Difference between revisions of "Breast cancer"

Revision as of 04:55, 19 February 2012

Adjuvant Therapy

HER-2 negative

TAC

TAC: Taxotere, Adriamycin, Cytoxan

Regimen

Docetaxel (Taxotere) 75 mg/m2 IV over 1 hour on day 1 (administered third, one hour after cyclophosphamide)
Doxorubicin (Adriamycin) 50 mg/m2 IV over 15 minutes on day 1 (administered first)
Cyclophosphamide (Cytoxan) 500 mg/m2 IV over 1-5 minutes on day 1 (administered second)
Dexamethasone 8 mg PO every 12 hours x 6 total doses, starting the day before treatment
Ciprofloxacin 500 mg PO BID on days 5-14 of every cycle (prophylaxis)
G-CSF not originally routinely administered unless patients had febrile neutropenia, but NCCN currently recommends routine filgrastim support:

Filgrastim (Neupogen) 5 mcg/kg SC on days 4-11
Lenograstim 150 mcg/m2 on days 4-11

21-day cycles x 6 cycles

References

Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, Tomiak E, Al-Tweigeri T, Chap L, Juhos E, Guevin R, Howell A, Fornander T, Hainsworth J, Coleman R, Vinholes J, Modiano M, Pinter T, Tang SC, Colwell B, Prady C, Provencher L, Walde D, Rodriguez-Lescure A, Hugh J, Loret C, Rupin M, Blitz S, Jacobs P, Murawsky M, Riva A, Vogel C; Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005 Jun 2;352(22):2302-13. link to original article (contains protocol) PubMed

Dose-dense AC -> Paclitaxel (Taxol)

Regimen

All cycles given with Filgrastim (Neupogen) support

Doxorubicin (Adriamycin) 60 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

14-day cycles x 4 cycles, THEN

Paclitaxel (Taxol) 175 mg/m2 IV over 3 hours day 1

14-day cycles x 4 cycles

References

Dose-dense ATC

ATC: Adriamycin, Taxol, Cytoxan

Regimen

All cycles given with Filgrastim (Neupogen) support

Doxorubicin (Adriamycin) 60 mg/m2 IV day 1

14-day cycles x 4 cycles, THEN

Paclitaxel (Taxol) 175 mg/m2 IV day 1

14-day cycles x 4 cycles, THEN

Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

14-day cycles x 4 cycles

References

AC -> Paclitaxel (Taxol)

Regimen

Doxorubicin (Adriamycin) 60 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

21-day cycles x 4 cycles, THEN

Paclitaxel (Taxol) 80 mg/m2 IV over 1 hour day 1

1-week cycles x 12 cycles/weeks

References

AC -> Docetaxel (Taxotere)

Regimen

Doxorubicin (Adriamycin) 60 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

21-day cycles x 4 cycles, THEN

Docetaxel (Taxotere) 100 mg/m2 IV day 1

21-day cycles x 4 cycles

References

TC

TC: Taxotere, Cytoxan

Regimen

All cycles given with Filgrastim (Neupogen) support

Docetaxel (Taxotere) 75 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

21-day cycles x 4 cycles

References

FAC #1

FAC: Five-FU, Adriamycin, Cytoxan

Regimen

Fluorouracil (5-FU) 500 mg/m2 IV over 15 minutes on day 1 (administered second)
Doxorubicin (Adriamycin) 50 mg/m2 IV over 15 minutes on day 1 (administered first)
Cyclophosphamide (Cytoxan) 500 mg/m2 IV over 1-5 minutes on day 1 (administered third)
If patients had febrile neutropenia or infection: Ciprofloxacin 500 mg PO BID on days 5-14 of every cycle (prophylaxis)
G-CSF not originally routinely administered unless patients had febrile neutropenia:

Filgrastim (Neupogen) 5 mcg/kg SC on days 4-11
Lenograstim 150 mcg/m2 on days 4-11

21-day cycles x 6 cycles

References

Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, Tomiak E, Al-Tweigeri T, Chap L, Juhos E, Guevin R, Howell A, Fornander T, Hainsworth J, Coleman R, Vinholes J, Modiano M, Pinter T, Tang SC, Colwell B, Prady C, Provencher L, Walde D, Rodriguez-Lescure A, Hugh J, Loret C, Rupin M, Blitz S, Jacobs P, Murawsky M, Riva A, Vogel C; Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005 Jun 2;352(22):2302-13. link to original article (contains protocol) PubMed

FAC #2

FAC: Five-FU, Adriamycin, Cytoxan

Regimen

Fluorouracil (5-FU) 500 mg/m2 IV on days 1 & 8 or days 1 & 4
Doxorubicin (Adriamycin) 50 mg/m2 IV on day 1 or via 72-hour continuous infusion
Cyclophosphamide (Cytoxan) 500 mg/m2 IV on day 1

21-day cycles x 6 cycles

References

CAF

CAF: Cytoxan, Adriamycin, Five-FU

Regimen

Cyclophosphamide (Cytoxan) 100 mg/m2 IV on days 1-14
Doxorubicin (Adriamycin) 30 mg/m2 IV on days 1 & 8
Fluorouracil (5-FU) 500 mg/m2 IV on days 1 & 8

28-day cycles x 6 cycles

References

CEF

CEF: Cytoxan, Epirubicin, Five-FU

Regimen

Cyclophosphamide (Cytoxan) 75 mg/m2 PO on days 1-14
Epirubicin (Ellence) 60 mg/m2 IV on days 1 & 8
Fluorouracil (5-FU) 500 mg/m2 IV on days 1 & 8
With cotrimoxazole support

28-day cycles x 6 cycles

References

CMF

CMF: Cytoxan, Methotrexate, Five-FU

Regimen

Cyclophosphamide (Cytoxan) 100 mg/m2 PO on days 1-14
Methotrexate (MTX) 40 mg/m2 IV on days 1 & 8
Fluorouracil (5-FU) 600 mg/m2 IV on days 1 & 8

28-day cycles x 6 cycles

References

EC

EC: Epirubicin, Cytoxan

Regimen

Epirubicin (Ellence) 100 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 830 mg/m2 IV day 1

21-day cycles x 8 cycles

References

FEC -> Docetaxel (Taxotere)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

Fluorouracil (5-FU) 500 mg/m2 IV day 1
Epirubicin (Ellence) 100 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 500 mg/m2 IV day 1

21-day cycles x 3 cycles, THEN

Docetaxel (Taxotere) 100 mg/m2 IV day 1

21-day cycles x 3 cycles

References

FEC -> Paclitaxel (Taxol)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

Fluorouracil (5-FU) 600 mg/m2 IV day 1
Epirubicin (Ellence) 90 mg/m2 IV day 1
Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1

21-day cycles x 4 cycles, THEN 3 weeks of no treatment, THEN

Paclitaxel (Taxol) 100 mg/m2 IV day 1

1-week cycles x 8 cycles/weeks

References

HER-2 positive

Metastatic Disease

Single agent

Eribulin (Halaven)

Regimen

Eribulin (Halaven) 1.4 mg/m2 IV over 2 to 5 minutes on days 1 and 8

21-day cycles

References

Cortes J, O'Shaughnessy J, Loesch D, Blum JL, Vahdat LT, Petrakova K, Chollet P, Manikas A, Diéras V, Delozier T, Vladimirov V, Cardoso F, Koh H, Bougnoux P, Dutcus CE, Seegobin S, Mir D, Meneses N, Wanders J, Twelves C; EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician's Choice Versus E7389) investigators. Eribulin monotherapy versus treatment of physician's choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study. Lancet. 2011 Mar 12;377(9769):914-23. link to original article (contains protocol) PubMed

Ixabepilone (Ixempra)

Regimen

Ixabepilone (Ixempra) 40 mg/m2 IV on day 1
Capecitabine (Xeloda) 2,000 mg/m2 orally on days 1 through 14

21-day cycles

References

Sparano JA, Vrdoljak E, Rixe O, Xu B, Manikhas A, Medina C, Da Costa SC, Ro J, Rubio G, Rondinon M, Perez Manga G, Peck R, Poulart V, Conte P. Randomized phase III trial of ixabepilone plus capecitabine versus capecitabine in patients with metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol. 2010 Jul 10;28(20):3256-63.link to original article (contains protocol) PubMed
Thomas ES, Gomez HL, Li RK, Chung HC, Fein LE, Chan VF, Jassem J, Pivot XB, Klimovsky JV, de Mendoza FH, Xu B, Campone M, Lerzo GL, Peck RA, Mukhopadhyay P, Vahdat LT, Roché HH. Ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol. 2007 Nov 20;25(33):5210-7. [1] (contains protocol) PubMed

@@ Line 1: / Line 1: @@
-{{TOC limit|limit=3}}
+{{TOC limit|limit=4}}
 ==Adjuvant Therapy==
+===HER-2 negative===
-===TAC===
+====TAC====
 TAC: '''<u>T</u>'''axotere, '''<u>A</u>'''driamycin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Docetaxel (Taxotere)]] 75 mg/m2 IV over 1 hour on day 1 (administered third, one hour after cyclophosphamide)
 *[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV over 15 minutes on day 1 (administered first)
@@ Line 18: / Line 18: @@
 '''21-day cycles x 6 cycles'''
-====References====
+=====References=====
 # Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, Tomiak E, Al-Tweigeri T, Chap L, Juhos E, Guevin R, Howell A, Fornander T, Hainsworth J, Coleman R, Vinholes J, Modiano M, Pinter T, Tang SC, Colwell B, Prady C, Provencher L, Walde D, Rodriguez-Lescure A, Hugh J, Loret C, Rupin M, Blitz S, Jacobs P, Murawsky M, Riva A, Vogel C; Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005 Jun 2;352(22):2302-13. [http://www.nejm.org/doi/full/10.1056/NEJMoa043681 link to original article] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/15930421 PubMed]
-===Dose-dense AC -> Paclitaxel (Taxol)===
+====Dose-dense AC -> Paclitaxel (Taxol)====
-====Regimen====
+=====Regimen=====
 '''All cycles given with [[Filgrastim (Neupogen)]] support'''
 *[[Doxorubicin (Adriamycin)]] 60 mg/m2 IV day 1
@@ Line 33: / Line 33: @@
 '''14-day cycles x 4 cycles'''
-====References====
+=====References=====
-===Dose-dense ATC===
+====Dose-dense ATC====
 ATC: '''<u>A</u>'''driamycin, '''<u>T</u>'''axol, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 '''All cycles given with [[Filgrastim (Neupogen)]] support'''
 *[[Doxorubicin (Adriamycin)]] 60 mg/m2 IV day 1
@@ Line 52: / Line 52: @@
 '''14-day cycles x 4 cycles'''
-====References====
+=====References=====
-===AC -> Paclitaxel (Taxol)===
+====AC -> Paclitaxel (Taxol)====
-====Regimen====
+=====Regimen=====
 *[[Doxorubicin (Adriamycin)]] 60 mg/m2 IV day 1
 *[[Cyclophosphamide (Cytoxan)]] 600 mg/m2 IV day 1
@@ Line 65: / Line 65: @@
 '''1-week cycles x 12 cycles/weeks'''
-====References====
+=====References=====
-===AC -> Docetaxel (Taxotere)===
+====AC -> Docetaxel (Taxotere)====
-====Regimen====
+=====Regimen=====
 *[[Doxorubicin (Adriamycin)]] 60 mg/m2 IV day 1
 *[[Cyclophosphamide (Cytoxan)]] 600 mg/m2 IV day 1
@@ Line 78: / Line 78: @@
 '''21-day cycles x 4 cycles'''
-====References====
+=====References=====
-===TC===
+====TC====
 TC: '''<u>T</u>'''axotere, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 '''All cycles given with [[Filgrastim (Neupogen)]] support'''
 *[[Docetaxel (Taxotere)]] 75 mg/m2 IV day 1
@@ Line 90: / Line 90: @@
 '''21-day cycles x 4 cycles'''
-====References====
+=====References=====
-===FAC #1===
+====FAC #1====
 FAC: '''<u>F</u>'''ive-FU, '''<u>A</u>'''driamycin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Fluorouracil (5-FU)]] 500 mg/m2 IV over 15 minutes on day 1 (administered second)
 *[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV over 15 minutes on day 1 (administered first)
@@ Line 106: / Line 106: @@
 '''21-day cycles x 6 cycles'''
-====References====
+=====References=====
 # Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, Tomiak E, Al-Tweigeri T, Chap L, Juhos E, Guevin R, Howell A, Fornander T, Hainsworth J, Coleman R, Vinholes J, Modiano M, Pinter T, Tang SC, Colwell B, Prady C, Provencher L, Walde D, Rodriguez-Lescure A, Hugh J, Loret C, Rupin M, Blitz S, Jacobs P, Murawsky M, Riva A, Vogel C; Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005 Jun 2;352(22):2302-13. [http://www.nejm.org/doi/full/10.1056/NEJMoa043681 link to original article] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/15930421 PubMed]
-===FAC #2===
+====FAC #2====
 FAC: '''<u>F</u>'''ive-FU, '''<u>A</u>'''driamycin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Fluorouracil (5-FU)]] 500 mg/m2 IV on days 1 & 8 or days 1 & 4
 *[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV on day 1 or via 72-hour continuous infusion
@@ Line 119: / Line 119: @@
 '''21-day cycles x 6 cycles'''
-====References====
+=====References=====
-===CAF===
+====CAF====
 CAF: '''<u>C</u>'''ytoxan, '''<u>A</u>'''driamycin, '''<u>F</u>'''ive-FU
-====Regimen====
+=====Regimen=====
 *[[Cyclophosphamide (Cytoxan)]] 100 mg/m2 IV on days 1-14
 *[[Doxorubicin (Adriamycin)]] 30 mg/m2 IV on days 1 & 8
@@ Line 131: / Line 131: @@
 '''28-day cycles x 6 cycles'''
-====References====
+=====References=====
-===CEF===
+====CEF====
 CEF: '''<u>C</u>'''ytoxan, '''<u>E</u>'''pirubicin, '''<u>F</u>'''ive-FU
-====Regimen====
+=====Regimen=====
 *[[Cyclophosphamide (Cytoxan)]] 75 mg/m2 PO on days 1-14
 *[[Epirubicin (Ellence)]] 60 mg/m2 IV on days 1 & 8
@@ Line 145: / Line 145: @@
 '''28-day cycles x 6 cycles'''
-====References====
+=====References=====
-===CMF===
+====CMF====
 CMF: '''<u>C</u>'''ytoxan, '''<u>M</u>'''ethotrexate, '''<u>F</u>'''ive-FU
-====Regimen====
+=====Regimen=====
 *[[Cyclophosphamide (Cytoxan)]] 100 mg/m2 PO on days 1-14
 *[[Methotrexate (MTX)]] 40 mg/m2 IV on days 1 & 8
@@ Line 158: / Line 158: @@
 '''28-day cycles x 6 cycles'''
-====References====
+=====References=====
-===EC===
+====EC====
 EC: '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Epirubicin (Ellence)]] 100 mg/m2 IV day 1
 *[[Cyclophosphamide (Cytoxan)]] 830 mg/m2 IV day 1
@@ Line 169: / Line 169: @@
 '''21-day cycles x 8 cycles'''
-====References====
+=====References=====
-===FEC -> Docetaxel (Taxotere)===
+====FEC -> Docetaxel (Taxotere)====
 FEC: '''<u>F</u>'''ive-FU, '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Fluorouracil (5-FU)]] 500 mg/m2 IV day 1
 *[[Epirubicin (Ellence)]] 100 mg/m2 IV day 1
@@ Line 186: / Line 186: @@
 '''21-day cycles x 3 cycles'''
-====References====
+=====References=====
-===FEC -> Paclitaxel (Taxol)===
+====FEC -> Paclitaxel (Taxol)====
 FEC: '''<u>F</u>'''ive-FU, '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
-====Regimen====
+=====Regimen=====
 *[[Fluorouracil (5-FU)]] 600 mg/m2 IV day 1
 *[[Epirubicin (Ellence)]] 90 mg/m2 IV day 1
@@ Line 202: / Line 202: @@
 '''1-week cycles x 8 cycles/weeks'''
-====References====
+=====References=====
+===HER-2 positive===
 ==Metastatic Disease==
-===Eribulin (Halaven)===
+===Single agent===
-====Regimen====
+====Eribulin (Halaven)====
+=====Regimen=====
 *[[Eribulin (Halaven)]] 1.4 mg/m2 IV over 2 to 5 minutes on days 1 and 8
 '''21-day cycles'''
-====References====
+=====References=====
 # Cortes J, O'Shaughnessy J, Loesch D, Blum JL, Vahdat LT, Petrakova K, Chollet P, Manikas A, Diéras V, Delozier T, Vladimirov V, Cardoso F, Koh H, Bougnoux P, Dutcus CE, Seegobin S, Mir D, Meneses N, Wanders J, Twelves C; EMBRACE (Eisai Metastatic Breast Cancer Study Assessing Physician's Choice Versus E7389) investigators.  Eribulin monotherapy versus treatment of physician's choice in patients with metastatic breast cancer (EMBRACE): a phase 3 open-label randomised study.  Lancet. 2011 Mar 12;377(9769):914-23. [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960070-6/fulltext link to original article] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/21376385 PubMed]
-===Ixabepilone (Ixempra)===
+====Ixabepilone (Ixempra)====
-====Regimen====
+=====Regimen=====
 *[[Ixabepilone (Ixempra)]] 40 mg/m2 IV on day 1
 *[[Capecitabine (Xeloda)]] 2,000 mg/m2 orally on days 1 through 14
@@ Line 221: / Line 225: @@
 '''21-day cycles'''
-====References====
+=====References=====
 # Sparano JA, Vrdoljak E, Rixe O, Xu B, Manikhas A, Medina C, Da Costa SC, Ro J, Rubio G, Rondinon M, Perez Manga G, Peck R, Poulart V, Conte P. Randomized phase III trial of ixabepilone plus capecitabine versus capecitabine in patients with metastatic breast cancer previously treated with an anthracycline and a taxane.  J Clin Oncol. 2010 Jul 10;28(20):3256-63.[http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20530276/?tool=pubmed link to original article] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/20530276 PubMed]
 # Thomas ES, Gomez HL, Li RK, Chung HC, Fein LE, Chan VF, Jassem J, Pivot XB, Klimovsky JV, de Mendoza FH, Xu B, Campone M, Lerzo GL, Peck RA, Mukhopadhyay P, Vahdat LT, Roché HH. Ixabepilone plus capecitabine for metastatic breast cancer progressing after anthracycline and taxane treatment. J Clin Oncol. 2007 Nov 20;25(33):5210-7. [http://www.jco.org/cgi/pmidlookup?view=long&pmid=17968020] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/17968020 PubMed]
+===Combination chemotherapy===
+===HER-2 positive===

Difference between revisions of "Breast cancer"

Revision as of 04:55, 19 February 2012

Adjuvant Therapy

HER-2 negative

TAC

Regimen

References

Dose-dense AC -> Paclitaxel (Taxol)

Regimen

References

Dose-dense ATC

Regimen

References

AC -> Paclitaxel (Taxol)

Regimen

References

AC -> Docetaxel (Taxotere)

Regimen

References

TC

Regimen

References

FAC #1

Regimen

References

FAC #2

Regimen

References

CAF

Regimen

References

CEF

Regimen

References

CMF

Regimen

References

EC

Regimen

References

FEC -> Docetaxel (Taxotere)

Regimen

References

FEC -> Paclitaxel (Taxol)

Regimen

References

HER-2 positive

Metastatic Disease

Single agent

Eribulin (Halaven)

Regimen

References

Ixabepilone (Ixempra)

Regimen

References

Combination chemotherapy

HER-2 positive

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