Question: How does the oncologist decide what kind of chemotherapy to use?
Answer: The first decision that the oncologist and the patient make together is whether or not chemotherapy would be helpful in her particular circumstance. Most of my patients have just been diagnosed with breast cancer, and the first decision is: Is chemotherapy going to be helpful in trying to keep that cancer from coming back?
Realizing we have a lot of drugs now -- that aren't chemotherapy -- that we use in this circumstance, and the question is whether chemotherapy would be helpful added to these. If it's decided that chemotherapy would be useful, then we decide what kind of regimens to use.
And in truth, we have a lot of drugs that are very effective in breast cancer. When we're trying to help keep the cancer from coming back, we usually don't just use one drug; we combine them in several different regimens that are very well-accepted and well-known. Some of these regimens are a little more complicated; some of the more modern ones in particular, they're more effective, but they're a little more complicated, and they can have a little more side effects. So for a higher-risk breast cancer, many times we'll choose one of those. For a lower-risk breast cancer, we have some other regimens that are a little less aggressive, a little less complicated, and may be more appropriate for that setting.
In addition to characteristics of the tumor, there are also characteristics of the woman -- the breast cancer patient -- that help us decide. For example, some women have illnesses that make it harder for them to take one kind of drug and easier to take another kind, and so that influences the choices that we make together. So I would say that, really, it's a combination of both the characteristics of the cancer and the characteristics of the patient that help us decide which chemotherapy to use.