Adriamycin,“A”, also known as Doxorubicin, belongs to the general group of medicines known as anthracyclines. It is actually a type of antibiotic, but like none you ever had before or will again. This particular drug has nicknames because of its color- Red. Some call it ‘The Red Cure’, ‘The Red Devil’, ‘Hi-test Hawaiian Punch”, etc.

Cytoxan, “C”, is also known as Cyclophosphamide. This drug interferes with the growth of cancer cells by blocking the copying of DNA.

Epirubicin, “E” sometimes referred to as Ellence, is an anthracycline just like Adriamycin. Only this drug isn’t red, doesn’t have the cardiac side effects that Adriamycin has and it works the exact same way.

Fluorouracil, or “5-FU” is an antimetabolite and interferes with the growth of cancer cells by blocking necessary enzymes. Meaning, it starves the cancer cells of what they need to divide so they die.

Methotrexate, “M” also belongs to the group of medicines known as antimetabolites. It works by blocking an enzyme that cells need to live. Basically, it works like 5-FU but on different enzyme.

Taxol “T” or Paclitaxel from the group of drugs called taxanes, was initially derived from the bark a yew tree. The Taxanes which are Taxol and Taxotere climb into a cancer cell and wreak havoc. Like a computer virus, it stops the cell from being able to function normally. It can no longer divide and become two new cells. It breaks down the entire hard drive and kills the cancer cell.

Taxotere“T” or Docetaxel is the cousin of Taxol. This is also a Taxane and it is also from the bark of a yew tree. Many people have found that if they have a hard time with Taxol, Taxotere is easier to tolerate.

Trastuzumab, HERCEPTIN, is for women who are her2nue positive. Meaning, their cancer carries the her2nue protein that promotes cancer growth. This breaks down that protein. Think of a regular cancer cell as a plain M&M. A her2nue positive cell is a peanut M&M. After the first line of chemo is used to break down the candy coating and the chocolate, a Her2Nue tumor still has the peanut inside. Herceptin goes in after your first chemo is finished and takes care of the peanut and your cancer is destroyed.

Newcomers and Advanced Disease Drugs:

These drugs are being used for advanced disease and have not been officially approved for primary disease. However, some of them work better than their older counterparts. Almost all have ongoing studies to assess if they can benefit women with primary disease as well.

DOXIL, (doxorubicin liposome) is Adriamycin that is encapsulated in a lipid sphere (fat bubble). It travels through the blood supply with the lipid coating on it. When it reaches its destination the coating disappears and the full effect of the drug is unleashed on the cancer cell. Because it only attacks the cancer cell and not the rest of your body, there are fewer side effects and it is very easily tolerated.

ABRAXANE (paclitaxol protein bound) is also like Doxil. It is pure Taxol that is suspended in albumin. It travels through the body without harming innocent bystanders. The amazing thing about Abraxane is the time it takes to get it. If you were to get Taxol the infusion lasts for close to four hours. This is because Taxol is mixed with a detergent and many people are allergic to it. So before they begin your infusion they pump you up with steroids and Benadryl. Then they start the infusion. They watch you carefully because they want to catch the allergic reaction right away. The symptoms can range from flushing of the face to difficulty in breathing. If you should have this reaction they stop the Taxol drip and give you more Benadryl. Then they start again. If you were to receive Abraxane, there would be no premedication of steroids or Benadryl, and the time it takes for the infusion is 31 minutes and you are good to go.

Bevacizumab, AVASTIN, is the all star short stop in the lineup. It is a monoclonal antibody and an anti-angiogenesis drug which means it targets the cancer cell and only the cancer cell, gets into it, and stops it from being able to create its own blood supply that enables it to grow. It is reserved for advanced disease, but there are studies ongoing to get it approved for certain types of primary cancers.

Lapatinib, TYKERB, is the newest generation of drugs that attack Her2Nue proteins and the Epidermal Growth Factor Receptors in breast cancer cells. It has been shown to be superior to Herceptin, and is getting approval for wide range use. It is good news for the Her2Nue positive woman. It has the potential to be very be good news to women who are estrogen/progesterone negative since ER/PR cancer cells have an over abundance of the Epidermal Growth Factor Receptors. Ongoing studies need to continue to see if this will benefit the 35-40% of women who are diagnosed ER/PR negative.

The platinol drugs, such as
CISPLATIN, are now being tested for use as first line therapy for estrogen/progesterone negative women. It targets certain proteins that make up ER/PR Negative disease. Look for it, ask for it if you are ER/PR Negative.

Gemcitabine, GEMZAR. This is an anti-metabolite drug that is usually given in advanced disease only, or if primary chemotherapy fails.

Capecitibine, XELODA, is another anti-metabolite that converts to the action of 5-FU once in the blood stream. It, too, has been reserved for advanced disease, but is being slowly tested in primary treatment as well.

Vinorelbine, NAVELBINE, is a plant alkaloid that comes from the periwinkle plant. Don’t let that pleasant image fool you. It is a powerful treatment for advanced disease and can be used alone or in combination. The latest use has been combining it with Herceptin.


Over the years it was found that a chemo cocktail of two or more drugs greatly improves overall survival. Here is where your oncologist will start speaking in code. The initials can be hard to follow so we have decoded everything for you. Get out your Little Orphan Annie Decoder Rings:

AC Adriamycin and Cytoxan

CAF Cytoxan, Adriamycin, 5-Fu (fluorouracil)

CMF Cytoxan, Methotrexate, 5-Fu (fluorouracil)

CEF Cytoxan, Epirubicin, 5-Fu (fluorouracil)

AC + T Adriamycin, Cytoxan and Taxol

ATC Adriamycin, Taxol, Cytoxan

TAC Taxotere, Adriamycin and Cytoxan

TC Taxotere, Cytoxan

Combinations of these treatments are calculated based on your particular cancer. Your doctor can figure out from your pathology report what best suits your needs. The educated patient is her own best healthcare advocate. You now have the tools to better understand the pathology of your cancer. With this knowledge, choosing the right chemo gets easier.

This is a very good website to go to for more complete information,

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