. Breast Cancer | 6 | Chemotherapy Regimens and Cancer Care

ABSTRACT

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 21 days

Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radio therapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

A -> CMF doxorubicin followed by cyclophospha mide/ methotrexate/ fluorouracil (5-FU)

Doxorubicin 75 mg/M2 IV day 1 -given every 21 days for 4 cycles

Cyclophosphamide 600 mg/M2 IV day 1 Methotrexate 40 mg/M2 IV day 1 5-FU 600 mg/M2 IV day 1

-the CMF portion of this regimen is given every 21 days for 8 cycles

REF: Bonadonna et al. JAMA 1995; 273:542-547

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2with prior chest radiotherapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

AC -> T doxorubicin/ cyclophospha mide followed by paciitaxei

Doxorubicin 60 mg/M2 IV day 1 Cyclophosphamide 600 mg/M2 IV day 1

-above combination is given every 3 weeks for 4 cycles, followed by Paciitaxei 175 mg/M2 IV dayl -every 3 weeks for 4 cycles

REF: Henderson et al. Proc Amer Soc Clin Oncol 1998; 390A

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy (for AC) 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy 3. Cimetidine 300 mg IV 30 minutes before paciitaxei 4. Diphenhydramine 25-50 mg IV 30 minutes before

paciitaxei 5. Compazine 10 mg PO/IV 30 minutes before paciitaxei

OTHER MEDICATIONS ! 1. Dexamethasone 4 mg PO BID for 6 doses after paciitaxei

(for myalgias)

! Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Doxorubicin 90 mg/M2 IV daysl, 15,29

Paciitaxei 250 mg/M2 CIV days 43, (X 24 h) 57,71

Cyclophosphamide 3000 mg/M2 IV days 85, 99,113

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy on days 1,15,29,85,99, and 113 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on days 1,15, 29,85, 99, and 113 3. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on days 43,57, and 71

OR Dexamethasone 20 mg PO 6 hours and 12 hours prior to chemotherapy on days 43,57, and 71

4. Cimetidine 300 mg IV 30 minutes before chemotherapy on

days 43,57, and 71 5. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy on days 43,57, and 71 6. Compazine 10 mg PO/IV 30 minutes before chemotherapy

on days 43,57, and 71

OTHER MEDICATIONS 1. Dexamethasone 4 mg PO BID for 6 doses after paciitaxei

(for myalgias) 2. G-CSF through entire course of chemo (5 mcg/kg days

3-10 of each 14 day course) 3. Give non-cisplatin delayed emesis prophylaxis

Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

CAF/IV cyclophos phamide/ doxorbucin/ 5-FU

Cyclophosphamide 500 mg/M2 IV day 1 Doxorubicin 50 mg/M2 IV day 1 5-FU 500 mg/M2 IV day 1

REF: Smalley et al. Cancer 1977; 40:625-632

i PREMEDICATIONS ! 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy ! 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

; Repeat every 21 days

\ Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2with prior chest radiotherapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

CEF cyclophospha mide/ epirubucin/ 5-FU

Cyclophosphamide 75 mg/M2 PO days 1-14 Epirubicin 60 mg/M2 IV days 1,8 5-FU 500 mg/M2 IV days 1,8

REF: Levine et al. J Clin Oncol 1998; 16:2651 -2658

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy on day 1 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on day 1

OTHER MEDICATIONS 1. Trimethoprim-sulfamethoxazole DS 2 tabs PO BID for

duration of chemotherapy

Repeat every 28 days for 6 cycles

Epirubicin-monitor cumulative dose for cardiac toxicity (not to exceed 1000 mg/M2); vesicant-avoid extravasation

CMF/IV cyclophos phamide/ methotrexate/ 5-FU-21 day

Cyclophosphamide 600 mg/M2 IV day 1 Methotrexate 40 mg/M2 IV day 1 5-FU 600 mg/M2 IV day 1

REF: Hainsworth et ai. Cancer 1997; 79:740-748

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 21 days

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

CMF/IV cyclophos phamide/ methotrexate/ 5-FU-28 day

Cyclophosphamide 600 mg/M2 IV days 1,8 Methotrexate 40 mg/M2 IV days 1,8 5-FU 600 mg/M2 IV days 1,8

REF: Harper-Wynne et al. Br J Cancer 1999; 81:316-322

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy on days 1 and 8 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on days 1 and 8

Repeat every 28 days

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

CMF/PO cyclophos phamide/ methotrexate/ 5-FU

(Bonadonna regimen) Cyclophosphamide 100 mg/M2 PO days 1-14 Methotrexate 30-40 mg/M2 IV days 1,8

; 5-FU 400-600 mg/M2 IV days 1,8 -use lower doses listed for age > 65

REF: Bonadonna et al. NEJM 1976; 294:405-410

PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy

on days 1 and 8

Repeat every 28 days

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

FEC fluorouracil (5-FU)/ epirubicin/ cyclophos phamide

5-FU 500 mg/M2 IV day 1 Epirubicin 60 mg/M2 IV day 1 Cyclophosphamide 500 mg/M2 IV day 1

REF: Blomqvist et al. J Clin Oncol 1993; 11:467-473

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 28 days

Epirubicin-monitor cumulative dose for cardiac toxicity (not to exceed 1000 mg/M2); vesicant - avoid extravasation

MV mitomycin C/ vinblastine

Mitomycin C 12 mg/M2 IV day 1 Vinblastine 6 mg/M2 IV days 1,22

| REF: Nabholtz et al. J Clin Oncol 1999; 17:1413-1424

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy on day 1 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on day 1 3. Compazine 10 mg PO/IV before chemotherapy on day 22

Repeat every 42 days

Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity

Mitomycin C-myelosuppression occurs late (approximately 4 weeks); limit cumulative dose to 50 mg/M2 (vascular toxicity)

TA docetaxel/ doxorubicin

Docetaxel 75 mg/M2 IV(overlh) dayl Doxorubicin 50 mg/M2 IV day 1

REF: Dieras et al. Oncology 1997; 11 :(8 Suppl 8):31-33

OR Docetaxel 60mg/M2 IV(overlh) dayl Doxorubicin 60 mg/M2 IV day 1

REF: Sparano et al. J Clin Oncol 2000; 18:2369-2377

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy 2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy 4. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy

OTHER MEDICATIONS 1. Dexamethasone 8 mg PO BID for 8 doses-start day prior

to chemo (decreases lower extremity edema)

Repeat every 21 days

2M mitoxantrone/ methotrexate

Mitoxantrone 6.5 mg/M2 IV day 1 Methotrexate 30 mg/M2 IV day 1

REF: Stein et al. Eur J Cancer 1992; 28A:1963-1965

PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy

Repeat every 21 days

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

Mitoxantrone-watch cumulative dose-do not exceed 140 mg/M2; possible cardiac toxicity

VATH vinblastine/ doxorubicin/ thiotepa/fiuoxymesterone

Vinblastine 4.5 mg/M2 IV day 1 Doxorubicin 45 mg/M2 IV day 1 Thiotepa 12 mg/M2 IV day 1 Fluoxymesterone 30 mg PO days 1-21

REF: Hart et al. Cancer 1981; 48:1522-1527

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 21 days

Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant - avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity

Capecitabine Capecitabine 2510mg/M2/d PO days 1-14 divided BID

REF: Blum et al. J Clin Oncol 1999; 17:485-493

PREMEDICATIONS 1. Compazine 10 mg PO before chemotherapy prn

i Repeat every 21 days Docetaxel I Docetaxel 100 mg/M2 IV(overlh) day 1

REF: Nabholtz et al. J Clin Oncol 1999; 17:1413-1424

Repeat every 21 days

OR Docetaxel 40 mg/M2 IV(over 1 h) day 1

REF: Burstein et al. J Clin Oncol 2000; 18:1212-1219

Repeat every 7 days for 6 weeks, followed by a 2 week rest

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy 2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy 4. Compazine 10 mg PO/IV 30 minutes before chemotherapy

OTHER MEDICATIONS 1. Dexamethasone 8 mg PO BID for 8 doses-start day prior

to chemo (decreases lower extremity edema)

Gemcitabine Gemcitabine 1000 mg/M2 IV days 1,8,

15 REF: Possinger et al. Anticancer Drugs 1999; 10:155-162

PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy

Repeat every 28 days

Liposomal Doxorubicin (Doxil)

Doxil 45-60 mg/M2 IV day 1

REF: Ranson et al. J Clin Oncol 1997; 15:3185-3191

PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 21-28 days

| Doxorubicin-monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Paclitaxel Paclitaxel 175 mg/M2 IV (over 3 h) dayl REF: Nabholtz et al. J Clin Oncol 1996; 14:1858-1867 PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy 4. Compazine 10 mg PO/IV 30 minutes before chemotherapy OTHER MEDICATIONS 1. Dexamethasone 4 mg PO BID for 6 doses after (for

myalgias)

Repeat every 21 days Pamidronate Pamidronate 90 mg IV day 1

REF: Theriault et al. J Clin Oncol 1999; 17:846-854

Repeat every 28 days

Trastuzumab (Herceptin)

Herceptin

4 mg/kg

2 mg/kg

-initial infusion is over 90 min; if well-tolerated, subsequent doses are given over 30 min.