In our case above, Jill did receive chemotherapy for her TNBC. Many chemotherapy treatments in the adjuvant (meaning chemotherapy after breast surgery) setting are designed for one treatment every 3 weeks. However, in Jill’s case, the first four treatments were given once every 2 weeks.
This is called dose dense chemotherapy and is the second concept I would like to review. Dose dense chemotherapy has become more popular over the past few years. It was introduced in an attempt to improve existing treatments for more aggressive cancers.
Dose dense chemotherapy is basically giving the same dose of chemotherapy closer together in an attempt to minimize cancer cell re-growth in between chemotherapy cycles. It is based on the work performed by Dr. Larry Norton at Memorial Sloan Kettering Cancer Center in New York. Some resistant cells may live through chemotherapy but by giving them another slug of chemotherapy sooner (2 versus 3 weeks) before they have fully recovered should improve cell kill. Think of this as kicking the cancer cell while it is still down. Remember, in cancer – don’t fight fair!
Giving the chemotherapy in a dose dense fashion does not allow that extra week of recovery for the patient so it may be a little tougher. It also requires the use of white cell growth factor shots to allow recovery of the white blood cells which help prevent infection. Further research has determined that the dose dense approach yield better benefits for patients with ER/PR negative breast cancer (due to the fact that they are faster growing cancer cells) but not ER/PR positive breast cancers. I rarely use this approach in ER/PR positive breast cancers.
By: Dr. Chris Charlton