Preoperative systemic therapy for invasive breast cancer NCCN2016v1

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Preoperative systemic therapy for invasive breast cancer:In patients receiving preoperative systemic therapy, radiotherapy indications and t

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Preoperative systemic therapy for invasive breast cancer:

In patients receiving preoperative systemic therapy, radiotherapy indications and treatment sites should be based on the highest stage of clinical staging, histological grade, and tumor characteristics.

Preoperative / adjuvant therapy

HER2 negative disease programme

Preferred solution:

* dose dense AC (doxorubicin / cyclophosphamide) sequential paclitaxel every 2 weeks for 1 times

* dose dense AC (doxorubicin / cyclophosphamide) sequential paclitaxel 1 times a week

*TC (docetaxel and cyclophosphamide)

Other programme:

* dose dense AC (doxorubicin / cyclophosphamide)

*AC (doxorubicin / cyclophosphamide) q3w (level 2B)

* CMF (cyclophosphamide / methotrexate / fluorouracil)

*AC sequential docetaxel q3w

*AC sequential weekly paclitaxel solution

* EC (epirubicin / cyclophosphamide)

*FEC/CEF sequential T (fluorouracil / epirubicin / cyclophosphamide (sequential docetaxel) or 5-fluorouracil / epirubicin / cyclophosphamide followed 1 times weekly paclitaxel)

*FAC sequential T (fluorouracil / doxorubicin / cyclophosphamide sequential paclitaxel 1 times a week)

* TAC (docetaxel / doxorubicin / cyclophosphamide)

HER2 positive disease programme

Preferred solution:

T+ + *AC sequential trastuzumab, pertuzumab (plan doxorubicin / cyclophosphamide followed by paclitaxel plus trastuzumab plus pertuzumab, a variety of)

* TCH (docetaxel / carboplatin / trastuzumab, pertuzumab).

Other programme:

*AC sequential docetaxel plus trastuzumab, pertuzumab.

* docetaxel + cyclophosphamide + trastuzumab

*FEC sequential docetaxel plus trastuzumab and pertuzumab

*FEC sequential paclitaxel plus trastuzumab and pertuzumab

* paclitaxel plus trastuzumab

* pertuzumab plus trastuzumab plus docetaxel sequential FEC

* pertuzumab plus trastuzumab plus paclitaxel, FEC

Retrospective evidence suggests that anthracycline based chemotherapy in patients with HER2 positive tumors may be superior to non anthracycline based regimens.

Randomized clinical trials have shown that the addition of taxane to anthracycline based chemotherapy improves outcomes.

CMF and radiotherapy can be given simultaneously, or may be given to CMF. All other chemotherapy regimens should be given before radiotherapy.

Adjuvant chemotherapy and endocrine therapy should be administered sequentially after endocrine therapy.

The list of HER2 negative disease programs that are used for auxiliary purposes are all 1 categories (except those indicated).

In HER2 positive and positive axillary lymph nodes in patients with breast cancer, trastuzumab should be added to adjuvant therapy (grade 1).

For HER2 positive lymph node negative tumors than 1cm patients should also consider trastuzumab (1 class).

AC as a part of the sequential paclitaxel trastuzumab and paclitaxel was given at the same time should be the best, and the total duration of administration should be 1 years.

For more than T2 or more than N1, HER2 positive early breast cancer patients can be given before a perjeta scheme. None of the patients receiving an adjuvant trastuzumab treatment has been accepted for the inclusion of a trastuzumab programme.

Trastuzumab combined with anthracycline cardiotoxicity associated with significant. You should avoid trastuzumab and pertuzumab and an anthracycline antibiotic use.

Paclitaxel plus trastuzumab can be considered for low-risk patients with stage I, HER2 positive disease, especially those due to the auxiliary scheme is not suitable for other comorbidities of standard.

Combined drug delivery scheme for HER2 negative disease: the preferred option

Dose dense AC sequential paclitaxel chemotherapy

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q14d * 4.

All cycles were associated with bone marrow growth factor support

Sequential:

* paclitaxel intravenous infusion of 3H D1 175mg/ square meters

Q14d * 4.

All cycles were associated with bone marrow growth factor support

Dose dense AC sequential weekly paclitaxel regimen chemotherapy 1

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q14d * 4.

All cycles were associated with bone marrow growth factor support

Sequential:

* 80mg/ square meters of paclitaxel intravenous infusion of 1H QW * 12.

TC chemotherapy

* 75mg/ IV D1 square meters of docetaxel

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

All cycles were associated with bone marrow growth factor support

The selection, dosage and administration of anticancer drugs and the treatment of related toxicities are complex. It is often necessary to adjust the dosage of the drug and to initiate a supportive treatment intervention because of the anticipated toxicity, as well as individual patient variability, previous treatment, and comorbidities. Therefore, the best anti-cancer drugs in cancer patients need to have the use of anti-cancer drugs and related toxicity treatment experience of the health care team.

Combined drug delivery plans for HER2 negative diseases: other options

Dose dense AC chemotherapy

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q14d * 4.

All cycles were associated with bone marrow growth factor support

AC chemotherapy

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

TAC chemotherapy

* 75mg/ IV D1 square meters of docetaxel

* 50mg/ IV D1 square meters of adriamycin

* 500mg/ IV D1 m cyclophosphamide

Q21d * 6.

All cycles were associated with bone marrow growth factor support

CMF chemotherapy

* 100mg/ m d1-14 oral cyclophosphamide

* 40mg/ IV D1, 8 square meters of methotrexate

*5- 600mg/ IV D1, 8 square meters of fluorouracil

Q28d * 6.

AC sequential docetaxel chemotherapy

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

* 100mg/ IV D1 square meters of docetaxel

Q21d * 4.

AC sequential weekly paclitaxel solution

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

* 80mg/ square meters of paclitaxel intravenous infusion of 1H QW * 12.

EC chemotherapy

* epirubicin 100mg/ IV D1 M

* 830mg/ IV D1 m cyclophosphamide

Q21d * 8.

FEC sequential docetaxel chemotherapy

500mg/ IV D1 m *5- fluorouracil

* epirubicin 100mg/ IV D1 M

* 500mg/ IV D1 m cyclophosphamide

Q21d * 3.

Sequential:

* 100mg/ IV D1 square meters of docetaxel

Q21d * 3.

FEC sequential paclitaxel 1 times a week

600mg/ IV D1 m *5- fluorouracil

* 90mg/ IV D1 square meters of epirubicin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

Paclitaxel 100mg/ intravenous infusion of QW * 8 square meters

FAC sequential paclitaxel 1 times a week

*5- 500mg/ IV D1, 8 square meters of fluorouracil or D1, 4

* 50mg/ IV D1 square meters of adriamycin

(or CIV 72h)

* 500mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

* 80mg/ square meters of paclitaxel intravenous infusion of 1H QW * 12.

Combination regimens for HER2 positive disease: the preferred option

AC transfer T combined trastuzumab

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

80mg/ square meters of paclitaxel intravenous infusion of 1H QW * 12

Joint:

* 4mg/kg IV plus trastuzumab first dose of paclitaxel

Sequential:

* 2mg/kg IV QW to trastuzumab completed 1 years of treatment. As an alternative to paclitaxel after trastuzumab can use 6mg/kg IV q21d and completed trastuzumab for 1 years.

Left ventricular ejection fraction (LVEF) was assessed before and during treatment.

AC transfer of T combined with trastuzumab plus trastuzumab

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4.

Sequential:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 80mg/ IV D1, paclitaxel 8, 15 square meters

Q21d * 4

* 6mg/kg IV D1 trastuzumab

Repeated every 21 days until the completion of trastuzumab for 1 years

LVEF was assessed before and during treatment.

Dose dense AC sequential paclitaxel combined with trastuzumab

TCH chemotherapy plus trastuzumab

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* trastuzumab 840mg IV D1 and then 420mg IV

* 60mg/ IV D1 square meters of adriamycin

* 75mg/ IV D1 square meters of docetaxel

* 600mg/ IV D1 m cyclophosphamide

* AUC D1 6 IV carboplatin

Q14d * 4.

Q21d * 6

Sequential:

* paclitaxel intravenous infusion of 3H D1 175mg/ square meters

Q14d * 4.

Joint:

* 4mg/kg IV plus trastuzumab first dose of paclitaxel

Sequential:

* 2mg/kg IV QW to trastuzumab completed 1 years of treatment.

As an alternative to paclitaxel after trastuzumab can use 6mg/kg IV q21d and completed trastuzumab for 1 years.

LVEF was assessed before and during treatment.

TCH chemotherapy

* 75mg/ IV D1 square meters of docetaxel

* AUC D1 6 IV carboplatin

Q21d * 6

Joint:

* trastuzumab 4mg/kg IV for first weeks

Sequential:

* trastuzumab 2mg/kg IV for 17 weeks

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

or

* trastuzumab 8mg/kg IV for first weeks

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

In the period of adjuvant trastuzumab therapy the best frequency of LVEF assessment is not clear.

FDA labeling proposal is before the start of trastuzumab and during treatment every 3 months by LVEF.

The selection, dosage and administration of anticancer drugs and the treatment of related toxicities are complex. It is often necessary to adjust the dosage of the drug and to initiate a supportive treatment intervention because of the anticipated toxicity, as well as individual patient variability, previous treatment, and comorbidities. Therefore, the best anti-cancer drugs in cancer patients need to have the use of anti-cancer drugs and related toxicity treatment experience of the health care team.

Combination regimens for HER2 positive disease: other options

AC sequential docetaxel chemotherapy plus trastuzumab

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4

Sequential:

* 100mg/ IV D1 square meters of docetaxel

Q21d * 4

Joint:

* trastuzumab 4mg/kg IV for first weeks

Sequential:

Trastuzumab 2mg/kg IV QW * * 11

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

AC sequential docetaxel chemotherapy plus trastuzumab and pertuzumab

* 60mg/ IV D1 square meters of adriamycin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4

Sequential:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 75-100mg/ IV D1 square meters of docetaxel

Q21d * 4

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

Docetaxel / cyclophosphamide chemotherapy plus trastuzumab

* 75mg/ IV D1 square meters of docetaxel

* 600mg/ IV D1 m cyclophosphamide

Q21d * 4

Joint:

Trastuzumab 4mg/kg IV for first weeks

Then:

Trastuzumab 2mg/kg IV QW * 11

Then:

Trastuzumab 6mg/kg IV q21d until the completion of trastuzumab for 1 years

or

* trastuzumab 8mg/kg IV for first weeks

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

FEC sequential chemotherapy of pertuzumab plus trastuzumab plus docetaxel

500mg/ IV D1 m *5- fluorouracil

* epirubicin 100mg/ IV D1 M

* 600mg/ IV D1 m cyclophosphamide

Q21d * 3

Sequential:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 75-100mg/ IV D1 square meters of docetaxel

Q21d * 3

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

In the period of adjuvant trastuzumab therapy the best frequency of LVEF assessment is not clear.

FDA labeling proposal is before the start of trastuzumab and during treatment every 3 months by LVEF.

FEC sequential chemotherapy of pertuzumab plus trastuzumab plus paclitaxel

500mg/ IV D1 m *5- fluorouracil

* epirubicin 100mg/ IV D1 M

* 600mg/ IV D1 m cyclophosphamide

Q21d * 3

Sequential:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 80mg/ IV D1, paclitaxel 8, 15 square meters

Q21d * 3

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

Paclitaxel plus trastuzumab

* 80mg/ IV QW * m paclitaxel 12

Joint:

* 4mg/kg IV plus trastuzumab first dose of paclitaxel

Sequential:

* 2mg/kg IV QW to trastuzumab completed 1 years of treatment. As an alternative to paclitaxel after trastuzumab can use 6mg/kg IV q21d and completed trastuzumab for 1 years.

LVEF was assessed before and during treatment.

Pertuzumab plus trastuzumab plus docetaxel FEC sequential chemotherapy

Neoadjuvant therapy:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 75-100mg/ IV D1 square meters of docetaxel

Q21d * 4

Adjuvant therapy

600mg/ IV D1 m *5- fluorouracil

* 90mg/ IV D1 square meters of epirubicin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 3

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

Pertuzumab plus trastuzumab plus paclitaxel chemotherapy FEC

Neoadjuvant therapy:

* trastuzumab 840mg IV D1 and then 420mg IV

* 8mg/kg IV D1 trastuzumab and 6mg/kg IV

* 80mg/ IV D1, paclitaxel 8, 15 square meters

Q21d * 4

Adjuvant therapy

600mg/ IV D1 m *5- fluorouracil

* 90mg/ IV D1 square meters of epirubicin

* 600mg/ IV D1 m cyclophosphamide

Q21d * 3

Sequential:

* 6mg/kg IV q21d trastuzumab until completion of trastuzumab in 1 years

LVEF was assessed before and during treatment.

In the period of adjuvant trastuzumab therapy the best frequency of LVEF assessment is not clear. FDA labeling proposal is before the start of trastuzumab and during treatment every 3 months by LVEF.

NCCN guide first edition 2016

 

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