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Lester and Sue Smith Breast Center

Houston, Texas

The Lester and Sue Smith Breast Center's mission is to improve prevention, diagnosis and treatment of breast disease.
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Chemotherapy Medication and Side Effects

Adriamycin (Doxorubicin)

Adriamycin belongs to a group of medicines known as anti-tumor antibiotics. It is used to treat some kinds of cancer. Adriamycin, which is a red fluid, is administered intravenously.

Possible Side Effects

  • Urine color may be red to reddish-orange lasting 1-2 days
  • Mild to moderate nausea and vomiting beginning a few hours following treatment, lasting up to a day
  • Decrease in blood cell counts (white blood cells, platelets, and red blood cells) that could result in infection, bleeding, or anemia
  • Complete hair loss, starting 2-3 weeks after first dose
  • Sores in mouth or on lips
  • Darkening of nail beds and skin
  • Increased sensitivity to sunlight

Less Common Side Effects

  • Changes in heart function – uncommon with conventional doses
  • Diarrhea
  • Pain (burning or stinging) or redness, around the intravenous site caused from leakage of the drug

These are the most common side effects of this drug. Others may occur. Please report any persistent or severe problems to your physician.

Carboplatin (Paraplatin)

Carboplatin belongs to a group of medicines known as alkylating agents. It is used to treat some kinds of cancer. Carboplatin is given in the vein.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) that could lead to infection, bleeding, or anemia
  • Nausea and vomiting, loss of appetite
  • Constipation or diarrhea
  • Hair loss – minimal

Less Common Side Effects

  • Changes in kidney function. Increase fluid intake to 8 glasses daily, the day before, the day of, and the day following treatment
  • Numbness or tingling in hands or feet
  • Ringing in ears or hearing loss
  • Sores in mouth or on lips

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Cytoxan (Cyclophosphamide)

Cytoxan belongs to a group of medicines known as alkylating agents that work by slowing the growth of, or destroying, cancer cells in the body. It is used to treat some kinds of cancer. Cytoxan is usually administered intravenously, although it may be taken as a tablet.

Possible Side Effects

  • Mild to moderate nausea and vomiting – usually begins within 2-4 hours following treatment and may last up to 24 hours
  • Loss of appetite
  • Decrease in blood cell counts (white blood cells, red blood cells, and platelets) that could result in infection, bleeding, or anemia
  • Hair loss
  • Sinus congestion with infusion
  • Metallic taste
  • Missed or irregular menstrual periods
  • Fertility problems
  • Darkening of nail beds and skin

Less Common Side Effect

  • Bladder irritation or bleeding should be reported immediately. Drink plenty of fluids after treatment. Empty your bladder every few hours for the first 8 hours after treatment.

These are the most common side effects of this drug. Others may occur. Please report any persistent or severe problems to your physician.

Doxil (Doxorubicin, liposomal)

Doxorubicin belongs to a group of medicines known as anti-tumor antibiotics. Doxil is doxorubicin encapsulated in a lipid (fat) droplet. It is used to treat some kinds of cancer. Doxil, which is a red fluid, is given in the vein.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) leading to infection, bleeding, or anemia
  • Sores in mouth or on lips, taste changes
  • Soreness and redness of palms of hands and soles of feet. Notify your nurse/physician if uncomfortable.
  • Increased sensitivity of skin to sun exposure. Use sunscreen.
  • Flu-like symptoms – headache, back pain
  • Nausea and vomiting – mild
  • Diarrhea or constipation
  • Hair thinning

Less Common Side Effects

  • Infusion related allergic reaction with shortness of breath, flushing, chills, tightness of chest or throat, decreased blood pressure.
  • Changes in heart muscle function – uncommon with conventional doses

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Epirubicin (Ellence)

Epirubicin belongs to a group of medicines known as anti-tumor antibiotics. It is used to treat some kinds of cancer. Epirubicin, which is a red fluid, is given in the vein.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) that could lead to infection, bleeding, or anemia
  • Hair loss – thinning to complete
  • Nausea and vomiting
  • Sores in mouth or on lips, taste changes
  • Urine color may be pinkish-red lasting 1-2 days
  • Skin rash and itching

Less Common Side Effects

  • Changes in heart muscle function – uncommon with conventional doses
  • Diarrhea
  • Changes in nails – darkening, white lines
  • Pain (burning or stinging) or redness, around the intravenous site caused from leakage of the drug
  • Allergic reaction – rare

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

5-FU (Fluorouracil)

5-FU belongs to a group of medicines known as antimetabolites. It is used to treat some kinds of cancer. 5-FU is usually given in the vein.

Possible Side Effects

  • Sores in mouth or on lips
  • Diarrhea (report if more than 4 loose stools per day)
  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) that could lead to infection, bleeding, or anemia
  • Headaches and/or mild visual disturbances
  • Skin rash, itching, or darkening, discoloration of vein used for infusion

Less Common Side Effects

  • Mild nausea and vomiting
  • Thinning of hair
  • Changes in nails – more brittle or chipped
  • Increased sensitivity of skin to sun exposure
  • Soreness and redness on palms of hands and soles of feet. Notify your nurse/physician if uncomfortable.
  • Eye changes may include tearing, dryness, or blurred vision

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Gemzar (Gemcitabine)

Gemzar belongs to a group of medicines known as antimetabolites. It is used to treat some kinds of cancer. Gemzar is given in the vein.

Possible Side Effects

  • Decrease in blood counts (white blood cells, platelets, red blood cells) that could result in infection, bleeding, or anemia
  • Skin rash, may have some itching
  • Flu-like symptoms (fever, chill, headache, cough, muscle pain, weakness)
  • Swelling of legs, hands, or abdomen
  • Tingling in hands or feet

Less Common Side Effects

  • Sores in mouth or on lips
  • Diarrhea or constipation
  • Mild to moderate nausea and vomiting, loss of appetite
  • Minimal hair loss
  • Fast or irregular heartbeat, increased blood pressure, chest pain – rare

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Methotrexate (Mexate, Folex)

Methotrexate belongs to a group of medicines known as antimetabolites. It is used to treat some kinds of cancer as well as non-cancerous conditions.

Methotrexate may be given orally, by intramuscular injection, or in the vein.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) that could lead to infection, bleeding, or anemia
  • Sores in mouth or on lips. Notify nurse/physician if severe
  • Diarrhea – report if more than 4 loose stools per day
  • Skin rash, itching, or darkening
  • Increased sensitivity to sunlight or prolonged sun exposure. Use sunscreens.

Less Common Side Effects

  • Cough or shortness of breath
  • Mild nausea and vomiting, loss of appetite, taste changes
  • Blurred vision
  • Minimal hair loss

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Navelbine (Vinorelbine)

Navelbine belongs to a group of medicines known as vinca or plant alkaloids. It is used to treat some kinds of cancer. Navelbine is given in the vein.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, platelets, red blood cells) that could result in infection, bleeding, or anemia
  • Mild to moderate fatigue
  • Minimal hair loss
  • Muscle and joint aches
  • Constipation or diarrhea
  • Sores in mouth or on lips
  • Numbness or tingling of hands and feet

Less Common Side Effects

  • Mild nausea and vomiting, loss of appetite
  • Redness, increased warmth, pain or discoloration of vein at injection site
  • Allergic reaction – rare

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Taxol (Paclitaxel)

Taxol belongs to a group of medicines known as anti-microtubular agents that interfere with the cancer cell’s ability to reproduce. Taxol is administered as an infusion in the vein over approximately 3 hours.

Possible Side Effects

  • Decrease in blood cell counts (white blood cells, red blood cells, and platelets) that could result in fever, anemia, and bleeding
  • Muscle and joint pain beginning 2-3 days after treatment, lasting 2-3 days. Anti-inflammatory drugs (i.e., ibuprofen) and Tylenol help decrease discomfort
  • Hair loss beginning 2-3 weeks after first dose
  • Numbness, burning or tingling in hands and feet
  • Mild nausea and vomiting

Less Common Side Effects

  • Hypersensitivity reaction – shortness of breath, flushing of face, low blood pressure. Severe reactions may occur. You will be given premedication including Decadron (dexamethasone) to minimize this reaction
  • Sores in mouth or on lips

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Taxotere (Docetaxel)

Taxotere belongs to a group of medicines known as anti-microtubular agents.
This particular drug damages the structures involved in cell division, which stops growth of cancer cells. It is used to treat some kinds of cancers. Taxotere is usually administered intravenously.

Possible Side Effects

  • Fluid retention, usually beginning in the legs but may be generalized. You will be given Decadron (Dexamethasone) to minimize this reaction
  • Decrease in blood cell counts (white blood cells, platelets, and red blood cells) that could result in infection, bleeding, or anemia
  • Mild nausea, vomiting, and diarrhea
  • Sores in mouth and on lips
  • Muscle and joint aches 2-3 days after infusion. May last 3-5 days.
  • Numbness and/or tingling of hands and feet
  • Hair loss, beginning 2-3 weeks after first treatment
  • Skin rash; red, swollen or peeling areas of skin; changes in nail bed color (darkening)

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Xeloda (Capecitabine)

Xeloda is a medicine that is changed in the body to 5-fluorouracil, an anti-cancer agent which interferes with the growth and spread of cancer cells. It is taken by mouth as capsules twice daily. The capsules should be taken 12 hours apart.

Possible Side Effects

  • Soreness and redness of the palms of the hands and the soles of the feet. Notify your nurse/physician if uncomfortable.
  • Sores in mouth and on lips
  • Nausea – usually mild
  • Diarrhea – notify nurse/physician if more than 4 times in 24 hours
  • Abdominal pain and constipation
  • Loss of appetite

Less Common Side Effects

  • Decrease in blood cell counts (white blood cells, red blood cells, and platelets) that could result in infection, anemia, and bleeding.
  • Increased production of tears.
  • Headache and dizziness.

These are the most common side effects for this drug. Others may occur. Please report any persistent or severe problems to your physician.

Endocrine Therapy

Aromatase Inhibitors

Aromatase inhibitors are a group of endocrine agents that lower the amount of circulating estrogen in the body. All aromatase inhibitors are tablets that are taken once daily. They should be taken at approximately the same time each day. There are three aromatase inhibitors available:

Arimidex (Anastrozole)

Femara (Letrozole)


Aromasin (Exemestane)

Possible Side Effects

  • Hot flashes and sweats – usually mild, decrease with time

Less Common Side Effects

  • Vaginal dryness
  • Joint pains and stiffness
  • Bone fractures

These are the most common side effects for these drugs. Others may occur. Please report any persistent or severe problems to your physician.

Faslodex (Fulvestrant)

Faslodex belongs to a group of medicines known as hormonal or endocrine therapy. It works as an estrogen receptor blocker. Faslodex is given as an intramuscular injection monthly in women with hormone receptor positive breast cancer that has recurred.

Possible Side Effects

  • Hot flashes and sweats – usually mild
  • Injection site reaction – pain and redness

Less Common Side Effects

  • Diarrhea
  • Joint pains and stiffness
  • Skin rashes – usually mild

These are the most common side effects. Others may occur. Please report any persistent or severe problems to your physician.

Tamoxifen (Nolvadex)

Tamoxifen belongs to a group of drugs known as endocrine agents. It acts as an anti-estrogen in breast tissue by blocking the estrogen required by certain breast cancer cells to grow. Tamoxifen is taken by mouth in a tablet form. It should be taken at approximately the same time each day. Tamoxifen is commonly taken for 5 years.

Possible Side Effects

  • Hot flashes
  • Vaginal discharge
  • Irregular menstrual periods
  • Vaginal dryness or itching

Less Common Side Effects

  • Skin rash

Rare Side Effects

  • Blood clots
  • Increased risk of uterine cancers
  • Increased risk of cataracts

Due to potential increased risk of blood clots, Tamoxifen should be discontinued 2-4 weeks prior to major elective surgery. Please discuss further with your surgeon and medical oncologist when to restart tamoxifen.

These are the most common side effects of this drug. Others may occur. Please report any persistent or severe problems to your physician.

Zoladex (Goserlin)

Zoladex belongs to a group of medicines know as LHRH antagonists. Zoladex ultimately results in a reduction of estrogen production by the ovaries in women. It is used for breast cancer. Zoladex is given by injection under the skin in the abdomen.

Possible Side Effects

  • Hot flashes
  • Decreased libido (sexual desire)
  • Loss of menstrual cycle
  • Injection site reactions – redness and soreness

These are the most common side effects for this drug. Other may occur. Please report any persistent or severe problems to your physician.

Immunotherapy

Herceptin (Trastuzumab)

Herceptin belongs to a newer group of medicines called monoclonal antibodies. Herceptin is indicated for treatment, either alone or with chemotherapy, in women with high levels of HER2 proteins on their cancer cells. It is used to treat selected patients with breast cancer. Herceptin is given in the vein.

Possible Side Effects

  • Flu-like symptoms including fever and chilling. Medications such as Tylenol or ibuprofen can be given to decrease these effects.
  • Achiness and pain at site of tumor
  • Changes in heart muscle function – requires careful monitoring
  • Headache

Less Common Side Effects

  • Skin rash

These are the most common side effects for this drug. Other may occur. Please report any persistent or severe problems to your physician.

Supportive Therapies

Growth Factors– Red Blood Cells

Red blood cell growth factors are used to treat anemia (low red blood cell count). Your physician may use this medication to stimulate production of red cells that carry oxygen in your body. These drugs are usually given by injection under the skin (subcutaneously) every 1-3 weeks. There are two red blood cell growth factors used:

Aranesp (Darbopoetin Alfa)

Procrit (Epoetin Alfa)

Possible Side Effects

  • Flu-like symptoms including headache, joint pain, weakness, dizziness and tiredness
  • Rise in blood pressure
  • Skin rash
  • Pain at injection site

Less Common Side Effects

  • Shortness of breath, chest discomfort
  • Swelling of extremities

These are the most common side effects for this drug. Other may occur. Please report any persistent or severe problems to your physician.

Growth Factors – White Blood Cells

White blood cell growth factors are used to increase the production of white blood cells and results in a decreased risk of infection. They are given by injection under the skin (subcutaneously). There are two white blood cell growth factors available:

Neulasta (Pegfilgrastim)

Neupogen (Filgrastim)

Possible Side Effects

  • Flu-like symptoms – fever, chills, fatigue, and headache
  • Mild on moderate bone pain which can be controlled with over the counter pain medicines such as Tylenol or ibuprofen
  • Injection site reaction – redness and discomfort

Less Common Side Effects

  • Allergic reaction – rare

These are the most common side effects for this drug. Other may occur. Please report any persistent or severe problems to your physician.

Zometa (Zoledronic Acid)

Zometa belongs to a group of drugs known as bisphosphonates. It is used to treat bone damage from cancer. It helps to strengthen weakened bone. Zometa is given as an infusion into the veins over approximately 15 minutes.

Possible Side Effects

  • Flu-like syndrome with fever, chills, bones and/or muscle pain
  • Fatigue

Less Common Side Effects

  • Change in kidney function
  • Decrease in blood levels: calcium, phosphate

Side effects are usually mild and subside within 24-48 hours.These are the most common side effects of this drug. Others may occur. Please report any persistent or severe problems to your physician.

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