- How is breast cancer in men treated?
- Surgery for breast cancer in men
- Radiation therapy for breast cancer in men
- Chemotherapy for breast cancer in men
- Hormone therapy for breast cancer in men
- Targeted therapy for breast cancer in men
- Bone-directed therapy for breast cancer in men
- Treatment of breast cancer in men, by stage
- What should you ask your doctor about breast cancer in men?
Chemotherapy for breast cancer in men
Chemotherapy (chemo) is treatment with cancer-fighting drugs that may be given intravenously (injected into a vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Chemo is given in cycles, with each treatment period followed by a recovery period.
When is chemo used?
Chemo may be recommended in several different situations.
After surgery (adjuvant chemotherapy): When therapy is given to patients who have no evidence of cancer after surgery, it is called adjuvant therapy. Surgery is used to remove all of the cancer that can be seen, but adjuvant therapy is used to kill any cancer cells that might be left behind or spread but can't be seen, even on imaging tests. If these cells are allowed to grow, they can establish new tumors in other places in the body. Adjuvant therapy after surgery to remove breast cancer lowers the risk of breast cancer coming back. Radiation and hormone therapy can also be used as adjuvant treatments. Adjuvant chemo is often given over 3 to 6 months.
Before surgery (neoadjuvant chemotherapy): Neoadjuvant therapy is like adjuvant therapy, except you get the treatments (or at least start them) before surgery instead of after. In terms of survival and the cancer coming back, there is no difference between getting chemo before or after surgery. But neoadjuvant chemo does have two benefits. First, chemo may shrink the tumor so that it can be removed with less extensive surgery. That is why neoadjuvant chemo is often used to treat cancers that are too big to be surgically removed at the time of diagnosis (called locally advanced). Also, by giving chemo before the tumor is removed, doctors can better see how the cancer responds. If the first set of drugs does not shrink the tumor, your doctor will know that other drugs are needed.
Chemotherapy for advanced breast cancer: Chemo can also be used as the main treatment for men whose cancer has already spread beyond the breast and underarm area when it is diagnosed, or if it spreads after initial treatments. The length of treatment depends on whether the cancer shrinks, how much it shrinks, and how well you tolerate treatment.
How is chemotherapy given?
For early stage breast cancer, combinations of drugs are often used. There are many combinations in use, and it's not clear that any single combination is clearly the best. Clinical studies continue to compare today's most effective treatments against something that may be better.
The most common chemo drugs used for early breast cancer include the anthracyclines (such as doxorubicin/Adriamycin® and epirubicin/Ellence®) and the taxanes (such as paclitaxel/Taxol® and docetaxel/Taxotere®). These may be used in combination with certain other drugs, like fluorouracil (5-FU), cyclophosphamide (Cytoxan®), and carboplatin.
For cancers that are HER2 positive, the targeted drug trastuzumab (Herceptin®) is often given with one of the taxanes. Pertuzumab (Perjeta®) can also be combined with trastuzumab and docetaxel for HER2 positive cancers if the chemo is given before surgery. (See the section on targeted therapy for more information about these drugs.)
Some of the most commonly used drug combinations for early breast cancer are:
- CAF (FAC): cyclophosphamide, doxorubicin (Adriamycin®), and 5-fluorouracil
- TAC: docetaxel (Taxotere®), doxorubicin (Adriamycin), and cyclophosphamide
- AC → T: doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel (Taxol®) or docetaxel (Taxotere). This can be given the other way around, with the T (paclitaxel or docetaxel) given first, followed by AC. Either way, carboplatin may be added to paclitaxel for cancers that are triple-negative (these were discussed in the diagnosis section).
- FEC (CEF)→ T: cyclophosphamide, epirubicin, and 5-fluorouracil followed by docetaxel or paclitaxel. This can be given the other way around, with the T (paclitaxel or docetaxel) given first, followed by FEC. Either way, carboplatin may be added to paclitaxel for cancers that are triple-negative (these were discussed in the diagnosis section).
- TC: docetaxel (Taxotere) and cyclophosphamide
- TCH: docetaxel, carboplatin, and trastuzumab (Herceptin) (this is only used if the cancer is HER2 positive)
Other combinations that are less often used for early breast cancer include:
- CMF: cyclophosphamide (Cytoxan®), methotrexate, and 5-fluorouracil (Fluorouracil, 5-FU)
- AC: doxorubicin (Adriamycin) and cyclophosphamide
- EC: epirubicin (Ellence®) and cyclophosphamide
- A → CMF: doxorubicin (Adriamycin), followed by CMF
Many drugs can be useful to treat advanced breast cancer, such as:
- Gemcitabine (Gemzar®)
- Vinorelbine (Navelbine®)
- Capecitabine (Xeloda®)
- Pegylated liposomal doxorubicin (Doxil®)
- Ixabepilone (Ixempra®)
- Albumin-bound paclitaxel (nab-paclitaxel or Abraxane®)
- Eribulin (Halaven®).
Although drug combinations are often used to treat early breast cancer, advanced disease is more often treated with single chemo drugs. Still some combinations, such as carboplatin or cisplatin plus gemcitabine are commonly used to treat advanced breast cancer.
Some targeted therapy drugs target HER2. These may be used with chemo drugs for cancers that are HER2 positive. These drugs are discussed in more detail in the "Targeted therapy for breast cancer in men" section.
Doctors give chemo in cycles, with each period of treatment followed by a rest period. Chemo begins on the first day of each cycle, but the schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given every day for 14 days, or weekly for 2 weeks. Then, at the end of the cycle, the schedule of chemo repeats to start the next cycle. Cycles are most often 2 or 3 weeks long, but they vary according to the specific drug or combination of drugs. Some drugs are given more often. Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on what drugs are used. Treatment is often longer for advanced breast cancer, and is based on how well it is working and what side effects you have.
Dose-dense chemotherapy: Doctors have found that giving the cycles of certain chemo agents closer together can lower the chance that the cancer will come back and improve survival in some patients. This usually means giving the same chemo that is normally given (such as AC → T), but giving it every 2 weeks instead of every 3 weeks. A drug (growth factor) to help boost the white blood cell count is given after the chemo to make sure the white blood cell count returns to normal in time for the next cycle. This approach can be used for both adjuvant and neoadjuvant chemo. It can lead to more problems with low blood counts, though, so it isn’t for everyone.
Possible side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are likely to be affected by chemo too, which can lead to side effects. Some men have many side effects while other men may have few.
The side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of treatment. Some of the most common possible side effects include:
- Hair loss
- Mouth sores
- Loss of appetite (or increased appetite)
- Nausea and vomiting
- Low blood cell counts
Chemo can affect the blood-forming cells of the bone marrow, which can lead to:
- Increased chance of infections (from too few white blood cells)
- Easy bruising or bleeding (from too few blood platelets)
- Fatigue (from too few red blood cells or other reasons)
These side effects are usually short-term and go away after treatment is finished. It's important to let your health care team know if you have any side effects, as there are often ways to lessen them. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Several other side effects are also possible. Some of these are only seen with certain chemotherapy drugs. Your cancer care team will give you information about the possible side effects of the specific drugs you are getting.
Neuropathy: Many drugs used to treat breast cancer, including the taxanes (docetaxel and paclitaxel), platinum agents (carboplatin, cisplatin), vinorelbine, erubulin, and ixabepilone, can damage nerves outside the brain and spinal cord. This can sometimes lead to symptoms (mainly in the hands and feet) such as numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it might last a long time in some men.
Heart damage: Doxorubicin, epirubicin, and some other drugs may cause permanent heart damage (called cardiomyopathy). The risk of this occurring depends on how much of the drug is given, and is highest if the drug is used for a long time or in high doses. Doctors watch closely for this side effect. Most doctors check the patient's heart function (with a test like a MUGA or echocardiogram) before starting one of these drugs. They also carefully control the doses and watch for symptoms of heart problems, and may repeat the heart test to monitor heart function during treatment. If the heart function begins to decline, treatment with these drugs is stopped. In some patients, heart damage takes a long time to develop. They may not show signs of poor heart function until months or years after treatment ends. Heart damage from these drugs happens more often if other drugs can cause heart damage, such as trastuzumab and other drugs that target HER2 are used as well, so doctors are more cautious when these drugs are used together.
Hand-foot syndrome: Certain chemo drugs, such as capecitabine and liposomal doxorubicin, can irritate the palms of the hands and the soles of the feet. This is called hand-foot syndrome. Early symptoms include numbness, tingling, and redness. If it gets worse, the hands and feet can become swollen, uncomfortable, or even painful. The skin may blister and peel. There is no specific treatment, although some creams may help. These symptoms gradually get better when the drug is stopped or the dose is decreased. The best way to prevent severe hand-foot syndrome is to tell your doctor when early symptoms come up, so that the drug dose can be changed. This syndrome can also occur when the drug 5-FU is given as an IV infusion over several days (not a common way to treat breast cancer).
Chemo brain: Many women who are treated for breast cancer report a slight decrease in mental functioning. There may be some long-lasting problems with concentration and memory. Although many women have linked this to chemo, it also has been seen in women who did not get chemo as a part of their treatment. Also, most women do function well after chemotherapy. In studies of chemo brain as a side effect of treatment, the symptoms most often go away within a few years. There is very little research on chemo brain in men, but there is no reason to expect any differences. For more information, see our document Chemo Brain.
Increased risk of leukemia: Very rarely, certain chemo drugs can permanently damage the bone marrow, leading to a disease called myelodysplastic syndrome or even acute myeloid leukemia, a life-threatening cancer of white blood cells. When this happens it is usually within 10 years of treatment. For most men though, chemo's benefits of helping to prevent breast cancer from coming back or extending life are likely to far exceed the risk of this serious but rare complication.
Feeling unwell or tired: Many people do not feel as healthy after chemotherapy as they did before. They often still feel body pain or achiness and a mild loss of physical functioning. They may only mention these very subtle changes when questioned closely.
Fatigue is often another common (but often overlooked) problem for those who have had chemo. This may last up to several years. It can often be helped, so it is important to let your doctor or nurse know about it. Exercise, naps, and conserving energy may be recommended. If there are problems with sleep, these can be treated. Sometimes there is depression, which may be helped by counseling and/or medicines.
Last Medical Review: 10/10/2014
Last Revised: 01/26/2016