Breast cancer chemotherapy: Difference between revisions
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The HER2 receptor is overexpressed in approximately 20% to 25% of breast cancers.[http://www.sciencedirect.com/science?_ob=MiamiImageURL&_cid=273337&_user=1625289&_pii=S088985880700024X&_check=y&_origin=&_coverDate=30-Apr-2007&view=c&wchp=dGLzVBA-zSkWb&md5=5e66d7e65eeb92feb675e35a759717ea/1-s2.0-S088985880700024X-main.pdf 1] | The HER2 receptor is overexpressed in approximately 20% to 25% of breast cancers.[http://www.sciencedirect.com/science?_ob=MiamiImageURL&_cid=273337&_user=1625289&_pii=S088985880700024X&_check=y&_origin=&_coverDate=30-Apr-2007&view=c&wchp=dGLzVBA-zSkWb&md5=5e66d7e65eeb92feb675e35a759717ea/1-s2.0-S088985880700024X-main.pdf 1] | ||
HER2 status is an important predictive factor. There is evidence that [[Trastuzumab]] exhibits synergy when administered in combination with other cytotoxic therapies, such as taxanes and vinorelbine, among HER2-positive patients. <ref name="pmid15911866">Marty M, Cognetti F, Maraninchi D, Snyder R, Mauriac L, Tubiana-Hulin M et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15911866 Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment: the M77001 study group.] ''J Clin Oncol'' 23 (19):4265-74. [http://dx.doi.org/10.1200/JCO.2005.04.173 DOI:10.1200/JCO.2005.04.173] PMID: [http://pubmed.gov/15911866 15911866]</ref> | HER2 status is an important predictive factor. There is evidence that [[Trastuzumab]] exhibits synergy when administered in combination with other cytotoxic therapies, such as taxanes and vinorelbine, among HER2-positive patients. <ref name="pmid15911866">Marty M, Cognetti F, Maraninchi D, Snyder R, Mauriac L, Tubiana-Hulin M et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15911866 Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment: the M77001 study group.] ''J Clin Oncol'' 23 (19):4265-74. [http://dx.doi.org/10.1200/JCO.2005.04.173 DOI:10.1200/JCO.2005.04.173] PMID: [http://pubmed.gov/15911866 15911866]</ref> | ||
=== Oncotype Dx === | |||
== References == | == References == | ||
Revision as of 02:53, 29 November 2011
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Breast Cancer Microchapters |
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Breast cancer chemotherapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant Editor(s)-In-Chief: Jack Khouri
Overview
Breast cancer chemotherapy refers to the use of cytotoxic drugs (chemotherapy) in the treatment of breast cancer. The aim of chemotherapy is to prevent the growth of micrometastatic disease that is responsible for systemic disease recurrence.
Types
Chemotherapy can be given both before and after surgery. Neoadjuvant chemotherapy is used to shrink the size of a tumor prior to surgery. Adjuvant chemotherapy is given after surgery to reduce the risk of recurrence. Palliative chemotherapy is used to control (but not cure) the cancer in settings in which the cancer has spread beyond the breast and localized lymph nodes.
Regimens
Several different chemotherapy regimens may be used.[1] Determining the appropriate regimen depends on many factors, including the character of the tumor, lymph node status, and the age and health of the patient. In general, chemotherapy has increasing side effects as the patient's age passes 65. The following is a list of commonly used adjuvant chemotherapy for breast cancer:
- CMF: cyclophosphamide, methotrexate, and 5-fluorouracil given 4-weekly for 6 cycles
- FAC (or CAF): 5-fluorouracil, doxorubicin, cyclophosphamide given 3-weekly for 6 cycles
- AC (or CA): Adriamycin (doxorubicin) and cyclophosphamide given 3-weekly for 4 cycles
- AC-Taxol: AC given 3-weekly for 4 cycles followed by paclitaxel given either 3-weekly for 4 cycles or weekly (at a smaller dose) for 12 weeks
- TAC: Taxotere (docetaxel), Adriamycin (doxorubicin), and cyclophosphamide given 3-weekly for 6 cycles
- FEC: 5-fluorouracil, epirubicin and cyclophosphamide given 3-weekly for 6 cycles
- FECD: FEC given 3-weekly for 3 cycles followed by docetaxel given 3-weekly for 3 cycles
- TC: Taxotere (docetaxel) and cyclophosphamide given 3-weekly for 4 cycles
- Dose dense regimen: Some of the regimens above (e.g. AC followed by paclitaxel) may be given in a shorter period (i.e. every 2 weeks instead of every 3 weeks).
- In addition to chemotherapy, trastuzumab may also be added to the regimen depending on the tumor characteristics (i.e. HER2/neu status) and risk of relapse. It is usually given either 3 weekly or weekly for a total duration of 1 year.
Since chemotherapy affects the production of white blood cells, granulocyte colony-stimulating factor (G-CSF) is sometimes administered along with chemotherapy. This has been shown to reduce, though not completely prevent, the rate of infection and low white cell count. Most adjuvant breast cancer chemotherapy regimens do not routinely require growth factor support except for those associated with a high incidence of bone marrow suppression and infection. These may include chemotherapy given in the dose dense fashion i.e. 2-weekly instead of 3-weekly or TAC chemotherapy (see above).
Adjuvant Chemotherapy for Early-Stage Breast Cancer
Risk Stratification
The decision of whether a patient should or not receive adjuvant chemotherapy is generally made by estimating the individual's risk for recurrence and the expected benefit of therapy. Risk stratification is based on tumor size, nodal status, histologic grade, hormone receptor and Her-2 statuses.
Hormone Receptor Status
Hormone receptor status is a definite prognostic and predictive factor. Most breast cancers are Estrogen receptor- positive. ER-negative tumors have higher risk of recurrence during 1 to 2 years after surgery that declines rapidly thereafter; however, ER-positive tumors preserve the ability to recur many years after surgery. The role of ER status as a predictive factor was assessed in a retrospective subset analysis of three cooperative group adjuvant chemotherapy trials in women who had node-positive breast cancer results showed that absolute benefits due to chemotherapy were greater for patients with ER-negative compared with ER-positive tumors: 22.8% more ER-negative patients survived to 5 years disease-free if receiving chemotherapy vs 7.0% for ER-positive patients; corresponding improvements for overall survival were 16.7% vs 4.0%.[2]
HER2 Status
The HER2 receptor is overexpressed in approximately 20% to 25% of breast cancers.1 HER2 status is an important predictive factor. There is evidence that Trastuzumab exhibits synergy when administered in combination with other cytotoxic therapies, such as taxanes and vinorelbine, among HER2-positive patients. [3]
Oncotype Dx
References
- ↑ von Minckwitz, G (Mar 2007). "Docetaxel/anthracycline combinations for breast cancer treatment". Expert Opinion on Pharmacotherapy. 8 (4): 485–495.
- ↑ Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ et al. (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295 (14):1658-67. DOI:10.1001/jama.295.14.1658 PMID: 16609087
- ↑ Marty M, Cognetti F, Maraninchi D, Snyder R, Mauriac L, Tubiana-Hulin M et al. (2005) Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer administered as first-line treatment: the M77001 study group. J Clin Oncol 23 (19):4265-74. DOI:10.1200/JCO.2005.04.173 PMID: 15911866