Breast cancer drugs
Breast cancer drug treatment
Alkylating Agents
cyclophosphamide Cytoxan injection 500mg, 1g, 2g pwd for IV inj after reconstitution 40–50mg/kg in divided doses over 2–5 days or 10–15mg/kg every 7–10 days or 3–5mg/kg twice week, 25mg, 50mg tabs 1–5mg/kg/day
thiotepa-15mg, 30mg pwd for IV, intravesical, or intracavitary administration after reconstitution 0.3–0.4mg/kg IV once every 1–4 weeks
Antibiotics
doxorubicin Adriamycin 10mg, 20mg, 50mg pwd for IV inj after reconstitution
Monotherapy: 60–75mg/m2 every 21 days Combination therapy: 40–60mg/m2 every 21 to 28 days
Adriamycin Solution 2mg/mL soln for IV inj
epirubicin Ellence 2mg/mL soln for IV infusion 100–120mg/m2 on Day 1 or divided equally given on Days 1 and 8 of each cycle
Antiestrogen tamoxifen 10mg, 20mg tabs 20–40mg/day, Oral Solution 10mg/5mL
toremifene Fareston 60mg tabs 60mg once daily
Antimetabolites
capecitabine Xeloda 150mg, 500mg tabs
Monotherapy: 1250mg/m2 twice daily Combination therapy: give with docetaxel 75mg/m2 IV infused over 1 hour every 3 weeks.
fluorouracil 50mg/mL soln for IV inj 12mg/kg once daily for 4 successive days; max 800mg/day
gemcitabine Gemzar 200mg, 1g pwd for IV infusion after reconstitution 1250mg/m2 on Days 1 and 8 of each 21 day cycle
methotrexate
Methotrexate injection 25mg/mL soln for IV, IM, intra-arterial, or intra-thecal administration after dilution
1g pwd for IV, IM, intra-arterial, or intra-thecal administration after dilution
Tabs 5mg, 7.5mg, 10mg, 15mg
Antimicrotubule Agents
docetaxel Taxotere 40mg/mL soln for IV infusion after dilution 60–100mg/m2 once every 3 weeks
eribulin mesylate Halaven 0.5mg/mL soln for IV inj
1.4mg/m2 IV inj over 2–5min on Days 1 and 8 of each 21 day cycle.
ixabepilone Ixempra 15mg, 45mg pwd for IV infusion after constitution and dilution
40mg/m2 once every 3 weeks
Abraxane 100mg IV infusion; inj susp after reconstiution
260mg/m2 every 3 weeks
Taxol 6mg/mL soln for IV infusion after dilution
Paclitaxel 175mg/m2 every 3 weeks
vinblastine for injection 10mg lyophilized pwd for IV inj or infusion after reconstitution
5.5–7.4mg/m2 once weekly
vinblastine injection 1mg/mL soln for IV inj or infusion
Aromatase Inhibitor
anastrozole Arimidex 1mg tabs 1mg once daily
exemestane Aromasin 25mg tabs 25mg once daily
letrozole Femara 2.5mg tabs 2.5mg once daily
Estrogen
estradiol Estrace 0.5mg, 1mg, 2mg scored tabs
10mg 3 times daily for at least 3 months
Estrogen Receptor Antagonist
fulvestrant Faslodex 50mg/mL soln for IM inj 500mg on days 1, 15, 29, then once per month thereafter
GnRH Analogue goserelin Zoladex 3.6mg SC implant One 3.6mg implant every 28 days
Human Epidermal Growth Factor Receptor (HER2) inhibitor
pertuzumab Perjeta 420mg/14mL (30mg/mL) soln for IV infusion Initially 840mg IV over 60 minutes, followed every 3 weeks thereafter by a dose of 420mg IV over 30–60 minutes in combination with trastuzumab and docetaxel.
trastuzumab Herceptin (Genentech) 440mg lyophilized pwd for IV infusion
mTOR Kinase Inhibitor
everolimus Afinitor (Novartis) 2.5mg, 5mg, 7.5mg, 10mg tabs 10mg once daily
Progestin
megestrol acetate Megace 20mg, 40mg scored tabs 40mg 4 times daily
Selective Estrogen Receptor Modulator (SERM)
raloxifene Evista 60mg tabs 60mg once daily
Tyrosine Kinase Inhibitor lapatinib Tykerb 250mg tabs
Breast Cancer Treatment Regimens
Pref2242ed Regimens for HER2-negative Disease
Dose-dense AC followed by paclitaxel
• Doxorubicin 60mg/m2 IV day 1
• Cyclophosphamide 600mg/m2 IV day 1
Cycled every 14 days for 4 cycles. Followed by:
• Paclitaxel 175mg/m2 via 3-hour IV infusion day 1
Cycled every 14 days for 4 cycles.
Dose-dense AC followed by weekly paclitaxel • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 14 days for 4 cycles. Followed by: • Paclitaxel 80mg/m2 via 1-hour IV infusion weekly for 12 weeks. TC3 • Docetaxel 75mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles.
Other Regimens for HER2-negative Disease
AC4 • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles.
TAC5 • Docetaxel 75mg/m2 IV day 1 • Doxorubicin 50mg/m2 IV day • Cyclophosphamide 500mg/m2 IV day 1 Cycled every 21 days for 6 cycles.
FAC • 5-fluorouracil 500mg/m2 IV days 1 and 8 or days 1 and 4 • Doxorubicin 50mg/m2 IV day 1 (or via 72-hour continuous infusion) • Cyclophosphamide 500mg/m2 IV day 1 Cycled every 21 days for 6 cycles.
CAF • Cyclophosphamide 100mg/m2 PO days 1–14 • Doxorubicin 30mg/m2 IV days 1 and 8 • 5-fluorouracil 500mg/m2 IV days 1 and 8 Cycled every 28 days for 6 cycles.
CEF • Cyclophosphamide 75mg/m2 PO days 1–14 • Epirubicin 60mg/m2 IV days 1 and 8 • 5-fluorouracil 500mg/m2 IV days 1 and 8 With cotrimoxazole support. Cycled every 28 days for 6 cycles.
CMF • Cyclophosphamide 100mg/m2 PO days 1–14 • Methotrexate 40mg/m2 IV days 1 and 8 • 5-fluorouracil 600mg/m2 IV days 1 and 8 Cycled every 28 days for 6 cycles.
AC followed by docetaxel • Doxorubicin 60mg/m2 IV on day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • Docetaxel 100mg/m2 IV on day 1 Cycled every 21 days for 4 cycles.
AC followed by weekly paclitaxe • Doxorubicin 60mg/m IV on day 1 • Cyclophosphamide 600mg/m IV on day 1 Cycled every 21 days for 4 cycles. Followed by: • Paclitaxel 80mg/m by 1-hour IV infusion weekly for 12 weeks.
EC • Epirubicin 100mg/m2 IV day 1 • Cyclophosphamide 830mg/m2 IV day 1 Cycled every 21 days for 8 cycles.
FEC followed by docetaxel13 • 5-fluorouracil 500mg/m2 IV day 1 • Epirubicin 100mg/m2 IV day 1 • Cyclophosphamide 500mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Docetaxel 100mg/m2 IV day 1 Cycled every 21 days for 3 cycles.
FEC followed by weekly paclitaxel • 5-fluorouracil 600mg/m2 IV day 1 • Epirubicin 90mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • 3 weeks of no treatment. Followed by: • Paclitaxel 100mg/m2 IV infusion weekly for 8 weeks.
FAC followed by weekly paclitaxel • 5-fluorouracil 500mg/m2 IV days 1 and 8 (or days 1 and 4) • Doxorubicin 50mg/m2 IV day 1 (or via 72-hour continuous infusion) • Cyclophosphamide 500mg/m2 IV day 1 Cycled every 21 days for 6 cycles. Followed by: • Paclitaxel 80mg/m2 via 1-hour IV infusion weekly for 12 weeks.
Pref2242ed Regimens for HER2-positive Disease
AC followed by paclitaxel with trastuzumab15 • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • Paclitaxel 80mg/m2 via 1-hour IV infusion weekly for 12 weeks, with: • Trastuzumab 4mg/kg IV with first dose of paclitaxel Followed by: • Trastuzumab 2mg/kg IV weekly to complete 1 year of treatment. As an alternative, trastuzumab 6mg/kg IV every 21 days may be used following the completion of paclitaxel, and given to complete 1 year of trastuzumab treatment. Cardiac monitoring at baseline, 3, 6, and 9 months. I AC followed by paclitaxel with trastuzumab + pertuzumab • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Paclitaxel 80mg/m2 IV days 1, 8, and 15 Cycled every 21 days for 4 cycles.
• Trastuzumab 6mg/kg IV day 1 Cycled every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
Dose-dense AC followed by paclitaxel with trastuzumab • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 14 days for 4 cycles. Followed by: • Paclitaxel 175mg/m2 via 3-hour IV infusion day 1 (All cycles are with filgrastim support) Cycled every 14 days for 4 cycles, with: • Trastuzumab 4mg/kg IV with first dose of paclitaxel Followed by: • Trastuzumab 2mg/kg IV weekly to complete 1 year of treatment. As an alternative, trastuzumab 6mg/kg IV every 21 days may be used following the completion of paclitaxel, and given to complete 1 year of trastuzumab treatment. Cardiac monitoring at baseline, 3, 6, and 9 months.
TCH • Docetaxel 75mg/m2 IV day 1 • Carboplatin AUC 6 IV day 1 Cycled every 21 days for 6 cycles, with: • Trastuzumab 4mg/kg IV week 1 Followed by: • Trastuzumab 2mg/kg IV for 17 weeks Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
TCH chemotherapy + pertuzumab • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Pertuzumab 840mg IV day 1 followed by 420mg IV • Docetaxel 75mg/m2 IV day 1 • Carboplatin AUC 6 IV day 1 Cycled every 21 days for 6 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
Other Regimens for HER2-positive Disease
AC followed by docetaxel with trastuzumab • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 day 1 Cycled every 21 days for 4 cycles. Followed by: • Docetaxel 100mg/m2 IV day 1 Cycled every 21 days for 4 cycles, with: • Trastuzumab 4mg/kg IV week 1 Followed by: • Trastuzumab 2mg/kg IV weekly for 11 weeks Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
AC followed by docetaxel with trastuzumab and pertuzumab • Doxorubicin 60mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day I followed by 6mg/kg IV • Docetaxel 75–100mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
FEC followed by pertuzumab + trastuzumab + docetaxel18 • Fluorouracil 500mg/m2 IV day 1 • Epirubicin 100mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Docetaxel 75–100mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
FEC followed by pertuzumab + trastuzumab + paclitaxel • Fluorouracil 500mg/m2 IV day 1 • Epirubicin 100mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Paclitaxel 80mg/m2 IV days 1, 8, and 15 Cycled every 21 days for 3 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
Pertuzumab + trastuzumab + docetaxel followed by FEC • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Docetaxel 75–100mg/m2 IV day 1 Cycled every 21 days for 4 cycles. Followed by adjuvant therapy: • Fluorouracil 600mg/m2 IV day 1 • Epirubicin 90mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.
Pertuzumab + trastuzumab + paclitaxel followed by FEC • Pertuzumab 840mg IV day 1 followed by 420mg IV • Trastuzumab 8mg/kg IV day 1 followed by 6mg/kg IV • Paclitaxel 80mg/m2 IV days 1, 8, and 15 Cycled every 21 days for 4 cycles. Followed by adjuvant therapy: • Fluorouracil 600mg/m2 IV day 1 • Epirubicin 90mg/m2 IV day 1 • Cyclophosphamide 600mg/m2 IV day 1 Cycled every 21 days for 3 cycles. Followed by: • Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. Cardiac monitoring at baseline, 3, 6, and 9 months.