Difference between revisions of "Breast cancer"

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==Adjuvant Therapy==
 
==Adjuvant Therapy==
 
===HER-2 negative===
 
===HER-2 negative===
−
====TAC====
 
−
TAC: '''<u>T</u>'''axotere, '''<u>A</u>'''driamycin, '''<u>C</u>'''ytoxan
 
−
 
−
=====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. [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=====
Line 79: Line 61:
  
 
=====References=====
 
=====References=====
 +
 +
====TAC====
 +
TAC: '''<u>T</u>'''axotere, '''<u>A</u>'''driamycin, '''<u>C</u>'''ytoxan
 +
 +
=====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. [http://www.nejm.org/doi/full/10.1056/NEJMoa043681 link to original article] '''(contains protocol)''' [http://www.ncbi.nlm.nih.gov/pubmed/15930421 PubMed]
  
 
====TC====
 
====TC====
Line 274: Line 274:
 
*[[Docetaxel (Taxotere)]] 75 mg/m2 IV day 1  
 
*[[Docetaxel (Taxotere)]] 75 mg/m2 IV day 1  
 
*[[Carboplatin (Paraplatin)]] AUC 6 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
+
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 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'''
 
'''21-day cycles x 6 cycles, THEN'''
Line 292: Line 292:
 
=====Regimen=====
 
=====Regimen=====
 
*[[Docetaxel (Taxotere)]] 100 mg/m2 IV over 1 hour on day 1
 
*[[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
+
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 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'''
 
'''21-day cycles x 3 cycles, THEN'''
Line 315: Line 315:
  
 
*[[Docetaxel (Taxotere)]] 100 mg/m2 IV day 1
 
*[[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
+
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 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'''
 
'''21-day cycles x 4 cycles, THEN'''
Line 332: Line 332:
  
 
=====Regimen=====
 
=====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
+
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 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
 
*[[Paclitaxel (Taxol)]] 80 mg/m2 IV over 1 hour on days 1, 8, 15
  
Line 350: Line 350:
  
 
=====Regimen=====
 
=====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
+
*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 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
 
*[[Paclitaxel (Taxol)]] 225 mg/m2 IV over 24 hours on day 1
  
Line 367: Line 367:
 
==Metastatic Disease==
 
==Metastatic Disease==
 
===Single agent===
 
===Single agent===
 +
====Doxorubicin (Adriamycin)====
 +
=====Regimen=====
 +
*[[Doxorubicin (Adriamycin)]] 60-75 mg/m2 IV day 1
 +
 +
'''21-day cycles'''
 +
 +
Alternate schedule:
 +
*[[Doxorubicin (Adriamycin)]] 20 mg/m2 IV weekly
 +
 +
=====References=====
 +
 +
====Doxorubicin liposomal (Doxil)====
 +
=====Regimen=====
 +
*[[Doxorubicin liposomal (Doxil)]] 50 mg/m2 IV day 1
 +
 +
'''28-day cycles'''
 +
 +
=====References=====
 +
 +
====Epirubicin (Ellence)====
 +
=====Regimen=====
 +
*[[Epirubicin (Ellence)]] 60-90 mg/m2 IV day 1
 +
 +
'''21-day cycles'''
 +
 +
=====References=====
 +
 +
====Paclitaxel (Taxol)====
 +
=====Regimen=====
 +
*[[Paclitaxel (Taxol)]] 175 mg/m2 IV day 1
 +
 +
'''21-day cycles'''
 +
 +
Alternate schedule:
 +
*[[Paclitaxel (Taxol)]] 80 mg/m2 IV weekly
 +
 +
=====References=====
 +
 +
====Docetaxel (Taxotere)====
 +
=====Regimen=====
 +
*[[Docetaxel (Taxotere)]] 60-100 mg/m2 IV day 1
 +
 +
'''21-day cycles'''
 +
 +
Alternate schedule:
 +
*[[Docetaxel (Taxotere)]] 40 mg/m2 IV weekly for weeks 1-6, then off for weeks 7-8
 +
 +
'''8-week cycles'''
 +
 +
=====References=====
 +
 +
====nab-Paclitaxel (Abraxane)====
 +
=====Regimen=====
 +
*[[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] 100 or 150 mg/m2 IV days 1, 8, 15
 +
 +
'''28-day cycles'''
 +
 +
Alternate schedule:
 +
*[[Paclitaxel, nanoparticle albumin-bound (Abraxane)]] 260 mg/m2 IV day 1
 +
 +
'''21-day cycles'''
 +
 +
=====References=====
 +
 +
====Capecitabine (Xeloda)====
 +
=====Regimen=====
 +
*[[Capecitabine (Xeloda)]] 1000-1250 mg/m2 PO BID days 1-14
 +
 +
'''21-day cycles'''
 +
 +
=====References=====
 +
 +
====Gemcitabine (Gemzar)====
 +
=====Regimen=====
 +
*[[Gemcitabine (Gemzar)]] 800-1200 mg/m2 IV days 1, 8, 15
 +
 +
'''28-day cycles'''
 +
 +
=====References=====
 +
 +
 +
====Vinorelbine (Navelbine)====
 +
=====Regimen=====
 +
*[[Vinorelbine (Navelbine)]] 25 mg/m2 IV weekly
 +
 +
=====References=====
 +
 +
 
====Eribulin (Halaven)====
 
====Eribulin (Halaven)====
 
=====Regimen=====
 
=====Regimen=====
−
*[[Eribulin (Halaven)]] 1.4 mg/m2 IV over 2 to 5 minutes on days 1 and 8
+
*[[Eribulin (Halaven)]] 1.4 mg/m2 IV over 2 to 5 minutes on days 1 & 8
  
 
'''21-day cycles'''
 
'''21-day cycles'''
Line 388: Line 476:
  
 
===Combination chemotherapy===
 
===Combination chemotherapy===
 +
====Paclitaxel (Taxol) & Bevacizumab (Avastin)====
 +
=====Regimen=====
 +
*[[Paclitaxel (Taxol)]] 90 mg/m2 IV over 1 hour on days 1, 8, 15
 +
*[[Bevacizumab (Avastin)]] 10 mg/kg IV on days 1, 15
 +
 +
'''28-day cycles'''
 +
 +
=====References=====
  
 
===HER-2 positive===
 
===HER-2 positive===
 +
====TCH====
 +
TCH: '''<u>T</u>'''axol, '''<u>C</u>'''arboplatin, '''<u>H</u>'''erceptin
 +
 +
=====Regimen=====
 +
*[[Paclitaxel (Taxol)]] 175 mg/m2 IV day 1
 +
*[[Carboplatin (Paraplatin)]] AUC 6 IV day 1
 +
*EITHER
 +
:*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 1, then 2 mg/kg IV on day 8 & 15 of cycle 1; then on subsequent cycles, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15
 +
:OR *[[Trastuzumab (Herceptin)]] 8 mg/kg IV on cycle 1 day 1, then on subsequent cycles [[Trastuzumab (Herceptin)]] is 6 mg/kg IV on day 1
 +
 +
'''21-day cycles'''
 +
 +
Alternate schedule:
 +
*[[Paclitaxel (Taxol)]] 80 mg/m2 IV on days 1, 8, 15
 +
*[[Carboplatin (Paraplatin)]] AUC 2 IV on days 1, 8, 15
 +
*EITHER -- '''Note: Specific information was not found regarding adjustment of trastuzumab to this 28-day cycle.'''  Based on my best interpretation of the NCCN guidelines, if it is to be given weekly, one would administer trastuzumab on days 1, 8, 15, 22 of every 28-day cycle.  However, if trastuzumab is to be given once per cycle, it is unclear if it should still be given every 3 weeks as opposed to every 4 weeks. 
 +
:*[[Trastuzumab (Herceptin)]] 4 mg/kg IV on cycle 1 day 1, then 2 mg/kg IV on days 8, 15, 22 of cycle 1; then on subsequent cycles, [[Trastuzumab (Herceptin)]] is 2 mg/kg IV on days 1, 8, 15, 22
 +
:OR *[[Trastuzumab (Herceptin)]] 8 mg/kg IV on cycle 1 day 1, then future administrations of [[Trastuzumab (Herceptin)]] will be 6 mg/kg IV every 3 weeks
 +
 +
'''28-day cycles'''
 +
 +
=====Monitoring=====
 +
*Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
 +
 +
=====References=====

Revision as of 06:41, 19 February 2012


Adjuvant Therapy

HER-2 negative

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

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

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

Doxorubicin (Adriamycin)

Regimen

21-day cycles

Alternate schedule:

References

Doxorubicin liposomal (Doxil)

Regimen

28-day cycles

References

Epirubicin (Ellence)

Regimen

21-day cycles

References

Paclitaxel (Taxol)

Regimen

21-day cycles

Alternate schedule:

References

Docetaxel (Taxotere)

Regimen

21-day cycles

Alternate schedule:

8-week cycles

References

nab-Paclitaxel (Abraxane)

Regimen

28-day cycles

Alternate schedule:

21-day cycles

References

Capecitabine (Xeloda)

Regimen

21-day cycles

References

Gemcitabine (Gemzar)

Regimen

28-day cycles

References

Vinorelbine (Navelbine)

Regimen
References

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

Paclitaxel (Taxol) & Bevacizumab (Avastin)

Regimen

28-day cycles

References

HER-2 positive

TCH

TCH: Taxol, Carboplatin, Herceptin

Regimen
OR *Trastuzumab (Herceptin) 8 mg/kg IV on cycle 1 day 1, then on subsequent cycles Trastuzumab (Herceptin) is 6 mg/kg IV on day 1

21-day cycles

Alternate schedule:

  • Paclitaxel (Taxol) 80 mg/m2 IV on days 1, 8, 15
  • Carboplatin (Paraplatin) AUC 2 IV on days 1, 8, 15
  • EITHER -- Note: Specific information was not found regarding adjustment of trastuzumab to this 28-day cycle. Based on my best interpretation of the NCCN guidelines, if it is to be given weekly, one would administer trastuzumab on days 1, 8, 15, 22 of every 28-day cycle. However, if trastuzumab is to be given once per cycle, it is unclear if it should still be given every 3 weeks as opposed to every 4 weeks.
OR *Trastuzumab (Herceptin) 8 mg/kg IV on cycle 1 day 1, then future administrations of Trastuzumab (Herceptin) will be 6 mg/kg IV every 3 weeks

28-day cycles

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