Breast cancer
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Adjuvant Therapy
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
Metastatic Disease
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