RED CHEMOTHERAPY FOR BREAST CANCER
Many women who are about to undergo breast cancer treatment are very afraid that the doctor will prescribe the so-called red chemotherapy. There are many stories about how such treatment caused serious side effects. In the West, women have given this type of chemotherapy an even more sinister name – “red devil” (red devil).
We are talking about the use of chemotherapy drugs from the anthracycline group. They are one of the most powerful and at the same time one of the most toxic. In addition, their solutions have a characteristic red color that frightens many patients. Hence the fame.
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What does the phrase “red chemotherapy” mean?
In the form of red solutions, chemotherapy drugs from the anthracycline group are produced. They are obtained from actinobacteria streptomycetes (Streptomyces spp.). This group includes drugs: doxorubicin (Adriamycin), epirubicin (Ellens), daunorubicin, idarubicin, valrubicin, mitoxantrone.
Anthracyclines have two effects on breast cancer cells:
- Cytostatic – suppression of divisions. Malignant cells stop multiplying and eventually undergo apoptosis – programmed cell death.
- Cytotoxic – chemotherapy drugs act like toxins, poison cells and lead to their death.
In turn, these effects are provided by several mechanisms:
- Interaction with the enzyme topoisomerase-II. Normally, this enzyme unwinds overly twisted DNA during DNA duplication. Anthracyclines disrupt this function, and in this case, DNA replication (doubling) is disrupted.
- Violation of the structure of DNA. The molecules of anthracycline chemotherapy drugs have a special chromophore part. It can be inserted between adjacent DNA nucleotides and thereby disrupt its duplication, the reading of genetic information for protein synthesis. This effect is most pronounced in actively proliferating cells.
- Formation of reactive oxygen species (ROS). Anthracyclines cause oxidative reactions and lead to the formation of a large number of free radicals – there are so many of them that the cell does not have time to neutralize them, oxidative stress develops. It damages DNA, leads to lipid peroxidation and cell death.
- attachment to a DNA molecule. This compound is called a DNA adduct. Because of it, transcription factors cannot attach to DNA, it does not double, the cell stops reproducing, and apoptosis is triggered.
Of course, all these effects of chemotherapy with anthracyclines primarily affect the cells of breast cancer and other tumors. But chemo drugs in general as a class of drugs are not very picky. They are also capable of infecting actively multiplying normal cells. Because of this, certain side effects may develop. Moreover, as a rule, they occur the more often and the stronger, the more powerful the chemotherapy drug acts against cancer. But the possibilities of modern medicine make it possible to transfer comfortably even a course of such chemotherapy.
Indications for use
Chemotherapy with anthracyclines is used in many cancers. Here are some examples:
- ovarian cancer;
- bladder cancer;
- bone and soft tissue sarcomas;
- thyroid cancer;
- metastatic stomach cancer;
- neuroblastoma – a tumor of immature nerve cells of neuroblasts;
- Hodgkin’s lymphomas and non-Hodgkin’s lymphomas;
- malignant blood diseases: acute lymphoblastic and myeloblastic leukemias;
- Wilms tumors – occur in the kidneys, mainly in children;
- Kaposi’s sarcoma is a malignant tumor of the cells that line the inside of the walls of blood and lymphatic vessels.
And of course, drugs from the anthracycline group, in particular, doxorubicin, are very effective in breast cancer. It is from women with such a diagnosis that the phrase “red chemotherapy” is most often heard.
Anthracyclines should not be used in combination with certain other drugs. Their interaction in the body can lead to serious side effects. These drugs include: afatinib, apalutamide, dabigatran, dacomitinib, deferiprone, edoxaban, erdafitinib, idelicib, itraconazole, nefazodone, nintedanib, palifermine, pomalidomide, sofosbuvir, tofacitinib, trastuzumab. Before starting treatment for breast cancer, the patient should tell the oncologist what medications they are currently taking. This will help to correctly draw up a chemotherapy regimen and avoid complications.
For some concomitant health problems, drugs for red chemotherapy are completely contraindicated, or they must be used with caution, carefully monitoring the patient’s condition:
- Severe liver disease. Treatment with drugs from this group is contraindicated in Child-Pugh class C or blood bilirubin levels greater than 5 mg/dL. For milder disorders, low doses of drugs are used.
- Severe disorders of the heart muscle. Heart failure, cardiomyopathy, myocarditis, pericarditis.
- Recent myocardial infarction.
- Allergic reactions to anthracyclines. If during the administration of the drug the patient develops an anaphylactic reaction, then this drug is no longer used.
- Severe suppression of red bone marrow function during breast cancer treatment, when the patient develops severe anemia, leukopenia.
Red and in general any chemotherapy can not be carried out during pregnancy, because it affects the developing body of the fetus. During the course of treatment, sex is allowed, but contraception must be used.
Features of red chemotherapy for breast cancer
Red chemo usually works well for breast cancer. It is used for different purposes.
Adjuvant chemotherapy is given after surgery to remove breast cancer. Chemotherapy helps to destroy malignant cells that may have remained in the patient’s body, and thereby prevent recurrence. Currently, there are tests that help evaluate the expression (activity) of genes in cancer cells and sort out in doubtful cases whether adjuvant chemotherapy will be useful for a particular woman.
Neoadjuvant chemotherapy is given before surgery. It helps to solve the following tasks:
- Reduce breast cancer and make it easier to remove.
- Sometimes neoadjuvant treatment can help turn inoperable breast cancer into a resectable one.
- See how a malignant tumor responds to certain chemotherapy drugs in order to properly plan adjuvant therapy.
- Allow time for examination of the patient, planning the operation, preparation for it.
Chemotherapy as the main method of treatment is used for breast cancer with metastases. Such cancer can no longer be completely removed, because there are usually many metastatic foci, and many of them are very small. Remission, as a rule, is no longer possible, but the right treatment helps to improve well-being and prolong life.
Before starting treatment, the patient undergoes an examination, including a biopsy. In the pathomorphological laboratory, immunohistochemistry, genetic studies are carried out, and the sensitivity of cancer cells to chemotherapy drugs is determined – this helps to correctly draw up a chemotherapy regimen.
Before each course of chemotherapy for breast cancer, you need to take tests:
- general blood analysis;
- general urine analysis;
- biochemical blood test: bilirubin, ALT, AST, glucose, total protein, creatinine, urea – this helps to assess the functioning of the liver, kidneys and other organs;
- blood clotting tests may be ordered.
Also, the oncologist can prescribe an ECG and other studies, send for consultations to specialist doctors, for example, a cardiologist. You need to come to the course of chemotherapy with the results of the examination.
During the course, control examinations are periodically carried out. They help to check how well breast cancer responds to chemotherapy drugs and whether they cause side effects.
Possible consequences of red chemotherapy
The list of possible side effects of red chemotherapy is quite long, but not all of them are severe and not all patients develop. Among the undesirable effects are:
- Nausea and vomiting – can sometimes be very severe.
- Loss of hair on the head. Often, after treatment, they grow back, completely or partially. To protect hair from falling out during chemotherapy courses, Euroonco clinics use Orbis cooling caps .
- Increased fatigue, constant feeling of fatigue.
- Mucositis is a lesion of the mucous membranes. For example, the lining of the mouth may become swollen and sore, making it difficult to eat.
- Decreased appetite.
- Anemia is a decrease in the level of red blood cells and hemoglobin in the blood, as a result, less oxygen enters the tissues. It manifests itself in the form of pallor, increased fatigue, shortness of breath, headaches.
- Leukopenia is a decrease in the level of leukocytes in the blood. This leads to a decrease in the body’s defense against infectious agents.
- Thrombocytopenia – a decrease in the level of platelets in the blood and increased bleeding.
- Infertility occurs due to the fact that chemotherapy drugs affect the sex glands. This problem is very relevant, since some cases of breast cancer are diagnosed in young women. If the patient wants to have a child in the future, then he should discuss this issue with the doctor in advance. Most likely, the oncologist will recommend storing germ cells in a specialized cryobank before starting treatment.
- Damage to the heart muscle is one of the most severe side effects. During treatment, dysfunction of the left ventricle, heart failure may develop. The risk is increased in the treatment of high doses of anthracyclines, in people over 60 years of age, with concomitant problems with the cardiovascular system, obesity, and in smokers. In general, cardiac pathologies in cancer patients are a problem that complicates the active treatment of cancer. But often this problem can be solved. In recent years, a whole direction has emerged in medicine that deals with these issues – cardiooncology .
Most side effects can be managed with proper lifestyle and supportive care. Euroonco clinics are taking all necessary measures. If the side effects continue to bother or are very pronounced, the doctor adjusts the dosages of the drugs or replaces them with other anticancer drugs. We take into account the individual characteristics of patients with breast cancer and other oncological diseases when prescribing chemotherapy courses and do everything to make the treatment as safe and comfortable as possible.