Describe the treatment of end-stage breast cancer.
Palliative therapy in stage IV consists of systemic treatment (chemotherapy, hormone therapy, targeted therapy, and possibly immunotherapy), possibly in combination with radiation therapy.
Additionally, drugs to relieve symptoms of metastatic disease can be given (e.g., bisphosphonates, pain medication, antiemetics).
In some cases, palliative surgery can be done to control local symptoms (e.g., mastectomy).
Define end-stage.
Distal metastases are present.
List chemotherapy regimens.
Overview
Can be given as neoadjuvant or adjuvant chemotherapy
Usually combination therapy
Indications
Tumor size > 2 cm
Triple-negative breast cancer and tumor size ≥ 0.5 cm
HER-2 positive breast cancer and tumor size > 1 cm
Positive lymph nodes
Aggressive tumor histology
Regimens
FEC-D: 5-fluorouracil PLUS epirubicin PLUS cyclophosphamide, followed by docetaxel
CMF: cyclophosphamide PLUS methotrexate PLUS fluorouracil
Contraindication: pregnancy (first trimester)
Describe hormone therapy.
Indication: all ER/PR-positive tumors
Goal: suppression of extraovarian hormone production and blockade of estrogen receptors in order to decrease the risk of breast cancer recurrence
Contraindication: pregnancy
Premenopausal
Tamoxifen (see “Selective estrogen receptor modulators”)
GnRH agonists
Postmenopausal: aromatase inhibitors
Preventive: raloxifene (see “Selective estrogen receptor modulators”)
Describe targeted therapy.
Trastuzumab
Definition: humanized monoclonal antibody against the HER2 tyrosine kinase receptor that is used in the treatment of HER2-positive breast and gastric cancer
Mechanism of action: targets HER2/neu (c-erbB2) tyrosine kinase receptor → ↓ of HER2 initiated cellular signaling and ↑ antibody-dependent cytotoxicity → ↓ tumor growth
Indication: all HER2-positive tumors
Side effects
Cardiotoxicity (e.g., dilated cardiomyopathy with systolic CHF): An echocardiogram is recommended prior to initiating treatment to evaluate cardiac function.
Gastrointestinal symptoms (e.g., diarrhea, nausea)
Last changed2 years ago