Breast cancer
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Adjuvant Therapy
Endocrine
Anastrozole (Arimidex)
- Anastrozole (Arimidex) 1 mg PO daily
Duration of therapy: 5 years
References
Letrozole (Femara)
- Letrozole (Femara) 2.5 mg PO daily
Duration of therapy: 5 years
References
Exemestane (Aromasin)
- Exemestane (Aromasin) 25 mg PO daily
Duration of therapy: 5 years
References
Tamoxifen (Nolvadex)
- Tamoxifen (Nolvadex) 20 mg PO daily
Duration of therapy: 5 years
References
Chemotherapy, HER-2 negative
Dose-dense AC -> T
AC -> T: Adriamycin, Cytoxan -> 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 -> T (Taxol)
AC -> T: Adriamycin, Cytoxan -> 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 -> T (Taxotere)
AC -> T: Adriamycin, Cytoxan -> 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
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
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 -> T (Taxotere)
FEC -> T: Five-FU, Epirubicin, Cytoxan -> Taxotere
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 -> T (Taxol)
FEC -> T: Five-FU, Epirubicin, Cytoxan -> Taxol
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
Chemotherapy, HER-2 positive
AC -> weekly TH (Taxol)
AC -> weekly TH: Adriamycin, Cytoxan -> weekly Taxol, 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 -> TH (Taxol)
AC -> TH: Adriamycin, Cytoxan -> Taxol, 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 -> TH (Taxol)
AC -> TH: Adriamycin, Cytoxan -> Taxol, 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: Taxotere, Carboplatin, Herceptin
Regimen
- Docetaxel (Taxotere) 75 mg/m2 IV day 1
- Carboplatin (Paraplatin) AUC 6 IV day 1
- 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
- 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
TH (Taxotere) -> FEC
TH -> FEC: Taxotere, Herceptin -> Five-FU, Epirubicin, Cytoxan
Regimen
- Docetaxel (Taxotere) 100 mg/m2 IV over 1 hour on day 1
- 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
- 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 -> TH (Taxotere)
AC -> TH: Adriamycin, Cytoxan -> Taxotere, 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 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
- 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 TH (Taxol) -> FEC & H
weekly TH -> FEC & H: weekly Taxol, Herceptin -> Five-FU, Epirubicin, Cytoxan, Herceptin
Regimen
- 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
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 TH (Taxol) -> FEC & H
TH -> FEC & H: Taxol, Herceptin -> Five-FU, Epirubicin, Cytoxan, Herceptin
Regimen
- 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
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
Metastatic Disease
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
Regimen
- Vinorelbine (Navelbine) 25 mg/m2 IV weekly
References
Eribulin (Halaven)
Regimen
- Eribulin (Halaven) 1.4 mg/m2 IV over 2 to 5 minutes on days 1 & 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
- Eribulin (Halaven) package insert
Combination chemotherapy
CAF
CAF: Cytoxan, Adriamycin, Five-FU
Regimen
- Cyclophosphamide (Cytoxan) 100 mg/m2 PO 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
References
FAC
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
- Cyclophosphamide (Cytoxan) 500 mg/m2 IV on day 1
21-day cycles
References
FEC
FEC: Five-FU, Epirubicin, Cytoxan
Regimen
- Fluorouracil (5-FU) 500 mg/m2 IV days 1 & 8
- Epirubicin (Ellence) 50 mg/m2 IV days 1 & 8
- Cyclophosphamide (Cytoxan) 400 mg/m2 IV days 1 & 8
28-day cycles
References
AC
Regimen
- Doxorubicin (Adriamycin) 60 mg/m2 IV day 1
- Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1
21-day cycles
References
EC
EC: Epirubicin, Cytoxan
Regimen
- Epirubicin (Ellence) 75 mg/m2 IV day 1
- Cyclophosphamide (Cytoxan) 600 mg/m2 IV day 1
21-day cycles
References
AT (Taxol)
AT: Adriamycin, Taxol
Regimen
- Doxorubicin (Adriamycin) 60 mg/m2 IV day 1
- Paclitaxel (Taxol) 125-200 mg/m2 IV day 1
21-day cycles
References
AT (Taxotere)
AT: Adriamycin, Taxotere
Regimen
- Doxorubicin (Adriamycin) 50 mg/m2 IV day 1
- Docetaxel (Taxotere) 75 mg/m2 IV day 1
21-day 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
References
TX (Taxotere)
TX: Taxotere, Xeloda
Regimen
- Docetaxel (Taxotere) 75 mg/m2 IV day 1
- Capecitabine (Xeloda) 950 mg/m2 PO BID days 1-14
21-day cycles
References
GT
GT: Gemcitabine, Taxol
Regimen
- Gemcitabine (Gemzar) 1250 mg/m2 IV on days 1 & 8; on day 1, administer after paclitaxel
- Paclitaxel (Taxol) 175 mg/m2 IV day 1
21-day cycles
References
Ixabepilone (Ixempra) & Capecitabine (Xeloda)
Regimen
- Ixabepilone (Ixempra) 40 mg/m2 IV on day 1
- Capecitabine (Xeloda) 2000 mg/m2 PO on days 1-14
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
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
Endocrine
Anastrozole (Arimidex)
- Anastrozole (Arimidex) 1 mg PO daily
References
Letrozole (Femara)
- Letrozole (Femara) 2.5 mg PO daily
References
Exemestane (Aromasin)
- Exemestane (Aromasin) 25 mg PO daily
References
Fulvestrant (Faslodex)
- Fulvestrant (Faslodex) 500 mg IM every 2 weeks x 3 doses, and then every 4 weeks thereafter
References
Tamoxifen (Nolvadex)
- Tamoxifen (Nolvadex) 20 mg PO daily
References
Toremifene (Fareston)
- Toremifene (Fareston) 60 mg PO daily
References
HER-2 positive
TCH
TCH: Taxol, Carboplatin, Herceptin
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 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
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.
Monitoring
- Cardiac function: echocardiogram at baseline, then every 3 months while on Trastuzumab (Herceptin)
References
Paclitaxel (Taxol) & Trastuzumab (Herceptin)
Regimen
- Paclitaxel (Taxol) 175 mg/m2 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) 80-90 mg/m2 IV weekly
- Trastuzumab (Herceptin) 4 mg/kg IV on day 1, then 2 mg/kg IV weekly with paclitaxel
References
Docetaxel (Taxotere) & Trastuzumab (Herceptin)
Regimen
- Docetaxel (Taxotere) 80-100 mg/m2 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:
- Docetaxel (Taxotere) 35 mg/m2 IV weekly
- Trastuzumab (Herceptin) 4 mg/kg IV on day 1, then 2 mg/kg IV weekly with paclitaxel
References
Regimen
- Vinorelbine (Navelbine) 25 mg/m2 IV weekly
- Trastuzumab (Herceptin) 4 mg/kg IV on day 1, then 2 mg/kg IV weekly with paclitaxel
References
Capecitabine (Xeloda) & Trastuzumab (Herceptin)
Regimen
- Capecitabine (Xeloda) 1000-1250 mg/m2 PO BID days 1-14
- 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
References
Capecitabine (Xeloda) & Lapatinib (Tykerb)
Regimen
- Capecitabine (Xeloda) 1000 mg/m2 PO BID days 1-14
- Lapatinib (Tykerb) 1250 mg PO daily days 1-21
21-day cycles
References
Trastuzumab (Herceptin) & Lapatinib (Tykerb)
Regimen
- 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
- Lapatinib (Tykerb) 1250 mg PO daily days 1-21
21-day cycles
References
Trastuzumab (Herceptin) & other single agent chemotherapy
Regimen
- 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
- A single agent chemotherapy regimen described above
21-day cycles