Difference between revisions of "Breast cancer"

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===HER-2 positive===
 
===HER-2 positive===
 +
 +
====AC -> weekly Paclitaxel (Taxol) & Trastuzumab (Herceptin)====
 +
=====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
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV with first dose of paclitaxel, then 2 mg/kg IV on subsequent weeks
 +
 +
'''1-week cycles x 12 cycles/weeks, THEN EITHER'''
 +
 +
:*[[Trastuzumab (Herceptin)]] 2 mg/kg IV, '''1-week cycles x 40 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
:OR *[[Trastuzumab (Herceptin)]] 6 mg/kg IV, '''3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====
 +
 +
====AC -> Paclitaxel (Taxol) & Trastuzumab (Herceptin)====
 +
=====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)]] 175 mg/m2 IV over 3 hours day 1
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV with first dose of paclitaxel, then 2 mg/kg IV on days 8 & 15 of cycle 1; in cycles 2-4, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 4 cycles, THEN EITHER'''
 +
 +
:*[[Trastuzumab (Herceptin)]] 2 mg/kg IV, '''1-week cycles x 40 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
:OR *[[Trastuzumab (Herceptin)]] 6 mg/kg IV, '''3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====
 +
 +
 +
====Dose-dense AC -> Paclitaxel (Taxol) & Trastuzumab (Herceptin)====
 +
=====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
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV with first dose of paclitaxel, then 2 mg/kg IV on day 8 of cycle 1; in cycles 2-4, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1 & 8
 +
 +
'''14-day cycles x 4 cycles, THEN EITHER'''
 +
 +
:*[[Trastuzumab (Herceptin)]] 2 mg/kg IV, '''1-week cycles x 44 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
:OR *[[Trastuzumab (Herceptin)]] 6 mg/kg IV, '''3-week cycles x 15 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====
 +
 +
====TCH====
 +
TCH: '''<u>T</u>'''axotere, '''<u>C</u>'''arboplatin, '''<u>H</u>'''erceptin
 +
 +
=====Regimen=====
 +
*[[Docetaxel (Taxotere)]] 75 mg/m2 IV day 1
 +
*[[Carboplatin (Paraplatin)]] AUC 6 IV day 1
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on week 1, then 2 mg/kg IV on day 8 & 15 of cycle 1; then in cycles 2-6, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 6 cycles, THEN'''
 +
 +
*[[Trastuzumab (Herceptin)]] 6 mg/kg IV day 1
 +
 +
'''3-week cycles x 12 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====
 +
 +
====Docetaxel (Taxotere) & Trastuzumab (Herceptin) -> FEC====
 +
FEC: '''<u>F</u>'''ive-FU, '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
 +
 +
=====Regimen=====
 +
*[[Docetaxel (Taxotere)]] 100 mg/m2 IV over 1 hour on day 1
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on week 1, then 2 mg/kg IV on days 8 & 15 of cycle 1; then in cycles 2-3, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 3 cycles, THEN'''
 +
 +
*[[Fluorouracil (5-FU)]] 600 mg/m2 IV day 1
 +
*[[Epirubicin (Ellence)]] 60 mg/m2 IV day 1
 +
*[[Cyclophosphamide (Cytoxan)]] 600 mg/m2 IV day 1
 +
 +
'''21-day cycles x 3 cycles'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, after last cycle of FEC, 12 months after completion of chemotherapy, and 36 months after completion of chemotherapy
 +
 +
=====References=====
 +
 +
====AC -> Docetaxel (Taxotere) & Trastuzumab (Herceptin)====
 +
=====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
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on week 1, then 2 mg/kg IV on days 8 & 15 of cycle 1; then in cycles 2-4, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 4 cycles, THEN'''
 +
 +
*[[Trastuzumab (Herceptin)]] 6 mg/kg IV day 1
 +
 +
'''3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====
 +
 +
====Neoadjuvant weekly Paclitaxel (Taxol) -> FEC & Trastuzumab (Herceptin)====
 +
FEC: '''<u>F</u>'''ive-FU, '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
 +
 +
=====Regimen=====
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on week 1 prior to first dose of paclitaxel, then 2 mg/kg on days 8 & 15 of cycle 1; then in cycles 2-4, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
*[[Paclitaxel (Taxol)]] 80 mg/m2 IV over 1 hour on days 1, 8, 15
 +
 +
'''21-day cycles x 4 cycles, THEN'''
 +
 +
*[[Fluorouracil (5-FU)]] 500 mg/m2 IV on days 1 & 4
 +
*[[Epirubicin (Ellence)]] 75 mg/m2 IV on day 1
 +
*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV on day 1
 +
*[[Trastuzumab (Herceptin)]] 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 4 cycles'''
 +
 +
=====References=====
 +
 +
====Neoadjuvant Paclitaxel (Taxol) -> FEC & Trastuzumab (Herceptin)====
 +
FEC: '''<u>F</u>'''ive-FU, '''<u>E</u>'''pirubicin, '''<u>C</u>'''ytoxan
 +
 +
=====Regimen=====
 +
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on week 1 prior to first dose of paclitaxel, then 2 mg/kg on days 8 & 15 of cycle 1; then in cycles 2-4, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
*[[Paclitaxel (Taxol)]] 225 mg/m2 IV over 24 hours on day 1
 +
 +
'''21-day cycles x 4 cycles, THEN'''
 +
 +
*[[Fluorouracil (5-FU)]] 500 mg/m2 IV on days 1 & 4
 +
*[[Epirubicin (Ellence)]] 75 mg/m2 IV on day 1
 +
*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV on day 1
 +
*[[Trastuzumab (Herceptin)]] 2 mg/kg IV on days 1, 8, 15
 +
 +
'''21-day cycles x 4 cycles'''
 +
 +
=====References=====
  
  

Revision as of 05:46, 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:

21-day cycles x 6 cycles

References
  1. 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

14-day cycles x 4 cycles, THEN

14-day cycles x 4 cycles

References

Dose-dense ATC

ATC: Adriamycin, Taxol, Cytoxan

Regimen

All cycles given with Filgrastim (Neupogen) support

14-day cycles x 4 cycles, THEN

14-day cycles x 4 cycles, THEN

14-day cycles x 4 cycles

References

AC -> Paclitaxel (Taxol)

Regimen

21-day cycles x 4 cycles, THEN

1-week cycles x 12 cycles/weeks

References

AC -> Docetaxel (Taxotere)

Regimen

21-day cycles x 4 cycles, THEN

21-day cycles x 4 cycles

References

TC

TC: Taxotere, Cytoxan

Regimen

All cycles given with Filgrastim (Neupogen) support

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:

21-day cycles x 6 cycles

References
  1. 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

21-day cycles x 6 cycles

References

CAF

CAF: Cytoxan, Adriamycin, Five-FU

Regimen

28-day cycles x 6 cycles

References

CEF

CEF: Cytoxan, Epirubicin, Five-FU

Regimen

28-day cycles x 6 cycles

References

CMF

CMF: Cytoxan, Methotrexate, Five-FU

Regimen

28-day cycles x 6 cycles

References

EC

EC: Epirubicin, Cytoxan

Regimen

21-day cycles x 8 cycles

References

FEC -> Docetaxel (Taxotere)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

21-day cycles x 3 cycles, THEN

21-day cycles x 3 cycles

References

FEC -> Paclitaxel (Taxol)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

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

1-week cycles x 8 cycles/weeks

References

HER-2 positive

AC -> weekly Paclitaxel (Taxol) & Trastuzumab (Herceptin)

Regimen

21-day cycles x 4 cycles, THEN

1-week cycles x 12 cycles/weeks, THEN EITHER

  • Trastuzumab (Herceptin) 2 mg/kg IV, 1-week cycles x 40 additional cycles/weeks to complete a total of 52 weeks of therapy
OR *Trastuzumab (Herceptin) 6 mg/kg IV, 3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy
Monitoring
  • Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References

AC -> Paclitaxel (Taxol) & Trastuzumab (Herceptin)

Regimen

21-day cycles x 4 cycles, THEN

21-day cycles x 4 cycles, THEN EITHER

  • Trastuzumab (Herceptin) 2 mg/kg IV, 1-week cycles x 40 additional cycles/weeks to complete a total of 52 weeks of therapy
OR *Trastuzumab (Herceptin) 6 mg/kg IV, 3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy
Monitoring
  • Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References

Dose-dense AC -> Paclitaxel (Taxol) & Trastuzumab (Herceptin)

Regimen

All cycles given with Filgrastim (Neupogen) support

14-day cycles x 4 cycles, THEN

14-day cycles x 4 cycles, THEN EITHER

  • Trastuzumab (Herceptin) 2 mg/kg IV, 1-week cycles x 44 additional cycles/weeks to complete a total of 52 weeks of therapy
OR *Trastuzumab (Herceptin) 6 mg/kg IV, 3-week cycles x 15 additional cycles/weeks to complete a total of 52 weeks of therapy
Monitoring
  • Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References

TCH

TCH: Taxotere, Carboplatin, Herceptin

Regimen

21-day cycles x 6 cycles, THEN

3-week cycles x 12 additional cycles/weeks to complete a total of 52 weeks of therapy

Monitoring
  • Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References

Docetaxel (Taxotere) & Trastuzumab (Herceptin) -> FEC

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

21-day cycles x 3 cycles, THEN

21-day cycles x 3 cycles

Monitoring
  • Cardiac function: echocardiogram at baseline, after last cycle of FEC, 12 months after completion of chemotherapy, and 36 months after completion of chemotherapy
References

AC -> Docetaxel (Taxotere) & Trastuzumab (Herceptin)

Regimen

21-day cycles x 4 cycles, THEN

21-day cycles x 4 cycles, THEN

3-week cycles x 14 additional cycles/weeks to complete a total of 52 weeks of therapy

Monitoring
  • Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References

Neoadjuvant weekly Paclitaxel (Taxol) -> FEC & Trastuzumab (Herceptin)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

21-day cycles x 4 cycles, THEN

21-day cycles x 4 cycles

References

Neoadjuvant Paclitaxel (Taxol) -> FEC & Trastuzumab (Herceptin)

FEC: Five-FU, Epirubicin, Cytoxan

Regimen

21-day cycles x 4 cycles, THEN

21-day cycles x 4 cycles

References

Metastatic Disease

Single agent

Eribulin (Halaven)

Regimen

21-day cycles

References
  1. 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

21-day cycles

References
  1. 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
  2. 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

Combination chemotherapy

HER-2 positive

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