Breast Cancer Chemotherapy Regimens

Chemotherapy Regimens

Adjuvant Chemotherapy

• Goal: Reduce risk of recurrence and improve overall survival in early-stage breast cancer patients
• Common regimens:
  • AC (Adriamycin and Cyclophosphamide)
  • TAC (Taxotere, Adriamycin, and Cyclophosphamide)
  • EC-T (Epirubicin and Cyclophosphamide followed by Taxotere)
  • CEF (Cyclophosphamide, Epirubicin, and 5-Fluorouracil)

Neoadjuvant Chemotherapy

• Goal: Shrink tumor size and improve operability in locally advanced breast cancer patients
• Common regimens:
  • AC-T (Adriamycin and Cyclophosphamide followed by Taxotere)
  • TAC (Taxotere, Adriamycin, and Cyclophosphamide)
  • DD AC-T (Dose-dense Adriamycin and Cyclophosphamide followed by Taxotere)

Metastatic Breast Cancer Regimens

• Goal: Improve overall survival and quality of life in advanced breast cancer patients
• Common regimens:
  • Single-agent chemotherapy:
    • Taxanes (Paclitaxel, Docetaxel)
    • Anthracyclines (Epirubicin, Doxorubicin)
    • Capecitabine
  • Combination chemotherapy:
    • Paclitaxel + Bevacizumab
    • Docetaxel + Cyclophosphamide
    • Capecitabine + Lapatinib

Hormone Therapy Regimens

Adjuvant Hormone Therapy

• Goal: Reduce risk of recurrence in hormone receptor-positive breast cancer patients
• Common regimens:
  • Tamoxifen (5-10 years)
  • Aromatase inhibitors (Anastrozole, Letrozole, Exemestane) (5 years)

Advanced Hormone Therapy

• Goal: Improve overall survival and quality of life in advanced hormone receptor-positive breast cancer patients
• Common regimens:
  • Aromatase inhibitors (Anastrozole, Letrozole, Exemestane)
  • Fulvestrant
  • CDK 4/6 inhibitors (Palbociclib, Ribociclib) + hormone therapy

Targeted Therapy Regimens

HER2-positive Breast Cancer

• Goal: Improve overall survival and quality of life in HER2-positive breast cancer patients
• Common regimens:
  • Trastuzumab (Herceptin)
  • Pertuzumab (Perjeta) + Trastuzumab
  • Lapatinib (Tykerb) + Capecitabine

Note: These notes provide a general overview of breast cancer regimens and are not intended to be used as a substitute for medical advice or treatment.

Chemotherapy Regimens

Adjuvant Chemotherapy

• Reduces risk of recurrence and improves overall survival in early-stage breast cancer patients
• Common regimens include AC, TAC, EC-T, and CEF

Neoadjuvant Chemotherapy

• Shrinks tumor size and improves operability in locally advanced breast cancer patients
• Common regimens include AC-T, TAC, and DD AC-T

Metastatic Breast Cancer Regimens

• Improves overall survival and quality of life in advanced breast cancer patients
• Single-agent chemotherapy options include Taxanes, Anthracyclines, and Capecitabine
• Combination chemotherapy options include Paclitaxel + Bevacizumab, Docetaxel + Cyclophosphamide, and Capecitabine + Lapatinib

Hormone Therapy Regimens

Adjuvant Hormone Therapy

• Reduces risk of recurrence in hormone receptor-positive breast cancer patients
• Common regimens include Tamoxifen (5-10 years) and Aromatase inhibitors (5 years)

Advanced Hormone Therapy

• Improves overall survival and quality of life in advanced hormone receptor-positive breast cancer patients
• Common regimens include Aromatase inhibitors, Fulvestrant, and CDK 4/6 inhibitors + hormone therapy

Targeted Therapy Regimens

HER2-positive Breast Cancer

• Improves overall survival and quality of life in HER2-positive breast cancer patients
• Common regimens include Trastuzumab, Pertuzumab + Trastuzumab, and Lapatinib + Capecitabine

Breast Cancer

• A malignancy originating from breast tissues, with early stages being potentially curable, while Metastatic Breast Cancer (MBC) is usually incurable.

Screening Tools

• Clinical Breast Examination (CBE)
• Breast Self Examination
• Mammography (BI-RAD grading)
• Ultrasonography
• FNAC (Fine Needle Aspiration Cytology)
• Cytology of nipple discharge

Clinical Algorithm

• CBE: if negative, re-enter primary screening; if positive, evaluate with surgeons, followed by mammography, ultrasonography, and FNAC if suspicious of malignancy
• Core biopsy: if malignant, refer to Medical College/Regional Cancer Centre for staging/treatment

Risk Factors for Breast Cancer

• Female
• Aging
• First-degree relative with breast cancer or ovarian cancer
• Menstrual history: early onset, late menopause (early menarche)
• Nulliparity, child birth >30 yrs
• Long-term HRT (30% increased risk)
• Oral Contraceptives (slight risk, returns to normal once discontinued)
• Prior radiation exposure to breast at a young age
• Genetic risk factors: BRCA-1, BRCA-2, P53, Her-2/neu

Factors Influencing Survival

• Age at diagnosis
• Tumor size
• Stage at diagnosis
• Biologic characteristics of tumor:
  • Hormone receptor status
  • HER 2

Stages of Breast Cancer

• Stages 0 through IV, under the TNM classification
• Factors used in staging: tumor size, nodal status, metastasis
• Stage 0: Ductal Carcinoma in Situ (DCIS)
• Stage I: tumor < 2 cm, not spread outside breast
• Stage IIA: no tumor in breast, but cancer in axillary lymph nodes, or tumor ≤ 2 cm and spread to axillary lymph nodes, or tumor 2-5 cm and not spread to axillary lymph nodes
• Stage IIB: tumor 2-5 cm and spread to axillary lymph nodes, or > 5 cm and confined to breast
• Locally Advanced Breast Cancer: Stage IIIA, IIIB, IIIC
• Metastatic Breast Cancer (MBC): Stage IV, tumor has spread to other organs

Breast Cancer Treatment

• TNM stage 0: surveillance, surgery, radiotherapy, hormonal therapy
• TNM stage 1 & 2: breast-conservative surgery, radiotherapy, adjuvant chemotherapy, adjuvant hormonal therapy
• TNM stage 3: surgery, radiotherapy, adjuvant chemotherapy, adjuvant hormonal therapy
• TNM stage 4: surgery, radiotherapy, chemotherapy, hormonal therapy, monoclonal antibody therapy

Complications of Surgery

• Lymphedema
• Numbness
• Reduced shoulder mobility
• Psychosocial problems of mastectomy
• Phantom breast sensation

Local Therapy: Radiotherapy

• Adjuvant radiotherapy in Early-Stage Breast Cancer (ESBC): reduces risk of recurrence, improves survival
• Radiotherapy in MBC: relieves symptoms like pain, in patients with bone or brain metastasis

Systemic Therapy for Breast Cancer

• Hormonal therapy
• Chemotherapy
• Targeted therapy
• Clinical trials provide support for optimal implementation of these therapies

Evolution of Systemic Adjuvant Therapy for ESBC

• Mastectomy alone
• Adjuvant CMF (cyclophosphamide, methotrexate, fluorouracil)
• Addition of tamoxifen or aromatase inhibitors
• Adjuvant AC (doxorubicin, cyclophosphamide), EC (epirubicin, cyclophosphamide), FEC (fluorouracil, epirubicin, cyclophosphamide)
• Dose-dense AC + TTAC (taxotere, trastuzumab)

Preferred Chemotherapy for MBC

• Single agent options: anthracycline, taxane, capecitabine, others
• Combination options: CAF/FAC, AT, FEC, CMF, AC, EC, paclitaxel, carboplatin, trastuzumab