When doctors diagnose you with breast cancer, your doctor may recommend chemotherapy. It is normal to feel a little scared and anxious when you hear this. But when you are properly informed about these treatments , you can overcome that fear. There are different types of chemotherapy treatments. Alkylating agents are one of the main classes of drugs used for breast cancer. So, let's talk about this in detail and very simply today.
How do these drugs called Alkylating Agents actually work?
To understand this, we first need to think about cancer cells. Cancer cells are cells that divide and multiply very rapidly without any control. Alkylating agents were one of the first drugs discovered against cancer. They are still widely used today.
Simply put, this type of medication works by stopping cancer cells from making copies of themselves, that is, from dividing and growing. It does this by:
Every cell has the complete blueprint, or "blueprint," of that cell. We call this DNA. What alkylating agents do is go directly to and attach themselves to the DNA of the cancer cell. Just like one key can't work if you stick it to another, when this drug binds to the DNA, that cell can't divide.
When cell division stops in this way, the cancer cells gradually die. In medicine, we call this process apoptosis . That is, programmed cell death.
Another unique feature of these drugs is that they can attack and destroy a cancer cell at any stage of its life cycle. This is called `cell-cycle phase nonspecific`. Therefore, they are very effective against many types of cancer, especially those that grow rapidly.
This medicine may be given to you as a pill or as a saline solution through a vein (IV - intravenous). Often, your doctor will give this medicine in combination with other chemotherapy drugs (combination therapy).
What are the types of Alkylating Agents?
This group of drugs is divided into several main groups. Although the names of these are a bit complicated, it's good to know because you may find one of these listed on your medication sheet.
| Drug Group | Medicines belonging to that category (Examples) |
|---|---|
| Nitrogen mustards | bendamustine, chlorambucil, cyclophosphamide , ifosfamide, mechlorethamine, melphalan |
| Ethylenamine and methylenamine derivatives | altretamine, thiotepa |
| Alkyl sulfonates | busulfan |
| Triazenes | dacarbazine, procarbazine, temozolomide |
| Platinum-containing agents | carboplatin , cisplatin, oxaliplatin |
| Nitrosoureas | carmustine, lomustine, streptozocin |
Among these, the class of drugs called Nitrosoureas is a bit special. Because these drugs can cross the protective layer called the 'blood-brain barrier' that protects our brain. Most drugs cannot cross this barrier. Therefore, they are important when treating brain-related cancers.
What types are most commonly used for breast cancer?
Drugs in the categories of ` Nitrogen Mustards` and `Ethylenamine and methylenamine derivatives` are commonly used in the treatment of various stages of breast cancer.
Cytoxan (Cyclophosphamide)
This is a drug that belongs to the group of drugs called `Nitrogen mustard`. You can take it as a pill or give it as an IV into a vein. It is usually used for:
- Prevent early-stage cancer from coming back after surgery.
- If the cancer is advanced, shrink the lump before surgery.
- Treat advanced cancer after surgery and other treatments.
Thiotepa
This is a derivative of `Ethylenamine`. It is usually given intravenously. It is used for:
- In early stage cancer, reduce the risk of recurrence .
- Treat advanced-stage cancer.
Carboplatin
This is a platinum-containing drug. It is the only platinum drug approved for the treatment of breast cancer. `Carboplatin` is usually given for advanced cancer, and in combination with other chemotherapy drugs. It is also given as an IV.
What are the side effects of this medication?
One of the main challenges with chemotherapy is that it cannot tell the difference between cancer cells and healthy cells. These drugs target cells that divide rapidly. Cancer cells, like some healthy cells in our bodies (for example, the cells that make up our hair follicles, the cells that line the lining of our mouth and intestines, and blood cells), divide very quickly. So these drugs also affect those healthy cells, which is why they cause side effects.
These side effects don't happen to everyone the same way. Some people may have more, some may have fewer. Don't worry about this. Your doctor can help you manage most of these things.
| Type of side effect |
|---|
| Common side effects that many people may experience |
| Nausea and vomiting, loss of appetite, weight loss, stomach pain, diarrhea |
| Fatigue |
| Hair loss, mouth or tongue sores |
| Changes in skin color, color or growth of fingernails and toenails |
| Decreased white blood cell count (this can increase the risk of infections) |
| Irregular menstrual cycles in women |
| Serious symptoms that should be reported to your doctor immediately |
| Fever, chills, sore throat (signs of infection) |
| Slow healing of wounds, unusual bruising or bleeding |
| Black or tarry stools, pain when urinating, or blood in the urine |
| Skin rashes, hives, itching |
| Difficulty breathing or swallowing, shortness of breath, cough |
| Swelling of the legs, ankles, or feet, chest pain |
| Yellowing of the skin or eyes (symptoms of jaundice) |
Emergency!
If you experience any of the following symptoms, go to the nearest hospital Emergency Department (ETU) immediately or call the 1990 ambulance service:
* Black stools
* Bleeding that cannot be stopped
* Severe difficulty breathing
* Chest pain
* Signs of a severe allergic reaction (such as swelling of the face, lips)
Very rarely, these alkylating agents can damage our bone marrow. The bone marrow is where our body makes new blood cells. There is a very small risk of developing another type of cancer, such as leukemia, due to this damage. This risk usually increases slightly as the dose of the drug increases. Don't be unnecessarily worried about this. Before starting treatment, talk openly with your doctor about ways to reduce the risk of developing this type of second cancer. He or she will give you all the advice you need.
Other things to consider when undergoing treatment
Because these are very powerful medications, it's important to tell your doctor your complete medical history so he or she can tailor a treatment plan to suit you and minimize side effects. Be sure to discuss the following with your doctor:
- About any allergies you have (to medications, foods).
- About any vitamins, supplements, or herbal remedies you use.
- About your kidney or liver conditions.
- If you have previously received chemotherapy treatment, tell us about it.
- If you are pregnant, breastfeeding, or planning to have a baby soon .
- If you have any surgery to do in the future, talk about it.
Follow your doctor's instructions exactly, especially if you are taking pills. If you forget to take a dose, take the next dose as scheduled. Never take two doses at once to make up for a missed dose. Always talk to your doctor before stopping treatment.
Take-Home Message
- Alkylating agents are a type of powerful chemotherapy drug that damages the DNA of cancer cells and stops them from dividing.
- Because these drugs affect both cancer cells and rapidly dividing healthy cells, they can cause side effects such as nausea and hair loss. These can be managed.
- It is extremely important to talk openly with your doctor about your complete medical history, other medications you are taking, and allergies.
- If you develop serious symptoms such as difficulty breathing or severe bleeding, go to a hospital's Emergency Department (ETU) immediately.
- You should never change the dosage of medication or stop treatment without your doctor's advice.
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