change in drugs

[natia]

I want to share my concern with you. My aunt is a breast cancer patient, she has bone metastasis, I have already inquired once at the forum about her situation. She was diagnosed with breast cancer one and a half years ago and has undergone treatment (radiotherapy, surgery - radical mastectomy, chemotherapy (FEM and Tamoxifen. Aredia (Bondronat), Farmarubicin Ftoruracil, Endoxan, Tamoxifen has been replaced with Arimedex. Aredia (Bondronat), Taxol, Farmarubicin. Zoladex –Depo done. Klondronat. Taxol, Farmarubicin, Klondronat). She is currently on chemotherapy again (Zoladex), she has had three infusions of Zoladex the very last time and I think now they are going to start Xeloda (I think it's a pill) and I think she constantly takes Klondronat (or Clondronate ??). My concern is frequent changes of drugs, I do not know whether it can be harmful or not, but I have noticed that she has had different kinds of drugs (although I think they all are chemotherapy drugs). I would like to apologize in advance if my question is just too trivial, but I do not know much about cancer/cancer treatment. Is change in drugs conditioned by the fact that the previous ones have stopped working or didn't prove to be effective?

[CCF-RN,MSN-JS]

Dear Nadia, The goals of treatment of metastatic breast cancer are to control the disease and symptoms of the disease.   Generally therapies are continued in the setting of metastatic disease 1) as long as they are controlling the disease, 2) as long as the patient is not experiencing any severe side effects that would prompt stopping the treatment, or 3) the patient or oncologist decide to stop, for other reasons.  Your aunt is receiving combinations of medications, which are common. They are in different families of drugs, and each family of drugs contributes it’s own piece to the overall treatment.  The medications; farmorubicin(epirubicin), 5-flurouracil, Endoxan(cyclophosphomide) are chemotherapies and are a common combination either as adjuvant treatment or as first line treatment in metastatic breast cancer setting.   Usually 4 to 6 cycles are given in the adjuvant setting.  Because of the effects on the heart with farmorubicin (epirubicin) over time there is a limit as to the number of doses a person should receive in a lifetime, so with this combination there would be only a limited number of cycles of the medications given.  Taxol is another type of chemotherapy and is used frequently in treatment of metastatic disease.   Xeloda (capcitabine) is another type of chemotherapy, is given as a pill, it is converted to 5-flurouracil as the body metabolizes it.

Biphosphonates are a group of medications used to treat bone metastasis, to prevent the complications from these such as fractures, pain and high blood calcium levels (hypercalcemia).  Aredia and Clodronate (I found it with the new spelling) are biphosphonates.  I don’t see any reason they would be used together as they are both have similar actions.  Aredia is given usually intravenously on a monthly basis, Clodronate is given as a daily pill.

Zoledex, tamoxifen and arimidex are all in the broad category of hormone therapy.  Zoledex and tamoxifen work to decrease estrogen levels and arimidex acts by inhibiting an enzyme aromatase that is used by the body to convert certain hormones to estrogen.

In the treatment of metastatic breast cancer, they could use all of the above at various time points, in combination or in different sequences.  Biphosphonates may continue even if the disease is worsening and other treatments are switched.

Your question is not trivial.  I hope the above information will be of help in clarifying information for you.  I would suggest if you are a caretaker for your aunt, perhaps if you have not had the opportunity, that you accompany her to an appointment with her oncologist.  At that time ask for some clarification regarding the overall treatment plan and what medications are being used.