstruction, skin-sparing mastectomy can be done. In this procedure, most of the skin over the breast (other than the nipple and areola) is left intact.
  • Radical mastectomy: In this operation, the surgeon takes a modified radical mastectomy one step further by also removing the muscles of the chest wall under the breast. This is only needed if the cancer is growing into the muscles under the breast.
  • Axillary lymph node dissection: In this operation, about 10 to 40 (though in most cases less than 20) lymph nodes are removed. Axillary lymph node dissection is usually done at the same time as the mastectomy or breast-conserving surgery.
  • Sentinel lymph node biopsy: A sentinel lymph node biopsy is a way to learn if cancer has spread to the lymph nodes under the arm without removing so many of them. For this test, a radioactive substance and/or a blue dye are injected into the breast. This is carried by the lymph system to the nodes that first get lymph from the tumor. These lymph nodes (called the sentinel lymph nodes) are also the one most likely to contain cancer cells if the cancer has spread. The surgeon then removed the nodes containing the blue dye or radiation.

Radiation Therapy1,2

Breast Cancer Drugs in India

Radiation therapy is treatment with high-energy rays (such as x-rays) or particles to kill cancer cells. Radiation therapy may be used to kill cancer cells remaining in the breast, chest wall, or underarm area after surgery or, less often, to shrink a tumor before surgery. Radiation to the breast is often needed after breast-conserving surgery. Radiation may also be recommended after mastectomy in patients either with a cancer larger than 5 cm, or when cancer is found in the lymph nodes.It is usually given after any chemotherapy. Radiation is also used to treat cancer that has spread to other areas, for example to the bones or brain.


Breast Cancer Drugs in India

Chemotherapy (chemo) is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and reach most parts of the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.

Chemo can be used either before or after surgery for early-stage breast cancer. This is to kill any cancer cells that may have spread but are too small to be seen by exam or tests.

  • When chemo is given after surgery to patients who have no signs of cancer spread it is called adjuvant chemo. This lowers the chance of the cancer coming back later.
  • When chemo is given before surgery to cure the cancer it is called neoadjuvant chemo. This can shrink large cancers so that they are small enough to be removed with breast-conserving surgery instead of mastectomy. It also works as well as adjuvant chemo in lowering the chance that the cancer will come back later.

Chemo can also be used as the main treatment for women with cancer that has spread to distant sites (outside the breast and the nearby lymph nodes).

Hormone therapy: (ESMO guidelines) 1,2

Breast Cancer Drugs in India
  • Premenopausal patients: Tamoxifen 20 mg/day for 5–10 years.
  • In patients becoming postmenopausal during the first 5 years of tamoxifen, a switch to letrozole, an aromatase inhibitor (AI), seems to be particularly beneficial.
  • Postmenopausal patients: Aromatase inhibitors.

Targeted therapy1,2

Breast Cancer Drugs in India

Most of the targeted drugs used to treat breast cancer target HER2/neu. In some patients, their breast cancer cells have too much of this protein. Certain drugs target this protein, stopping it from causing breast cancer cell growth. These are trastuzumab, pertuzumab, ado Trastuzumab emtansine and lapatinib.


  1. Breast cancer- American cancer society available at accessed on november 2015.
  2. Senkus E, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rutgers E,Zackrisson S, Cardoso F; ESMO Guidelines Committee. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26 Suppl 5:v8-30


Stages of Breast Cancer

Breast Cancer Drugs in India

Stage I breast cancer. T1,N0,M0
Tumor is less than 2 cm with or without micrometastases in lymph node

Stage IIA T0, N1,M0 OR T1,N1,M0 OR T2,N0,M0
Tumor is less than 2 cm in size with 3 axillary lymph node involvement or tumor is of 5 cm in size

Stage IIB T2,N1,M0 OR T3,N0,M0
Tumor is larger than 2cm but not more than 5cm in size and involve 1-3 axillary lymphnodes

Stage IIIA T0,N2,M0 OR T3,N1,M0 OR T3,N2,M0
Tumor that involves either 4-9 axillary lymph nodes or > 5 cm in size and involves up to 9 axillary lymph nodes

Stage IIIB T4, N0/N1/N2,M0
Tumor that involves chest wall/skin or with ulceration
Stage IIIC Any T, N3,M0
Tumor is of any size that involves >10 axillary lymph nodes

Stage IV Stage IV –Any T, Any N, M1.
The cancer has spread to other parts of the body, most often the bones, lungs, liver, or brain.

HER2 Positive Metastatic Breast Cancer

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