Chemotherapy for Breast Cancer

April 10, 2025

This page was reviewed under our medical and editorial policy by Leah Naghi, M.D., assistant clinical professor, and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

Chemotherapy, also called chemo, uses medication to fight breast cancer. The medicines help to destroy cancer cells or prevent them from growing out of control. Chemotherapy drugs for breast cancer are systemic, meaning they enter the bloodstream and are able to reach cancer cells throughout the body. The chemotherapy medicines for breast cancer are most often delivered by oral pills or through an infusion into a vein. Sometimes they may be applied to the skin or delivered in other ways.

The type of chemotherapy drug given as a breast cancer treatment is tailored to the cancer’s stage and grade, the patient’s health and personal preferences.

How Is Chemotherapy Used in Treating Breast Cancer?

Chemotherapy may be recommended for some breast cancer patients. When a patient receives chemotherapy treatment, it is most often given along with other therapies as part of a broader treatment plan before or after surgery, for early-stage breast cancer or for advanced stages of breast cancer.

Before Surgery (Neoadjuvant)

The care team may recommend chemotherapy treatment before the main treatment. This is called neoadjuvant therapy. It may help to reduce the size of a tumor before surgery or radiation therapy for breast cancer.

Shrinking the tumor may make surgery more manageable and may offer valuable information about how the tumor responds to a particular therapy.

Not all breast cancers receive neoadjuvant therapy. The most appropriate candidates for this type of treatment include patients with:

• Inflammatory breast cancer
• High-risk HER2-positive breast cancer (cells that may grow quickly and spread to other areas of the body)
• Triple-negative breast cancer (in which cancer cells don’t have estrogen, progesterone or HER2 receptors)
• A desire to shrink the tumor and make the surgical area smaller, preserving more healthy tissue
• Delays in surgery based on personal or medical needs

After Surgery (Adjuvant)

Giving anticancer medications after breast cancer surgery is called adjuvant therapy. It is commonly used in early-stage breast cancer. That’s because microscopic cancer cells may remain after surgery, and may create new tumors. Adjuvant therapy uses chemotherapy to destroy any remaining cancer cells and reduce the risk of the cancer returning. Special tests may help determine if adjuvant chemotherapy will help a patient.

Primary Treatment for Metastatic Breast Cancer

Metastatic breast cancer is cancer that has spread to parts of the body far from the original tumor. Chemotherapy is sometimes the primary treatment for patients with metastatic breast cancer. The treatment may continue until the side effects become intolerable or the cancer begins to grow again.

How Is Chemotherapy Given?

Breast cancer chemotherapy is given in cycles. Chemotherapy cycles typically last two to three weeks. The patient then has a rest period to allow the body to recover from any negative effects of treatment. The frequency of treatments varies based on which medications a patient receives.

Typical treatment with neoadjuvant or adjuvant therapy lasts three to six months. Duration for metastatic cancer treatment depends on how the patient tolerates the side effects and how well the cancer responds to the treatment.

Chemotherapy treatments come in many forms.

Oral: Pills, capsules or liquids that are swallowed.

Intravenous (IV): Medication delivered through a needle directly into a vein; sometimes known as central venous catheters, central venous access devices or central lines.

Injection: A “shot” into the muscle of a hip, thigh or arm, or in the fatty part of an arm, leg or belly.

Intrathecal: Drugs injected into the fluid-filled space between layers of tissue that cover the brain and spinal cord.

Intraperitoneal (IP): Medication placed directly into the cavity around abdominal organs through a thin tube.

Intra-arterial (IA): Medication injected directly into an artery that flows to the tumor.

Topical: A cream or lotion applied directly to the skin.

What to Expect from Chemotherapy

Chemotherapy drugs for breast cancer are most often delivered directly into a vein in the hand or lower arm either by injection or a slower infusion. Patients may receive this treatment in a doctor’s office, infusion center or hospital. Prior to treatment, the care team checks vital signs and gives the patient an opportunity to ask questions. Patients usually receive treatment while seated in a comfortable chair or recliner.

For some patients, the needle is placed in a vein at each treatment. Other patients may be fitted with devices through which medication will be delivered each time, eliminating the need to find a vein each time. These are called catheters and ports.

Catheters: These are thin, soft tubes placed into a large vein, commonly in the chest. One end of the tube remains outside the body, allowing medications to be administered through it. Typically, a catheter stays in place until chemotherapy is completed.

Ports: These are small, round discs placed most often in the chest during minor surgery. The port is equipped with a catheter placed into a large vein. The health care provider will deliver treatment directly into the port. It will remain in position until treatment is completed.

In addition to chemotherapy, catheters and ports are used to draw blood and to deliver fluids and other medications. Treatment sessions may last from one hour to six hours, depending on the therapy given. Chemotherapy injections last just a few minutes, while infusions take longer. Afterward, patients are observed for a short time for any reactions to treatment before releasing them home.

Chemo Drugs for Breast Cancer

To target breast cancer, combinations of two or three chemotherapy drugs are often used. When choosing a treatment plan, the care team considers different factors, such as the cancer stage, grade and molecular status of the tumor. Examples of molecular status include estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) or triple-negative (ER-negative, PR-negative, HER2/neu-negative).

Neoadjuvant and adjuvant chemotherapy drugs may include:

• Ado-trastuzumab emtansine (Kadcyla^®)
• Anthracyclines (drugs that destroy cancer cells by damaging their DNA), including Epirubicin hydrochloride (Ellence^®) and Doxorubicin hydrochloride (Adriamycin)
• Capecitabine (Xeloda^®)
• Everolimus (Afinitor^®)
• Gemcitabine hydrochloride (Gemzar^®)
• Ixabepilone (Ixempra^®)
• Taxanes (drugs that stop cell division by blocking cell growth), including paclitaxel albumin-stabilized nanoparticle formulation (Abraxane^®) and docetaxel (Taxotere^®)
• Thiotepa (Tepadina^®)
• Vinblastine sulfate (Velban^®)

Chemotherapy drugs used for metastatic breast cancer (cancer spreading to distant parts of the body) may include:

• Ado-trastuzumab emtansine (Kadcyla^®)
• Docetaxel (Taxotere^®)
• Doxorubicin hydrochloride
• Eribulin mesylate (Halaven^®)
• Fam-trastuzumab deruxtecan-nxki (Enhertu^®)
• Paclitaxel albumin-stabilized nanoparticle formulation (Abraxane^®)
• Sacituzumab govitecan-hziy (Trodelvy^®)

Breast Cancer Chemotherapy Side Effects

Each patient’s experience with side effects from chemotherapy drugs is different and based on many factors, such as:

• Health status before treatment
• Severity of the cancer
• Type of chemotherapy drugs
• How long the course of therapy lasts

Side effects from chemotherapy arise because the treatments destroy both cancer cells and some healthy cells. Damage to healthy cells may cause some common side effects, such as:

• Hair loss
• Mouth sores
• Nausea

Chemotherapy drugs used for breast cancer may also cause these more troublesome side effects in some patients. Patients have support through their care team throughout their journey. There are known ways to help manage and cope with many side effects, which are often temporary.

Fatigue: An extreme feeling of weakness, tiredness and lack of energy is common, with more than 80% of patients complaining of posttreatment fatigue, according to the National Cancer Institute. Patients may feel more tired after each treatment or midway through a cycle. Fatigue generally eases when chemotherapy is done, but symptoms may last up to several years.

Nerve damage (neuropathy): Some chemotherapy drugs may damage nerves in arms, hands, legs or feet, causing symptoms such as burning pain, numbness or tingling sensation, weakness, or a sensitivity to heat and cold. This is called neuropathy. Symptoms may improve after treatment is complete, but some patients have permanent damage.

Fertility: Some chemotherapy drugs may damage the ovaries, called primary ovarian insufficiency. When this happens, the ovaries stop producing estrogen and releasing eggs in some women, causing their periods to stop. For some women, this is temporary, with normal periods and fertility returning when treatment is complete. Other women have permanent damage and go into early menopause. They may experience typical perimenopause symptoms, including hot flashes, vaginal dryness, night sweats, irritability, and irregular periods or none at all. Even if their periods stop, some women on chemotherapy may still get pregnant and the drugs may cause birth defects. If cancer is found during a pregnancy, treatment options are available. Patients who have not gone through menopause prior to their cancer diagnosis should work closely with their oncologist and gynecologist to determine the optimal treatments based on their future fertility plans.

“Chemo brain:” This is a nickname for the confusion, memory loss, and difficulty with concentration and decision-making that may accompany treatment. It may arise from the chemotherapy drugs or treatment-related issues, such as fatigue, anemia, hormone changes, sleep difficulty, depression or stress. Like other side effects, chemo brain may last for a few months or many years.

Heart damage (cardiomyopathy): Permanent heart damage is a risk associated with certain chemotherapy drugs, especially if they are used at high doses or for a long period. This damage, called cardiomyopathy, is not common. Patients who are most likely to develop it typically have other heart risk factors, such as a family history of heart disease, diabetes or high blood pressure. Some people may not show signs of damage for months or years after treatment is complete.

Hand-foot syndrome: Irritation to the palms of the hands or soles of the feet may occur with certain chemotherapy drugs. Symptoms typically begin with redness, numbness or tingling. As symptoms progress, the hands and feet may swell, the skin may blister and peel, and open sores may develop. Symptoms may improve by lowering the drug dosage or stopping treatment.

Leukemia or other bone marrow disease: In rare cases, some chemotherapy drugs may cause diseases in the bone marrow, such as leukemia, that result in significant numbers of abnormal blood cells in the bloodstream. Typically, this occurs within 10 years of treatment. 

Can Patients Work While Getting Chemotherapy for Breast Cancer?

Breast cancer patients often continue to work while undergoing chemotherapy treatment, but it’s a personal choice that depends on many factors, including fatigue levels, chemotherapy side effects and the demands of the job.

Clinical studies have been mixed on how often women stay at their jobs during chemotherapy. One study found that patients on chemotherapy for breast cancer weren’t more likely to leave the workforce, while another concluded that the odds of leaving a job were higher among women with breast cancer who were on chemotherapy compared to those not on the medication.

Studies indicate that working during treatment and afterward can contribute to a better quality of life, self-esteem and mental functioning. Ultimately, the decision of whether to keep working should be made by the patient, often in collaboration with family, employers and the care team.