Systemic Therapy

Chemotherapy

Chemotherapy destroys cancer cells by interfering with their ability to divide and grow. Since cancer cells grow quickly, they are more affected by chemotherapy than most healthy cells. However, some healthy cells can also be damaged, leading to side effects.

How Chemotherapy is Given

• Administration: Delivered as an intravenous (IV) infusion or taken as pills.
• Treatment Cycles: Given in cycles with recovery periods in between. Most treatments last 3 to 6 months. Some regimens use dose-dense chemotherapy, meaning shorter time between cycles to improve outcomes.
• Combination Therapy: Often used with other drugs to improve effectiveness and prevent resistance.

Factors Affecting Chemotherapy Decisions

Chemotherapy recommendations depend on:

• Tumour size
• Grade
• Hormone receptor (HR) and HER2 status 
• Lymph node involvement
• Genetic/genomic test results (e.g., Oncotype DX)
• Overall health.

Types of Chemotherapy Drugs

Different chemotherapy drugs work in various ways:

• Anthracyclines (e.g., doxorubicin, epirubicin): Interfere with cancer cell DNA
• Taxanes (e.g., paclitaxel, docetaxel): Disrupt cell division
• Platinum-based drugs (e.g., carboplatin, cisplatin): Damage cancer cell DNA
• Other agents, such as alkylating agents and antimetabolites, may also be used depending on the treatment plan

Common Chemotherapy Side Effects

• Short-term: Fatigue, nausea, hair loss, mouth sores, increased infection risk, tingling in hands/feet (neuropathy)
• Long-term: Heart problems (with certain drugs like anthracyclines), risk of leukemia (rare), early menopause

Managing Side Effects

Supportive treatments, such as anti-nausea medications, blood cell growth factors, and cold caps for hair preservation, can help you manage side effects. Your doctor will determine the most effective chemotherapy drugs based on your pathology report.

Medical Review by Roochi Arora, MD, FRCPC, August 2025

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