Week 16: Breast Cancer drugs

Breast cancer treatment

• Surgery (1st step)

• Radiation

• Chemo

• Hormone therapy

• Biological therapy (immunotherapy/targeted therapy)

Biopsy for cancer

Taking a piece of the mass and testing it to determine if it is cancerous, and if so, the type and aggressiveness

Immunohistochemistry for cancer

uses specific antibodies revealing markers that help diagnose cancer, classify tumor types, find the cancer's origin (especially in metastases), determine aggressiveness, and predict response to targeted therapies

Fluorescence In Situ Hybridization (FISH) for breast cancer

look for specific gene changes within cancer cells

HER-2 gene/protien

helps control cell growth, but when a tumor has extra copies of this gene or makes too much protein, cells can grow and divide rapidly, leading to aggressive cancers

Traditional/generalized chemotherapy drugs (2)

• Doxorubicin (Adriamycin)

• Cyclophosphamide (AC)

Targeted chemotherapy drugs (2)

• Doxorubicin (Adriamycin)

• Cyclophsphamide (AC)

Doxorubicin (Adriamycin)

Cyclophosphamide (AC)

Paclitaxel (T)

Trastuzumab (H)

Growth fraction (GF) and tumor GF

Ratio of the number of cells proliferating to the total number of cells

• tumors typically have relatively high GF (30-50%)

Chemo is more toxic to tissue with a ____ growth fraction

High

• chemo kills fast growing cells

What normal tissues with a high GF are also sensitive to chemo?

• Bone marrow

• Hair follicles

• Sperm

• GI tract

Common side effects of chemo d/t acting on tissues with high GFs

• bone marrow suppression

• alopecia

• reproductive toxicities

• stomatisis — sores in mouth

• diarrhea

Pre-infusion considerations

• Hydration

• Emesis risk

• Vesicant

• Cardiac and pulmonary issues

• Infusion rxns

Pre-infusion considerations: hydration

Patients receiving cyclophosphamide should maintain adequate oral hydration (2 to 3 L/day during administration and for one to two days thereafter) and void frequently to reduce the risk of hemorrhagic cystitis

Pre-infusion considerations: Emesis risk

• During AC: HIGH (>90% frequency of emesis)

• Pre-treat with antiemetics including serotonin receptor antagonist Ondansetron (Zofran)

• Improved efficacy when combined with the steroid dexamethasone

Pre-infusion considerations: Vesicant

• Doxorubicin is a vesicant; avoid extravasation

• Administer infusional regimens through a central venous line

• Pacliaxel can cause significant tissue damage; avoid extravasation

Pre-infusion considerations: Cardiac issues

• Doxorubicin is associated with cardiomyopathy

• Tratuzumab associated with cardiotoxicity

Pre-infusion considerations: Pulmonary issues

Trastuzumad has been associated with serious lung toxicity

• do not give to pts with preexisting pulmonary disease

Pre-infusion considerations: Infusion reactions

Paclitaxel and Trastuzumab are associated with infusion rxns

• Can pre-medicate for Paclitaxel to prevent inflammatory response

WBCs should be monitored during chemo, but chemo should be delayed if the absolute neutrophil count is >_____ per microL, and platelet count is >____ per microL

• Neutrophil count > 1000

• Platelet count > 100,000

Chemotherapy-induced peripheral neuropathy (CIPN)

Psychoneurological symptoms during chemotherapy

• Fatigue

• Pain

• Cognitive difficulties

• Depression/anxiety

What should you monitor prior to giving AC or Trastizumab and every 3 months? Why?

Cardiac function

Anastrozole adverse effects

• Hypotension — dizziness and fainting

• Hot flash

• GI distress

• Nervous systems: lack of energy/fatigue, depression/mood disorder

• HA

• Pain