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March 26, 2012

BREAST CANCER TREATMENT REGIMENS


BREAST CANCER TREATMENT REGIMENS
General treatment note: All trastuzumab-containing regimens require cardiac monitoring at baseline and at Months 3, 6, and 9.1
REGIMEN
DOSING
Adjuvant Therapy With Concomitant Trastuzumab
AC (doxorubicin [Adriamycin] +cyclophosphamide [Cytoxan])followed by paclitaxel (Taxol) +concurrent trastuzumab(Herceptin)
Cycles 1–4
Day 1: Doxorubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles.
Subsequent cycles
Day 1: Paclitaxel 80mg/m2 IV once weekly for 12 weeks, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly (or trastuzumab 6mg/kg IV once every 3 weeks) to complete 1 year of treatment.
OR
Cycles 1–4
Day 1: Doxorubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles.
Subsequent cycles
Day 1: Paclitaxel 175mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly (or trastuzumab 6mg/kg IV once every 3 weeks) to complete 1 year of treatment.
Dose-dense AC (doxorubicin +cyclophosphamide) followed bypaclitaxel + concurrent trastuzumab
Cycles 1–4
Day 1: Doxorubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 2 weeks for 4 cycles.
Day 2: Pegfilgrastim 6mg SC approximately 24 hrs after chemotherapy.
OR
Days 3–10: Filgrastim 5mcg/kg (total 300mcg or 480mcg) after chemotherapy.
Subsequent cycles
Day 1: Paclitaxel 175mg/m2 IV.
Repeat cycle every 2 weeks for 4 cycles, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly until completion of paclitaxel. Then administertrastuzumab 6mg/kg IV once every 3 weeks to complete 1 year of treatment.
Day 2: Pegfilgrastim 6mg SC approximately 24 hrs after paclitaxel.
OR
Days 3–10: Filgrastim 5mcg/kg (total 300mcg or 480mcg) after paclitaxel.
Docetaxel (Taxotere) +concurrent trastuzumab
Cycles 1–8
Day 1: Docetaxel 100mg/m2 IV, plus
Days 1, 8 and 15: Trastuzumab 2mg/kg.
Repeat cycle every 3 weeks for 8 cycles.
Subsequent cycles
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 6mg/kg IV once every 3 weeks until disease progression or cumulative toxicity.
Docetaxel + concurrent trastuzumab followed by FEC (5-fluorouracil [5-FU] epirubicin [Ellence] + cyclophosphamide)
Weeks 1–8
Day 1: Docetaxel 100mg/m2 IV.
Repeat cycle every 3 weeks for 3 cycles, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly for 8 weeks.
Subsequent cycles
Day 1: 5-FU 600mg/m2 IV + epirubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks for 3 cycles.
Adjuvant Therapy Without Concomitant Trastuzumab
Exemestane (Aromasin)
Exemestane 25mg orally once daily; used only after 2–3 years of tamoxifen therapy for a total of 5 years hormonal therapy.
Tamoxifen
Tamoxifen 20–40mg orally daily for no longer than 5 years (doses higher than 20mg should be divided into 2 doses, AM and PM).
TAC (docetaxel + doxorubicin +cyclophosphamide)
Day 1: Doxorubicin 50mg/m2 IV, followed by cyclophosphamide 500mg/m2 IV, followed by docetaxel 75mg/m2 IV after a 1-hr interval,plus
Days 4–11: Lenograstim 150mcg/m2/day or filgrastim 5mcg/kg/day.
Repeat cycle every 3 weeks for 6 cycles.
AC (doxorubicin +cyclophosphamide + paclitaxel)
Cycles 1–4
Day 1: Doxorubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles.
Subsequent cycles
Day 1: Paclitaxel 80mg/m2 IV once weekly for 12 weeks.
Dose-dense AC (doxorubicin +cyclophosphamide) followed bypaclitaxel
Cycles 1–4
Day 1: Doxorubicin 60mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 2 weeks.
Subsequent cycles
Day 1: Paclitaxel 175mg/m2 IV.
Repeat cycle every 2 weeks for 4 cycles.
All cycles
Day 1: Check Hgb levels. Administer darbepoetin alfa 200mcg SC if Hgb <12g/dL for first cycle. Determine Hgb on Day 1 of each subsequent cycle: darbepoetin alfa 200mcg SC if Hgb 10–12g/dL, 300mcg SC if Hgb<10g/dL, withhold if Hgb >12g/dL, plus
Day 2: Pegfilgrastim 6mg SC approximately 24 hrs after chemotherapy.
OR
Days 3–10: Filgrastim 5mcg/kg (total 300mcg or 480mcg) after chemotherapy.
TC (docetaxel +cyclophosphamide)
Day 1: Docetaxel 75mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles.
Neoadjuvant Therapy
Trastuzumab + paclitaxel + FEC(5-FU + epirubicin +cyclophosphamide)
Cycles 1–4
Day 1: Trastuzumab 4mg/kg IV for one dose (for first dose, administer 1 day before paclitaxel to monitor for infusion reactions), followed by
trastuzumab 2mg/kg once weekly for 24 weeks total, plus
Day 1: Paclitaxel 225mg/m2 continuous IV infusion over 24 hrs.
Repeat cycle every 3 weeks for 4 cycles.
Subsequent cycles
Day 1: Epirubicin 75mg/m2 IV + cyclophosphamide 500mg/m2 IV, plus
Days 1 and 3: 5-FU 500mg/m2 IV.
Repeat cycle every 3 weeks for 4 cycles.
Recurrent or Metastatic Breast Cancer—Combination Therapy
Ixabepilone (Ixempra) +capecitabine (Xeloda)
Day 1: Ixabepilone 40mg/m2 IV, plus
Days 1–14: Capecitabine 1,000mg/m2 orally twice daily.
Repeat cycle every 3 weeks.
FEC (5-FU + epirubicin +cyclophosphamide)
Days 1 and 8: 5-FU 500mg/m2 IV + epirubicin 50mg/m2 IV +cyclophosphamide 400mg/m2 IV.
Repeat cycle every 3 or 4 weeks for 6–9 cycles.
EC (epirubicin +cyclophosphamide)
Day 1: Epirubicin 75mg/m2 IV + cyclophosphamide 600mg/m2 IV.
Repeat cycle every 3 weeks.
AT (doxorubicin + docetaxel)
Day 1: Doxorubicin 50mg/m2 IV + docetaxel 75mg/m2 IV.
Repeat cycle every 3 weeks for max 8 cycles.
Docetaxel + capecitabine
Day 1: Docetaxel 75mg/m2 IV, plus
Days 1–14: Capecitabine 1,250mg/m2 (patients ≥60 yrs: reduce to 950mg/m2) orally twice daily.
Repeat cycle every 3 weeks.
GT (paclitaxel + gemcitabine [Gemzar])
Day 1: Paclitaxel 175mg/m2 IV, plus
Days 1 and 8: Gemcitabine 1,250mg/m2 IV.
Repeat cycle every 3 weeks.
Recurrent or Metastatic Breast Cancer—Single-Agent Therapy
Exemestane
Exemestane 25mg orally once daily.
Ixabepilone
Day 1: Ixabepilone 40mg/m2 IV.
Repeat cycle every 3 weeks.
Tamoxifen
Tamoxifen 20–40mg orally daily for no longer than 5 years (doses higher than 20mg should be divided into 2 doses, AM and PM).
Pegylated liposomal encapsulated doxorubicin (PLD; Doxil)
Day 1: PLD 50mg/m2 IV.
Repeat cycle every 4 weeks.
Albumin-bound paclitaxel(Abraxane)
Day 1: Albumin-bound paclitaxel 260mg/m2 IV.
Repeat cycle every 3 weeks.
Capecitabine
Days 1–14: Capecitabine 1,000–1,250mg/m2 orally twice daily.
Repeat cycle every 3 weeks.
Recurrent or Metastatic HER2+ Breast Cancer—First-Line Agents with Concomitant Trastuzumab
TPC (trastuzumab + paclitaxel +carboplatin [Paraplatin])
Cycle 1
Day 1: Trastuzumab 4mg/kg IV, followed by
Day 2: Paclitaxel 175mg/m2 IV + carboplatin AUC=6mg/mL/min IV,followed by
Days 8 and 15: Trastuzumab 2mg/kg IV.
Subsequent cycles
Days 1, 8 and 15: Trastuzumab 2mg/kg IV, followed by
Day 2: Paclitaxel 175mg/m2 IV + carboplatin AUC=6mg/mL/min.
Repeat cycle every 3 weeks.
After chemotherapy, administer trastuzumab 2mg/kg IV weekly until disease progression or other discontinuation event occurs.
Paclitaxel + trastuzumab
Day 1: Paclitaxel 175mg/m2 IV.
Repeat every 3 weeks for 6 cycles, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly until disease progression.
OR
Day 1: Paclitaxel 80mg/m2 IV once weekly.
Repeat cycle every 3 weeks, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly for at least 2 cycles until disease progression.
Docetaxel + trastuzumab
Day 1: Docetaxel 100mg/m2 IV.
Repeat cycle every 3 weeks for 6 cycles, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly until disease progression.
OR
Days 1, 8 and 15: Docetaxel 35mg/m2 IV and trastuzumab 2mg/kg IV (first dose: give trastuzumab 4mg/kg as loading dose).
Repeat cycle every 4 weeks until disease progression.
Vinorelbine (Navelbine) +trastuzumab
Day 1: Vinorelbine 2mg/m2 IV once weekly for 8 weeks, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly until disease progression.
Capecitabine + trastuzumab
Days 1–14: Capecitabine 1,250mg/m2 orally twice daily.
Repeat cycle every 3 weeks, plus
Day 1: Trastuzumab 8mg/kg IV loading dose, followed by trastuzumab 6mg/kg IV once every 3 weeks.
Lapatinib (Tykerb) +trastuzumab for trastuzumab-exposed HER-2 positive disease
Day 1: Lapatinib 1,000mg orally once daily, plus
Day 1: Trastuzumab 4mg/kg IV loading dose, followed by trastuzumab 2mg/kg IV once weekly until disease progression.
Source: NCCN Clinical Practice Guidelines in Oncology™. Breast Cancer. v 2.2011.
by
AKSHAYA SRIKANTH
Pharm.D Resident
Hyderabad, India

3 comments:

  1. There are lots of researches about cancer and what really interests me is the natural treatment of cancer. There are studies about herbal treatment of cancer and how plants are used as drugs to treat or minimize signs and symptoms of cancer.

    ReplyDelete
    Replies
    1. Dear Folk, Its really need to work on... and I would like to add Screening of Cancer is the best for detection and treating the patient at early stage.

      Delete
  2. Thanks for your advice and you have nicely proscribed medicines for the different conditions...

    Breast cancer treatment

    ReplyDelete