Breast Cancer Chemotherapy Regimens
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Questions and Answers

What is the primary goal of adjuvant chemotherapy in early-stage breast cancer patients?

Reduce risk of recurrence and improve overall survival.

What is the common regimen used in neoadjuvant chemotherapy for locally advanced breast cancer patients?

AC-T (Adriamycin and Cyclophosphamide followed by Taxotere) or TAC (Taxotere, Adriamycin, and Cyclophosphamide).

What is the goal of metastatic breast cancer regimens?

Improve overall survival and quality of life.

What is the common regimen used in adjuvant hormone therapy for hormone receptor-positive breast cancer patients?

<p>Tamoxifen (5-10 years) or Aromatase inhibitors (Anastrozole, Letrozole, Exemestane) (5 years).</p> Signup and view all the answers

What is the goal of advanced hormone therapy in advanced hormone receptor-positive breast cancer patients?

<p>Improve overall survival and quality of life.</p> Signup and view all the answers

What is the common regimen used in targeted therapy for HER2-positive breast cancer patients?

<p>Trastuzumab (Herceptin) or Pertuzumab (Perjeta) + Trastuzumab.</p> Signup and view all the answers

What is the regimen used in combination with hormone therapy for advanced hormone receptor-positive breast cancer patients?

<p>CDK 4/6 inhibitors (Palbociclib, Ribociclib).</p> Signup and view all the answers

What is the regimen used in metastatic breast cancer in combination with Bevacizumab?

<p>Paclitaxel.</p> Signup and view all the answers

What is the primary site of origin for breast cancer?

<p>Breast tissues</p> Signup and view all the answers

What is the typical outcome for breast cancer in its early stages?

<p>Potentially curable</p> Signup and view all the answers

What is the purpose of Clinical Breast Examination (CBE) in breast cancer screening?

<p>To screen for breast cancer</p> Signup and view all the answers

Which of the following is a risk factor for breast cancer?

<p>Female gender</p> Signup and view all the answers

What is an important factor that influences survival in breast cancer patients?

<p>Age at diagnosis</p> Signup and view all the answers

What is the increased risk of breast cancer associated with?

<p>Long term HRT</p> Signup and view all the answers

What is the purpose of staging in breast cancer diagnosis?

<p>Determine the prognosis</p> Signup and view all the answers

Which of the following genetic mutations is a risk factor for breast cancer?

<p>Both A and B</p> Signup and view all the answers

What is the characteristic of Stage 0 breast cancer?

<p>Ductal carcinoma in situ (DCIS) that has not spread beyond the duct</p> Signup and view all the answers

What is the next step in the clinical algorithm for breast cancer screening if the CBE is positive?

<p>Evaluation by surgeons</p> Signup and view all the answers

What is a characteristic of Stage IIIA breast cancer?

<p>Tumor in the breast is smaller than 5 centimeters and has spread to underarm lymph nodes</p> Signup and view all the answers

What is the purpose of FNAC in breast cancer screening?

<p>To obtain a sample for cytology</p> Signup and view all the answers

What is the function of the TNM classification?

<p>To classify breast cancer into different stages</p> Signup and view all the answers

What is a characteristic of HER-2/neu in breast cancer?

<p>It is a biologic characteristic of the tumor</p> Signup and view all the answers

What is the characteristic of Stage IIA breast cancer?

<p>Tumor is ≤ 2 cm and has spread to the axillary lymph nodes, or tumor is 2-5 cm but has not spread to the axillary lymph nodes</p> Signup and view all the answers

What is a characteristic of Stage IIIB breast cancer?

<p>Tumor has spread to the skin or chest wall and may have spread to lymph nodes within the breast area or under the arm</p> Signup and view all the answers

What is the typical treatment approach for TNM stage 0 breast cancer?

<p>Surveillance, surgery, and hormonal therapy</p> Signup and view all the answers

What is the primary role of radiotherapy in TNM stage 1 and 2 breast cancer treatment?

<p>To accompany lumpectomy</p> Signup and view all the answers

In TNM stage 3 breast cancer, what is the role of radiotherapy?

<p>To treat the affected breast and chest wall</p> Signup and view all the answers

What is the primary goal of surgery in TNM stage 4 breast cancer?

<p>To relieve symptoms</p> Signup and view all the answers

In which scenario is hormonal therapy typically used in breast cancer treatment?

<p>ER+ve breast cancer</p> Signup and view all the answers

What is the typical duration of adjuvant chemotherapy in TNM stage 1 and 2 breast cancer treatment?

<p>3-6 months</p> Signup and view all the answers

What is the typical duration of adjuvant hormonal therapy in DCIS?

<p>5 years</p> Signup and view all the answers

What is the primary goal of chemotherapy in TNM stage 4 breast cancer treatment?

<p>To prolong survival</p> Signup and view all the answers

What percentage of women who undergo axillary dissection are at risk of developing lymphedema?

<p>10-30%</p> Signup and view all the answers

What is the benefit of adjuvant radiotherapy in early-stage breast cancer?

<p>It reduces the risk of recurrence but not overall survival</p> Signup and view all the answers

What is the primary goal of radiotherapy in metastatic breast cancer?

<p>Relieve symptoms</p> Signup and view all the answers

What is the role of hormonal therapy in breast cancer?

<p>It is used to treat ER- and/or PR-positive breast cancer</p> Signup and view all the answers

What is the benefit of targeted therapy in breast cancer?

<p>It is used to treat HER2-positive breast cancer</p> Signup and view all the answers

What is the complication of mastectomy that is characterized by a sensation of a breast that is no longer present?

<p>Phantom breast sensation</p> Signup and view all the answers

What is the benefit of dose-dense AC+TTAC in breast cancer treatment?

<p>It improves both overall survival and recurrence rate</p> Signup and view all the answers

What is the preferred chemotherapy regimen in metastatic breast cancer?

<p>Combination therapy</p> Signup and view all the answers

Study Notes

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

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Learn about the goals and common regimens of adjuvant and neoadjuvant chemotherapy in breast cancer treatment. Explore the different combinations of medications used to reduce recurrence risk and improve survival rates.

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