What to know about oral chemotherapy and breast cancer

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Oral chemo is cancer-killing medication in the form of a pill. The medication works in a similar way as other chemo drugs, targeting cancer and other cells to slow or stop the growth of cancer.

A person will still experience the side effects of chemo and need to see their doctor regularly.

It is important to take the chemo drugs on a regular schedule, as the doctor prescribed them.

The fact that a drug is in the form of a pill rather than an IV infusion does not mean that it is less potent or less likely to harm a person if they use it incorrectly.

Some examples of oral chemo drugs for breast cancer include:

• cyclophosphamide
• etoposide
• capecitabine
• methotrexate sodium

As oral chemo becomes more popular, scientists continue to develop more pill-based chemo options.

A person with breast cancer might get several benefits from oral chemo. Possible benefits include:

• Effective: Many oral chemo drugs for breast cancer are reformulations of traditional chemo drugs and have a similar effectiveness. Most research shows that these drugs work well. However, the specific efficacy of a drug depends on the type of breast cancer.
• COVID-19 safety: During the COVID-19 pandemic, avoiding hospitals and medical offices may help slow the spread of the virus, which is particularly important for cancer patients with a weakened immune system. Oral chemo can help reduce a person’s doctor’s visits and time in the hospital.
• Convenience: People with breast cancer may prefer oral chemo because it saves time. They do not have to get dressed, sit in traffic, find hospital parking, and give up much of their day for chemo.
• Less pain: For some people, IV chemo infusions are frightening or painful, and interactions with medical providers are stressful. In contrast, taking chemo at home may feel more comfortable.
• Geographic convenience: People who live in rural regions or do not have easy access to quality doctors or hospitals may get better care if they can travel to see their doctor less frequently and take chemo at home.
• Price: As oral chemo requires fewer resources, it may be more affordable. However, insurance in the United States does not cover all oral chemo, so a person who is interested in taking it should check with their insurance provider.
• Reduced medical resources: Traditional chemo requires at least one medical provider to administer treatment, whereas a person can take oral chemo on their own. This independence may be especially important during times of reduced doctor and hospital availability, such as the COVID-19 pandemic.
• More time with loved ones: In-person chemo may require spending half of the day away from home. Oral chemo means that people can undergo treatment with their loved ones in the comfort of their homes.

Chemo targets cancer cells, but it also kills healthy cells. As a result, it can cause a wide range of side effects.

The specific side effects vary from person to person and may depend on the type of pill that a person takes.

Oral chemo is not a lighter or less intense form of chemo — it is simply chemo in a pill form. Therefore, the side effects are similar to those that a person might experience with an IV infusion or injection.

The most common side effects include:

• hair loss
• nausea, vomiting, or diarrhea
• constipation
• dry mouth
• brain fog or inattention
• damage to the bone marrow
• depression
• fatigue, sometimes from trouble sleeping at night
• infertility
• a higher risk of infections because chemo weakens the immune system

Oral chemo is a toxic drug that can be dangerous, or even deadly, to children or pets who consume it. A doctor may recommend preventive measures, such as keeping the drug locked away.

In some cases, hot or cold temperatures may damage the drug. A healthcare provider will give instructions on how to keep the drug at the appropriate temperature.

The American Cancer Society note that in most cases, a person receives chemo — oral or otherwise — in cycles that involve 2–3 weeks of treatment and then a few weeks of rest. A person must follow their treatment instructions precisely and alert their doctor if they miss a dose or take an extra dose.

There is no one-size-fits-all approach to oral chemo, so a person receiving it should contact a doctor if they have any questions.

A person may sometimes need additional treatment before or after oral chemo, such as radiation, surgery, or more chemo.

A doctor will usually establish a visit schedule to assess side effects and progress. They may use imaging scans of the tumor to determine whether chemo is working.

It is very important to go to these visits because a doctor might change the chemo drug or dosage. In some cases, they might even recommend a different treatment.

A person should call their doctor if they:

• experience chemo side effects that interfere with daily life
• feel very sick
• miss a dose or take the incorrect dose
• have any questions about their care

Anyone who has a significant reaction right after taking chemo should seek emergency medical help immediately. The reaction could include developing a rash, having trouble breathing, or experiencing pain.

Oral chemotherapy is a convenient treatment option that some people with breast cancer may prefer over traditional injectable or IV infusion chemo.

People considering this option should discuss the risks and benefits with an oncologist, a doctor who specializes in cancer.

Each oral chemo drug is different, so it is important for a person to discuss with a specialist which specific drugs might work best for them.