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Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy can downstage IBC to allow for surgery. All IBC patients require chemotherapy first. This includes all types of breast cancers, namely, ER/PR+, Her2+ and TNBC.

Chemotherapy drugs are typically given in combination, two or three different drugs at the same time. These combinations are called regimens. You may want to ask your physician if you are eligible for more than one regimen and, if so, what are the pluses and minuses associated with each one (e.g., clinical outcomes, side effects). Your eligibility for different therapies will depend on your hormonal receptor status and other tumor factors.

  • The most commonly used drug combinations:
  • CMF: cyclophosphamide (Cytoxan®), methotrexate, and 5-fluorouracil (fluorouracil, 5-FU)
  • CAF (or FAC): cyclophosphamide, doxorubicin (Adriamycin®), and 5-fluorouracil
  • AC: doxorubicin (Adriamycin) and cyclophosphamide12
  • EC: epirubicin (Ellence®) and cyclophosphamide
  • TAC: docetaxel (Taxotere®), doxorubicin (Adriamycin), and cyclophosphamide
  • AC → T: doxorubicin (Adriamycin) and cyclophosphamide followed by paclitaxel
  • (Taxol®) or docetaxel (Taxotere). Trastuzumab (Herceptin) may be given with the paclitaxel or docetaxel for HER2/neu positive tumors the following treatments are considered:
  • A → CMF: doxorubicin (Adriamycin), followed by CMF
  • CEF (FEC): cyclophosphamide, epirubicin, and 5-fluorouracil (this may be followed by docetaxel)
  • TC: docetaxel (Taxotere) and cyclophosphamide
  • TCH: docetaxel, carboplatin, and trastuzumab (Herceptin) for HER-2 positive tumors

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