Trastuzumab in Breast Cancer Treatment

Study Notes

Indicated for treatment of breast cancer in patients with tumors that overexpress HER-2
Should not be given concurrently with anthracyclines due to increased risk of cardiotoxicity
Black-box warning regarding this combination is in the product information for trastuzumab
Reasonably well tolerated
Most common adverse effects are infusion-related (e.g., chills)
Infusion rate may be reduced, and acetaminophen and diphenhydramine may be given to alleviate symptoms
Rare adverse effects include pulmonary reactions (dyspnea, pulmonary infiltrates, non-cardiogenic pulmonary edema, and hypoxia) that may occur up to 24 hours after infusion

Hormonal therapies studied in the treatment of early breast cancer include:
- Selective estrogen receptor modulators (SERMs)
- Oophorectomy
- Ovarian irradiation
- Luteinizing hormone–releasing hormone (LHRH) agonists
- Aromatase inhibitors (AIs)
Tamoxifen is a SERM, anti-estrogenic in breast cancer cells, but estrogenic in other tissues and organs
Administration of tamoxifen should begin after completion of chemotherapy
Patients receiving tamoxifen must be counseled about warning signs of endometrial cancer and thromboembolism
Pharmacogenomics plays a role in tailoring therapy to individual patients
LHRH agonists (e.g., goserelin) or other means of ovarian ablation are beneficial in premenopausal women
AIs are recommended as the endocrine therapy of choice for postmenopausal women
Anastrozole and letrozole are non-steroidal compounds that exhibit reversible, competitive inhibition of aromatase
Exemestane is a steroidal compound that binds irreversibly to aromatase, forming a covalent bond