Preparations for the treatment of breast cancer

There are many ways to combat malignant tumors, but the most popular drugs are for the treatment of breast cancer. Medications are used both at the initial stages of the development of the disease, and in cases when the operation is no longer possible. Drugs in most cases will be able to alleviate the condition of the patient and slow down the growth of the neoplasm. Proceeding from this, the action of such medicines should be aimed at slowing down the reproduction of cancer cells, or strengthening the body and stimulating its own defenses to fight the disease.

[1], [2], [3]

Characteristics of drugs for the treatment of breast cancer

Drugs that are used to treat breast cancer are known more than fifty. According to the principle of action, such medicines are combined into specific groups that can be combined or replaced depending on the characteristics of the disease and at the discretion of the doctor. Here are these groups of medicines:

• alkylating agents;
• antimetabolites;
• alkaloids;
• anticancer antibiotics (cytotoxic agents);
• hormonal means;
• immunostimulants;
• phytopreparations;
• preparations of platinum.

In this topic, we will review the main characteristics of the most common representatives of each of the groups of drugs for the treatment of breast cancer.

[4], [5], [6], [7], [8],

Indications for use

Alkylating agents can be used in a cancer treatment regimen mainly in combination with other medications. Typically, in most cases, the active agent of such drugs is cyclophosphamide, an effective antitumor component. In addition to the malignant process in the mammary gland, cyclophosphamide is prescribed for lymphocytic leukemia, ovarian cancer, retinoblastoma, lymphomas, as well as to prevent the rejection of implants.

• Antimetabolites are used in the treatment of acute and other forms of leukemia, reticulosis, a cancerous tumor in the mammary gland, in the ovaries and cervix, as well as in chorionepithelioma.
• Alkaloids of plant origin can be prescribed not only in breast cancer, but also in other malignant tumors, including testicular tumors, chronic leukemia or lymphomas.
• Cytotoxic drugs (for example, the most famous of them - Doxorubicin) can be used to treat various kinds of neoplastic pathologies. Often, such drugs are prescribed for acute leukemia, lymphomas, with carcinoma of the mammary glands or lungs.
• Hormone drugs are used in the treatment of hormone-dependent neoplasms, that is, those that can not continue their development without the presence of any particular hormone - for example, estrogens or progesterone. According to statistics, such hormone-dependent tumors account for 75% of all mammary gland neoplasms.
• Immunostimulating agents help to maintain their own body defense, which is especially important for malignant tumors of any etiology. Immunostimulants are prescribed to prevent infectious complications, after surgical interventions, radiotherapy, against the background of hormonal and cytostatic drugs.
• Phytomedication is indicated as a biogenic stimulant to support the body of patients with malignant neoplasms and chronic diseases. These drugs can not eliminate the malignant focus, but can significantly improve the health of patients. A typical representative of phytopreparations used in breast cancer is Beefungin.
• Medicines based on platinum (such as carboplatin) are recommended for use in independent or complex treatment of ovarian and breast cancer.

Form of issue

The most common drugs for the treatment of breast cancer can be produced in the following dosage forms:

• Cyclophosphane (alkylating drug) - in the form of a powder for making a solution with subsequent intravenous or intramuscular injection;
• Methotrexate (antimetabolic) - in tablets or solution for injection (in ampoules or flacon);
• Vinblastine (alkaloid preparations) - in the form of lyophilizate (powder substance) for dissolution with subsequent injection;
• Doxorubicin (anthracycline, cytotoxic drug) - as a lyophilizate (porous mass of orange-red color) for the preparation of an injection solution;
• hormone means of antiestrogenic action Tamoxifen - in the form of tablets of 10 mg, 20 mg, 40 mg;
• Polyoxidonium (immunostimulating agent) - in the form of a porous lyophilizate in flacon or ampoules with subsequent injection, and also in suppositories of 10 pcs .;
• Beefungin (phyto-drug) - in the form of a semi-liquid extract of brown color, packaged in flakonchiki;
• Carboplatin (a platinum preparation) - in the form of a concentrate for making a solution with a subsequent intravenous infusion.

[9], [10], [11], [12], [13],

Pharmacodynamics of drugs for the treatment of breast cancer

• Cyclophosphane, representing a group of alkylating agents and cytostatics, is close in chemical composition to nitrogen compounds like mustard gas. Specialists believe that the effect of cyclophosphamide is due to the formation of cross-links with DNA and RNA strands. In addition, the production of proteins in atypical cells is inhibited.
• Methotrexate is an antimetabolic drug that is also an immunosuppressant. Methotrexate serves as an inhibitor of a substance that takes part in the transformation of dihydrofolic acid into tetrahydrofolic acid, which is considered to be an important link for the production of nucleotides. In addition, antimetabolite blocks the formation of DNA and mitosis of cells. The action of the drug is particularly sensitive to highly proliferative tissues, in particular, tissue layers of tumors.
• Vinblastine alkaloid is derived from the vinca plant. This agent makes cell mitosis impossible by binding to microtubular elements and slowing the formation of mitotic spindle-shaped inclusions. In malignant cells, the drug inhibits the synthesis of DNA and RNA.
• Doxorubicin (anthracycline) causes the death of cancer cells, presumably affecting the production of nucleic acids. There is no precise information on the pharmacodynamics of the drug at this time. It is assumed that the active component of the drug inhibits the synthesis of DNA, RNA and proteins.
• Tamoxifen (a hormonal antiestrogenic agent) interferes with the formation and function of estrogen by binding to estrogen receptors. As a result, the formation of the reacting complex is disrupted.
• Polyoxidonium has the capabilities of an immunomodulator, increasing the body's ability to resist infections. Under the influence of the drug, the activity of killer cells and phagocytes is stimulated, and the production of antibodies is increased. Polyoxidonium stabilizes protective forces, even in severe cases, with a pronounced deficit of immunity. Simultaneously, the toxic effect of medicines decreases, the resistance of cells to intoxication increases.
• Befungin is a phyto-drug, which is produced from a birch fungus. The pharmacodynamic properties of this drug have not been studied.
• Carboplatin is an inorganic combined platinum compound. The effect of this drug is aimed at the destruction of various types of tumors, regardless of their location. The process of action is to inhibit the production of nucleic acids, which provokes cell death. Carboplatin, in addition, affects the body's immunity, which can accelerate the regressive processes of primary neoplasms and metastatic elements.

Pharmacokinetics

Alkylating agents based on cyclophosphamide form metabolites in the liver: some of them undergo further transition to inactive metabolites, and the rest - into products with cytotoxic activity. The maximum amount of such active products is observed 2-3 hours after intravenous infusion. Binding to plasma proteins is small and amounts to approximately 13%. True, individual metabolites can bind 65% or more. Penetration through the blood-brain barrier is insignificant.

The active ingredient leaves the body with a filtering system of the kidneys, and in a small amount - with bile. Half-life can be from 3 to 12 hours.

• Antimetabolite Methotrexate is absorbed in the digestive tract predominantly well, which depends on the dose taken and on the presence of food in the stomach. The limiting concentration of the substance with oral intake is reached after about 1.5 hours, and with intramuscular injection - after 0.5-1 hour. Binding to plasma proteins is approximately 50%. Metabolism is mainly in the liver. The term half-life is from 2 to 15 hours, depending on the dose taken. Excretion occurs with urinary fluid, and only 10% with bile. Methotrexate has the property of accumulating as metabolites.
• Vinblastine alkaloid with intravenous injection perfectly penetrates tissues and organs, and only a small part of the drug can penetrate through the blood-brain barrier. The active ingredient is able to bind to plasma proteins. Biological transformation occurs in the liver, where the active products of metabolism are formed. The term half-life can be 24-25 hours. Excretion from the body is carried out through the intestine, with the calves.
• With intravenous infusion, Doxorubicin is excreted from the body in three stages - after 12 minutes, after three hours and after 30 hours. This is due to a prolonged distribution of the drug in the tissues. Inactive decay products leave the body through the urinary system.
• Hormonal antiestrogen Tamoxifen is well absorbed, reaching a limiting concentration in the plasma for 5-7 hours. A stable amount of the drug is observed after a monthly course of therapy in a standard dosage. The association with whey protein is more than 99%. Pharmacologically active metabolites are excreted mainly with feces. The term half-life itself of the drug itself is usually one week, and the active metabolic product is about two weeks.
• Immunomodulator Polyoxidonium in a tablet form is well absorbed in the digestive system and becomes biologically available approximately half. Limit content in the blood serum is observed after 60 minutes after oral administration.
• Polyoxidonium is distributed mostly between cells. The half-life is about 18 hours. The drug is excreted mainly by the kidneys, not accumulating in the body.
• Befungin is a herbal preparation, the pharmacokinetic properties of which have not been thoroughly studied.
• Platinum preparations in the form of carboplatin have the term half-life in 1-2 hours. With prolonged use, the accumulation of the active substance does not occur. About 80% of platinum binds to plasma proteins during the day after the infusion.

Removal of the drug from the body occurs through the kidneys, unchanged.

Use during pregnancy

• Cyclophosphamide is not used by pregnant or lactating women.
• Methotrexate is contraindicated during pregnancy and lactation. Moreover, before prescribing the drug and throughout the course of admission, you should make sure that there is no pregnancy.
• Vinblastine is not recommended for use by pregnant women, but sometimes it is prescribed. This is possible in cases where the benefits of the drug exceed the risk for the unborn child. When used in lactating women, it is necessary to temporarily give up breastfeeding.
• Doxorubicin is also prohibited for use during childbearing and feeding.
• Tamoxifen is categorically contraindicated in pregnant and lactating women.
• Polyoxidonium is not prescribed to pregnant women due to the lack of clinical experience in the use of the drug. The degree of ingestion of the drug into breast milk has not been studied.
• Befungin is allowed for use by pregnant and lactating women, but treatment should be carried out with caution and under the constant supervision of a doctor. The conducted experiments showed the safety of the drug for the child and the mother.
• Carboplatin is considered a toxic drug for the developing fetus and infant, so its use in these periods is contraindicated.

Contraindications for use

Alkylating drugs, in particular, Cyclophosphamide, as the vast majority of medicines, have their contraindications for use:

• allergic mood of the organism to the ingredients of the drug;
• bone marrow dysfunction;
• cystitis;
• difficulties with urination;
• acute infectious diseases, or chronic in the stage of exacerbation.

Methotrexate has the following contraindications:

• significant anemia, a decrease in the level of leukocytes, neutrophils and platelets in the blood;
• inadequate kidney or liver function;
• propensity to allergic reactions to the components of the drug.

Contraindications to the use of Vinblastine are:

• hypersensitivity of the body;
• acute viral and bacterial infections;
• active myelosuppressive therapy;
• severe liver disease;
• old age.

Doxorubicin also has its contraindications:

• allergy to the drug;
• myelosuppressive conditions;
• severe liver function disorders;
• severe heart disease;
• infectious diseases of the urinary system.

Tamoxifen is not prescribed:

• before menopause;
• with a tendency to allergic reactions;
• with kidney disease, with diabetes, with pathology of the organs of vision.

Contraindications to the appointment of Polyoxidonium:

• excessive hypersensitivity of the body;
• children under 12 years of age.

Befungin should not be taken:

• with allergic tendencies;
• with dyspeptic disorders such as diarrhea, vomiting, etc.

Contraindications to the use of carboplatin may be:

• allergy to the drug and its components;
• severe degree of myelosuppression;
• significant bleeding volume;
• disorders of renal function;
• disorders of auditory functions.

[14], [15], [16]

Side effects of drugs for the treatment of breast cancer

Antineoplastic agents are known for their numerous side effects, due to the high toxicity of active substances and the damage to healthy cells and tissues. What can be the most common side effects of typical representatives of antitumor groups of drugs?

Organs of hematopoiesis.

• Cyclophosphamide: signs of anemia, a decrease in the level of leukocytes, platelets;
• Methotrexate: anemia, leukopenia, lymphopenia, thrombocytopenia;
• Vinblastine: leukopenia;
• Doxorubicin: bone marrow depression, anemia, myeloblastic leukemia;
• Tamoxifen: thrombocytopenia;
• Polyoxidonium: hematopoiesis is normal;
• Befungin: the indicators are normal;
• Carboplatin: a violation of bone marrow function, myelosuppression.

Digestive system.

• Cyclophosphamide: dyspepsia, eating disorders, colitis, less often - violations of the hepatic function;
• Methotrexate: inflammatory diseases of gums and oral cavity, erosion and stomach ulcers, cirrhosis and necrotic changes in the liver, bleeding of the gastrointestinal tract;
• Vinblastine: hemorrhagic colitis, gastrointestinal bleeding, attacks of vomiting and nausea;
• Doxorubicin: indigestion, mucosal lesions of the oral cavity, esophagitis, stomach pain, erosion of the stomach, enterocolitis;
• Tamoxifen: fatty liver infiltration, hepatitis, the phenomenon of cholestasis;
• Polyoxidonium: has no side effects;
• Befungin: disorders of the digestive organs with prolonged use of the drug;
• Carboplatin: nausea (more often without vomiting), defecation disorders, epigastric pain.

Skin covers.

• Cyclophosphamide: baldness, hyperpigmentation of the skin, rashes, changes in the state of the nail plate;
• Methotrexate: skin itching, erythema, pinpoint hemorrhages, boils, dermatitis, acne;
• Vinblastine: baldness, numbness of the skin;
• Doxorubicin: baldness, itching and eruptions, photosensitivity and hypersensitivity of the skin, redness of the palms and feet;
• Tamoxifen: skin rash;
• Polyoxidonium: there are no side effects;
• Befungin: no skin adverse events;
• Carboplatin: baldness.

Cardiovascular system and CNS.

• Cyclophosphamide: congestion of cardiac activity, hemorrhagic myocarditis;
• Methotrexate: dizziness, convulsions, headaches, paralysis, tremor;
• Vinblastine: double vision, depression, headaches;
• Doxorubicin: tachycardia, arrhythmia, heart failure, changes on the cardiogram;
• Tamoxifen: thromboses;
• Polyoxidonium: no side effects;
• Befungin: no side effects;
• Carboplatin: hemorrhage, lowering blood pressure.

In addition, the reproductive system may suffer, which can manifest as a violation of spermatogenesis and complications with conception. After the withdrawal of medicines such problems tend to disappear.

Method of application and dose of drugs for the treatment of breast cancer

Any antineoplastic agents are prescribed according to an individually selected treatment regimen, when all the features of the patient's illness and body are taken into account. Nevertheless, there are also standard schemes for taking medications, on which further doctor appointments are based. Here you can get acquainted with such exemplary schemes.

• Cyclophosphane is administered intravenously by drip or by intramuscular injection, 50-100 mg / m2 every day for 14-20 days.
• Methotrexate is used orally or intramuscularly from 15 to 30 mg every day for five days, after which it should take a break in 1 week. This scheme can be changed at the discretion of the attending physician.
• Vinblastine is administered intravenously once a week for 0.1 mg / kg. Children use a lower dosage of 2.5 mg / m².
• Doxorubicin is administered intravenously or into the artery. Dosage is calculated based on the weight of the patient. The most commonly used is from 1.2 to 2.4 mg / kg at a time every three weeks.
• Tamoxifen is used from 20 to 40 mg to 2 times a day. The duration of therapy is determined by the doctor.
• Polyoxidonium is administered in the form of intramuscular or intravenous drips, in the amount of 6 to 12 g, once / day, 24 hours a day, or according to an individual scheme.
• Befungin take 2 tsp. In 150 ml of warm water (1 tbsp three times daily before meals). The course of therapy is usually lengthy, with interruptions of one week.
• For the treatment of carboplatin, there is a specially developed list of regimens. Treatment is selected depending on the patient's risk group and the characteristics of the disease. The drug is administered starting at a dose of 400 mg / m². Duration of treatment - 1 month.

Overdose

With an overdose of antitumor drugs, there is an increase in the severity of adverse symptoms. As a rule, there are no special preparations with the opposite effect, therefore, with obvious signs of an overdose, symptomatic and detoxification treatment with blood control is performed. The only drug that has its own antidote is Methotrexate. Its antidote is Calcium folinate, which is administered in the same dose as the drug (or higher, but not lower).

In severe cases, transfusion is possible.

Separately it is worth mentioning such a drug as Doxorubicin. Its overestimated dosages above 250 mg are lethal: degenerative processes of the myocardium and severe damage to the bone marrow occur. For this reason, medical professionals are advised to carefully monitor the dosages used by patients, and in case of symptoms of cardiac insufficiency, take appropriate urgent measures.

Interactions with other drugs

• It is not recommended simultaneous use of Cyclophosphamide and Allopurinol, as this enhances the intoxication of the bone marrow.
• Cyclophosphamide can influence the processes of blood coagulation, which should be taken into account when prescribing anticoagulants.
• Cyclophosphane increases the cardiotoxic activity of Doxorubicin.
• Combination of treatment with Cyclophosphamide and other myelosuppressive agents, as well as simultaneous use of radiation therapy, can lead to a violation of hematopoiesis.
• Vinblastine and Mitamycin with simultaneous admission can cause the phenomenon of bronchospasm.
• Vinblastine and Phenytoin in the complex increase the likelihood of a convulsive syndrome.
• Vinblastine and neurotoxic agents are incompatible in any variants.
• Doxorubicin is not recommended to be mixed with other products because of the risk of sediment formation in solution.
• Carboplatin is not used simultaneously with preparations based on aluminum salts.
• Toxic effect Methotrexate significantly increases in a complex with non-steroidal anti-inflammatory drugs (acetylsalicylic acid, diclofenac, etc.). For the same reason, simultaneous administration with sulfanilamide agents is avoided.
• Methotrexate and Acyclovir can provoke the appearance of disorders of the nervous system.
• The effect of methotrexate decreases with folic acid.
• Tamoxifen and Allopurinol together have a negative effect on liver function.

Conditions for storage of preparations for treatment of the mammary gland

Antineoplastic agents are usually dispensed only by the prescription of the doctor, as they are sufficiently specific and toxic drugs. Therefore, they can not be categorically stored in places where children can reach - this can have unpredictably dangerous consequences.

• Cyclophosphane is stored at temperature values of not more than + 10 ° C. Shelf life - up to 3 years, after which you should dispose of the drug.
• Methotrexate is stored at room temperature, away from direct sunlight. Shelf life - up to 3 years.
• Vinblastine is stored in the refrigerator, not giving in to freezing. Shelf life - up to 2 years. The prepared solution can be stored for up to 1 month.
• Doxorubicin is preserved at t ° + 8 ° C, up to 2 years.
• Tamoxifen is allowed to be stored at room temperature.
• Polyoxidonium is kept at a temperature range of +4 to + 25 ° C. Shelf life - up to 2 years.
• Befungin can be stored under ordinary room temperature conditions, up to 2 years.
• Carboplatin is stored in the refrigerator, at t ° up to + 8 ° C. The prepared solution is stored one day at the same temperature.

Preparations for the treatment of breast cancer are prescribed only by a qualified oncologist. Independent treatment with such medicines is not allowed.

[17], [18], [19], [20], [21], [22], [23]

Preparations for chemotherapy for breast cancer

Chemotherapy for the treatment of breast cancers is carried out with the help of specially designed schemes, with a different combination of drugs. Cancer is sensitive to such medicines as:

• Herceptin is an antineoplastic agent that blocks the growth of tumors, with the active ingredient of trastuzumab. Usually used in combination with Doxorubicin and Cyclophosphamide, or with docetaxel and carboplatin;
• Avastin is a preparation of Bevacizumab containing antitumor monoclonal antibodies. Very effectively inhibits the development of neoplasm and prevents the occurrence of metastases.
• Methotrexate - is a structural analogue of folic acid. Can be used either orally or injectively.
• Adriblavine is a drug based on Doxorubicin. Refers to anthracycline antibiotics and inhibits the production of nucleic acids. Inhibits the immune system.
• 5-fluorouracil is one of the most well-known antitumor drugs, which is represented by fluorouracil antimetabolite. Suppresses the process of dividing cancer cells.
• Cyclophosphane is an alkylating and cytostatic drug that disrupts stable processes in a cancer cell and blocks the growth of atypical cellular structures.
• Docetaxel - refers to the alkaloids of plant origin. Represents a number of taxanes. Often appointed in conjunction with trastuzumab or capecitabine.
• Paclitaxel - used in the defeat of lymph nodes, in conjunction with anthracyclines and cyclophosphamide.
• Xeloda is a cytostatic agent with the active ingredient capecitabine, which in the tumor tissues is transformed into active 5-fluorouracil.

Names of drugs for chemotherapy for breast cancer are provided for informational purposes only, self-treatment is strictly prohibited. Schemes of chemotherapy are selected individually, which makes it possible to alleviate the condition and improve the quality of life in the most hopeless patients. If you combine chemotherapy with surgery and radiotherapy, then it is likely to forget about the disease for a long time.

Antineoplastic drugs for breast cancer

In our country, more than two hundred drugs with antitumor activity have been registered. A large number of medicines can be divided into categories according to the principle of action.

1. Alkylating agents are drugs capable of functional alkylation of DNA strands, which leads to prolonged inhibition of bioprospecting of nucleic acids and cell death (Cyclophosphamide, Thiotepa, Melphalan).
2. Antimetabolic drugs are cytostatics, or antitumor drugs, whose action is directed at inhibiting certain biological processes in cancer cells, which makes their further development impossible (Methotrexate, Gemcitabine, Tegafur, Fluorouracil).
3. Alkaloids of natural origin are heterocyclic bases containing nitrogen. Such drugs are characterized by powerful biological activity (Vinblastine, Vincristine, Vinorelbine, Vindesin, Docetaxel).
4. Cytotoxic and similar drugs are drugs that trigger the process of necrosis of the structure of a cancer cell. The difference between cytotoxic drugs and cytotoxic agents is that they cause apoptosis, not necrosis, atypical cells (Doxorubicin, Mitoxantrone, Epirubicin).
5. Other antineoplastic agents include, for example, platinum compounds-carboplatin. The action of carboplatin is based on the inhibition of the synthesis of nucleic acids, which contributes to cell death.
6. Androgens are substances with biological activity of male sex hormones. They are prescribed to suppress the action of estrogens (testosterone preparations: Adriol, Tetrasterone, etc.).
7. Phyto-drugs are drugs that stimulate the body's internal defenses. Phytopreparations include chaga, Befungin, Immunal, extract from grape seeds, etc.

In addition to the listed products, depending on the hormonal status of the tumor, hormonal preparations can be prescribed.

[24], [25], [26], [27], [28], [29],

Hormonal preparations for breast cancer

Drugs based on hormones are prescribed only after the delivery of hormone levels and the degree of receptor sensitivity to progesterone and estrogens. As a rule, medicines are used according to a certain scheme. There are three options for such standard schemes:

• a decrease in the content of estrogens in the bloodstream is achieved by the administration of specific modulator drugs (eg, Tamoxifen);
• inhibition of the sensitivity of estrogen receptors is due to aromatase inhibitors (Letrozol, Anastorozol, Exemestan);
• suppression of estrogen production (Faslodex).

The most commonly used drug for hormone therapy is Tamoxifen. In most cases, it is prescribed to women in the pre-menopausal period in the early stages of the development of breast cancer. Duration of treatment can be 3-5 years.

Drugs that reduce the sensitivity of receptors to estrogen, are more effective, even in contrast to Tamoxifen. Usually they are used as a medicamental treatment at any stage of development of hormone-dependent invasive breast cancer. Often such treatment is used in patients who have reached postmenopausal, supplementing the main type of therapy, whether it is surgery, or other procedures.

Target drugs for breast cancer

Target drugs are substances that block the growth and multiplication of atypical cells by affecting the components that determine the development of the tumor. Such drugs are used successfully in oncology, especially since their effect on surrounding healthy tissues is minimal.

The effect of targeted therapy is expected as follows:

• stopping the cancer process and inhibiting its activity;
• prevention of relapses;
• relatively low degree of intoxication.

The most known such target means:

• Avastin is a drug that blocks the growth of the vasculature in a tumor. This means that the agent moves the process from the state of increased activity to a stable chronic state.
• Panitumumab is a drug that inhibits the growth and survival of selective cancer cell lines.
• Olaparib - blocks the action of the enzyme that restores the cells.
• Herceptin is a drug that blocks proliferative processes in cancer cells.

Target drugs are able to significantly increase the life expectancy of patients with breast cancer. In addition, such medications are used to prevent tumor recurrence and the spread of metastases.

Preparations for the prevention of breast cancer

As a drug prevention prophylaxis of breast cancers, hormone therapy with Tamoxifen may sometimes be prescribed. Many doctors believe that the use of Tamoxifen can significantly reduce the level of danger of developing a cancerous growth of the mammary glands.

Nevertheless, it must be taken into account that this drug has such a side effect as reducing the effect of estrogens on the function of the mammary gland. In the future, this threatens the emergence and development of malignant process in the uterus. Because of this, most medical experts agree that there are currently no specific drugs for the prevention of breast cancer.

Preparations for the treatment of breast cancer are prescribed only by a doctor, depending on the particular tumor and the age category of the patient. In some cases (for example, in the absence of the expected effect), one drug may be replaced by another. Such treatment often allows you to successfully fight the disease. One of the few shortcomings of these drugs are side effects - anemia, alopecia, dyspeptic syndrome, etc.