Dose-Dense Chemotherapy

What is chemotherapy?

Chemotherapy is a type of medicine that is used to treat cancer. Cancer cells grow and reproduce (multiply) very quickly. Normal, healthy cells know to stop growing and reproducing when they touch other cells. Cancer cells keep growing, not knowing when to stop. RNA and DNA in the cells tell them how to grow and reproduce. Chemotherapy hurts the RNA or DNA, stopping the cancer from growing. A chemotherapy regimen is a group of medications given to treat cancer.

What is dose-dense chemotherapy?

Dose-dense Chemotherapy (DDC) is a way to give chemotherapy more often than normal. The goal of DDC is to kill as much of the tumor as it can. The actual dose of chemotherapy is not increased, but there is less time between doses. By giving the same doses of chemotherapy more often, the chemotherapy stops the growth phase of the tumor cells. The medications hit the tumor cells at the time when they are just starting to grow again. 

A concern of DDC is that giving chemotherapy more often might lead to low white blood counts and infection. Through the use of growth factors like Filgrastim (Neupogen®, G-CSF), Pegfilgrastim (Neulasta®), and Sargramostim (Leukine®, GM-CSF), your white blood cell level can rise, lowering your risk of infection. DDC studies have shown a higher rate of anemia (low red blood cell count) and bone pain (likely linked to the use of a growth factor) with these regimens, but the DDC regimens also shorten the length of therapy by 4-6 weeks.

What types of cancer can DDC treat?

Studies have found that some types of high-risk breast cancer (hormone receptor-negative, Her2 positive, and lymph node-positive) see the most benefit from DDC. This study also found that the use of DDC does not seem to be linked with an added risk of early menopause or amenorrhea (loss of menstrual periods). This is important because early menopause can make your ovaries stop working, which can raise your risk of:

• Osteoporosis (makes your bones weak and brittle).
• Early heart disease.
• Infertility.
• Hot flashes.
• Vaginal dryness.
• Weight gain.

DDC is also used to treat some high-risk lymphomas. Studies are still looking at DDC used with Rituximab (Rituxan®). Studies have also looked at using DDC in ovarian cancer.

If your treatment plan includes dose-dense chemotherapy, talk with your provider about any concerns you may have.