chemotherapy for breast cancer
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Introduction
Also see breast cancer (management)
Indications
- most appropriate for triple-negative breast cancer > 5 mm, skin involvement, or positive axillary lymph nodes[17]
- other or prior indications
- combination chemotherapy for 2-6 months recommended for node-positive women < 50 years of age
- chemotherapy is considered for node positive, estrogen receptor negative breast cancer in postmenopausal women
- tumors > 1 cm in premenopausal women
- adding chemotherapy to endocrine therapy may not improve survival for patients with ER+ tumors < 8 mm in size[22]
- chemotherapy is considered for node-negative, estrogen receptor negative tumors > 1 cm in postmenopausal women
* consider life expectancy, functional status, & comorbidities prior to administering chemotherapy[17]
Contraindications
- women with estrogen receptor positive breast cancer with < 4 positive lymph nodes & low risk scores on the breast cancer 21 mRNA expression analysis have a favorable prognosis with anti-estrogen therapy alone & do not benefit from chemotherapy[17]
Complications
- cardiotoxicity of chemotherapy[6]
- no increase of secondary malignancies has been noted in 20 year follow-up of patients who had received adjuvant chemotherapy for breast cancer
- cognitive impairment
- anthracycline-based adjuvant chemotherapy associated with more self-perceived cognitive difficulties up to 6 months after chemotherapy compared with noncancer controls[18]
- persistent cognitive impairment > 20 years after adjuvant chemotherapy[13]
- no benefit of donepezil[23]
Management
- Active chemotherapeutic agents:*
- doxorubicin (Adriamycin)
- anthracyclines for early stage triple-negative breast cancer (ER-, PR-, HER2-)[17]
- HER2 + breast cancer
- trastuzumab[9] (HER2 +) 6 months duration[19]
- tucatinib crosses blood brain barrier, effective for brain metastasis[21]
- tamoxifen*
- aromatase inhibitors
- standard of care for estrogen receptor positive tumors
- letrozole may be better than tamoxifen[10]
- exemestane may be better than tamoxifen[10]
- anastrozole (Arimidex)
- cyclophosphamide
- methotrexate
- 5-fluorouracil
- vincristine/vinblastine
- mitomycin C
- etoposide (VP-16)
- cisplatin
- paclitaxel (Taxol)
- docetaxel (Taxotere)
- capecitabine
- Lapatinib
- atezolizumab (Tecentriq) FDA-approved for treatment of unresectable locally advanced or metastatic triple-negative breast cancer in tumors expressing PD-L1[20]
- doxorubicin (Adriamycin)
- Combination chemotherapy:
- cyclophosphamide, methotrexate & fluorouracil (CMF)[5]
- cyclophosphamide, Adriamycin & fluorouracil (CAF)*
- cyclophosphamide/epirubicin/fluorouracil (CEF)
- doxorubicin (Adriamycin) & Cytoxan (AC)*
- doxorubicin (Adriamycin)/paclitaxel (Taxol)*
- doxorubicin (Adriamycin)/docetaxel (Taxotere)*
- docetaxel (Taxotere) & cyclophosphamide[8]
- Lapatinib plus capecitabine
- paclitaxel plus bevacizumab
- trastuzumab plus docetaxel (HER2 +)
- pertuzumab, trastuzumab & docetaxel (HER2 +)
- letrozole + palbociclib
- abemaciclib
- letrozole + ribociclib
* anthracycline-based chemotherapy for triple-negative breast cancer[17]
Notes
- no role for high-dose chemotherapy with or without autologous stem cell support[4]
- capecitabine alone in elderly women inferior to standard therapy[12]
- melatonin may enhance efficacy of chemotherapy[3]
- chemotherapy for breast cancer during pregnancy associated with low birth weight & an increase in obstetric complications (17% of treated women vs 9%) & neonatal events (31 vs 7), but complications deemed not clinically important[14] & breast cancer during pregnancy can be treated as in non-pregnant women without putting fetal &/or maternal outcome at substantially increased risk[14]
- platinum analogues & taxanes may be indicated in basal-like breast cancer[15]
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 669
- ↑ Formulary Update, Kaiser Permanente Northern California, summer, 2000
- ↑ 3.0 3.1 Prescriber's Letter 8(5):29 2001
- ↑ 4.0 4.1 Journal Watch 24(15):120, 2004 Zander AR, Kroger N, Schmoor C, Kruger W, Mobus V, Frickhofen N, Metzner B, Schultze W, Berdel WE, Koenigsmann M, Thiel E, Wandt H, Possinger K, Trumper L, Kreienberg R, Carstensen M, Schmidt EH, Janicke F, Schumacher M, Jonat W. High-dose chemotherapy with autologous hematopoietic stem-cell support compared with standard-dose chemotherapy in breast cancer patients with 10 or more positive lymph nodes: first results of a randomized trial. J Clin Oncol. 2004 Jun 15;22(12):2273-83. Epub 2004 Apr 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15111618
Hortobagyi GN. What is the role of high-dose chemotherapy in the era of targeted therapies? J Clin Oncol. 2004 Jun 15;22(12):2263-6. Epub 2004 Apr 26. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15111620 - ↑ 5.0 5.1 Journal Watch 25(8):67, 2005 Bonadonna G, Moliterni A, Zambetti M, Daidone MG, Pilotti S, Gianni L, Valagussa P. 30 years' follow up of randomised studies of adjuvant CMF in operable breast cancer: cohort study. BMJ. 2005 Jan 29;330(7485):217. Epub 2005 Jan 13. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15649903 <Internet> http://bmj.bmjjournals.com/cgi/content/full/330/7485/217
- ↑ 6.0 6.1 Guarneri V et al, Long-term cardiac tolerability of trastuzumab in metastatic breast cancer. The M.D. Andersion Cancer Center experience. J Clin Oncol 2006, 24:4107 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16908934
Harris EE et al, Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J Clin Oncol 2006, 24:4100 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16908933 - ↑ Evidence-based Series #1-17: Section 1 The role of HER2/neu in systemic and radiation therapy for women with breast cancer: A clinical practice guideline http://www.cancercare.on.ca/pdf/pebc1-17s.pdf
- ↑ 8.0 8.1 Jones SE et al, Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol 2006, 24:5381 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17135639
- ↑ 9.0 9.1 Smith I et al, 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: A randomized controlled trial. Lancet 2007, 369:29 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17208639
- ↑ 10.0 10.1 10.2 Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Colleoni M, Lang I, Del Mastro L, Smith I, Chirgwin J, Nogaret JM, Pienkowski T, Wardley A, Jakobsen EH, Price KN, Goldhirsch A. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine- responsive early breast cancer: update of study BIG 1-98. J Clin Oncol. 2007 Feb 10;25(5):486-92. Epub 2007 Jan 2. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17200148
- ↑ Coombes RC et al, Survival and safety of exemestane versus tamoxifen after 2-3 years' tamoxifen treatment (Intergroup Exemestane Study): A randomised controlled trial. Lancet 2007, 369:559 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17307102
- ↑ 12.0 12.1 Muss HB et al Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med 2009 May 14; 360:2055. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19439741
- ↑ 13.0 13.1 Koppelmans V et al. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol 2012 Feb 27 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22370315 <Internet> http://jco.ascopubs.org/content/early/2012/02/27/JCO.2011.37.0189
- ↑ 14.0 14.1 14.2 Loibl S et al Treatment of breast cancer during pregnancy: an observational study The Lancet Oncology, Early Online Publication, 16 August 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22902483 <Internet> http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(12)70261-9/abstract
- ↑ 15.0 15.1 The Cancer Genome Atlas Network Comprehensive molecular portraits of human breast tumours Nature (2012) Sept 23, <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23000897 <Internet> http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11412.html
- ↑ Foulkes WD, Smith IE, Reis-Filho JS. Triple-negative breast cancer. N Engl J Med. 2010 Nov 11;363(20):1938-48. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21067385
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ 18.0 18.1 Janelsins MC, Heckler CE, Peppone LJ et al. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: An analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol 2016 Dec 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28029304
- ↑ 19.0 19.1 Bankhead C Six Months of Trastuzumab Equal to 12 in Breast Ca - Similar outcomes and less cardiotoxicity, but more research needed. MedPage Today. May 16, 2018 https://www.medpagetoday.com/meetingcoverage/asco/72917
Earl HM, et al PERSEPHONE: 6 versus 12 months (m) of adjuvant trastuzumab in patients (pts) with HER2 positive (+) early breast cancer (EBC): Randomised phase 3 non-inferiority trial with definitive 4-year (yr) disease-free survival (DFS) results. American Society of Clinical Oncology (ASCO) 2018; Abstract 506 - ↑ 20.0 20.1 FDA Approval Notice. March 8, 2019 FDA approves atezolizumab for PD-L1 positive unresectable locally advanced or metastatic triple-negative breast cancer. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm633065.htm
- ↑ 21.0 21.1 MedPage Today Staff. Feb 3, 2020 HER2 Breast Cancer Treatment Effective on Brain Metastases - Patients with brain metastases have historically been excluded from most clinical trials. https://www.medpagetoday.com/meetingcoverage/sabcsvideopearls/84671
- ↑ 22.0 22.1 Ma SJ, Oladeru OT, Singh AK et al. Association of survival with chemoendocrine therapy in women with small, hormone receptor-positive, ERBB2-positive, node-negative breast cancer. JAMA Netw Open 2020 Apr 1; 3:e202507 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32271387 Free PMC Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2764231
- ↑ 23.0 23.1 Bankhead C Donepezil Flunks Test for Chemotherapy-Related Cognitive Impairment. No improvement versus placebo in immediate recall or other outcomes in breast cancer survivors. MedPage Today May 14, 2024 https://www.medpagetoday.com/hematologyoncology/breastcancer/110123
Rapp SR et al Phase III Randomized, Placebo-Controlled Clinical Trial of Donepezil for Treatment of Cognitive Impairment in Breast Cancer Survivors After Adjuvant Chemotherapy (WF-97116). J Clin Oncol. 2024. May 6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/38709986 https://ascopubs.org/doi/10.1200/JCO.23.01100