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Tamoxifen

Nolvadex, hormonal therapy

Tamoxifen

10-20 mg QD or BID. 10 mg QD for prevention.

Tamoxifen

Nonsteroidal anti estrogen SERM. DDI with paxil, Prozac.

Tamoxifen

thromboembolism, endometrial cancer risk, risk of bleeding with warfarin, osteoporosis, retinopathy, WG, HA

Tamoxifen

need routine eye exams

Tamoxifen

menopausal symptoms, tumor flare

Raloxifene

Evista, hormonal therapy (prevention only)

Raloxifene

60 mg PO QD

Raloxifene

SERM, only for prevention

Raloxifene

menopausal symptoms, tumor flare, but benefit in osteoporosis

Anastrozole

arimidex, hormonal therapy

Anastrozole

nonsteroidal aromatase inhibitor

Anastrozole

musculoskeletal disorder (arthralgia, myalgia), osteoporosis

Letrozole

Femara, hormonal therapy

Letrozole

musculoskeletal disorder (arthralgia, myalgia), osteoporosis

Exemestane

Aromasin, hormonal therapy

Exemestane

musculoskeletal disorder (arthralgia, myalgia), osteoporosis

Toremifene

Farestron, SERM

Fulvestrant

Faslodex, estrogen receptor downregulator, IM

Goserelin

Zoladex, LHRH analog.

Doxorubicin

Adria

Doxorubicin

potential binder of iron, starts creating cardiomyopathy

Doxorubicin

myelosuppression (Dose limiting), red urine, mucositis, extravasions

Doxorubicin

overdose treat with dexrazoxane, DMSO

Doxorubicin

inhibit topoisomerase II. Lots of free radicals - starts necrotizing muscle

Epirubicin

similar to doxorubicin, less toxic on the heart

Cyclophosphamide

Cytoxan, alkylating agent

Cyclophosphamide

myelosuppression (DLT), leukopenia, hemorrhagic cystitis (clumps of blood in urine)

Methotrexate

given with leucovorin, PO, IV, or IT

Methotrexate

caution in renal dysfunction, prone to 3rd spacing. Keep patient hydrated though

Carboxypeptidase

glucarpidase - breaks mtx down

Methotrexate

BMS (Dose limiting), mucositig, renal impairment

5-FU Continuous infusion

TS inhibition

5-FU Bolus

RNA incorporation

5-FU Continuous infusion

Less BMS, mucositis (DLT). Ice chips. Hand-foot syndrome worse

5-FU Bolus

More BMS (DLT), mucositis, Less Hand-foot syndrome

5-FU

significant DDI with warfarin

Capecitabine

Xeloda

Capecitabine

oral prodrug of 5FU, bypasses DPD.

Capecitabine

take on full stomach within 30 minutes of finishing a meal. Don't take with fruit juices. Both renally and hepatically eliminated.

Capecitabine

Hand-foot syndrome dose limiting toxicity

Paclitaxel

Taxol or Abraxae

Docetaxel

Taxotere

Paclitaxel

dose adjustment in liver impairment, elevated bili. If giving with cisplatin, give this first

Docetaxel

dose adjustment in liver impairment, elevated bili

Paclitaxel

increased neutropenia with infusion, hypersensitivity, cardiac abnormalities, myalgia. Need to use cremophor

Docetaxel

edema, skin rash, nail change

Docetaxel

premedicate with dexamethasone only. This is done to minimize fluid retention

Paclitaxel

premedicate with Benadryl, dexa, h2. Need to filter

Abraxane

paclitaxel bound to albumin -> lower hypersensitivity. Can use PVC bag with this. expensive

Cisplatin

Platinol

Cisplatin

Pt surrounded by Cl, must be mixed in NS, need pre and post hydration

Cisplatin

DDI with nephrotoxins and ototoxins (loop diuretics)

Cisplatin

Neurotoxicity, nephrotoxicity are dose limiting

Carboplatin

Paraplatin

Carboplatin

Pt, no Cl. Replaced by carboxycyclobutanes. Can be put in NS or D5W

Carboplatin

slower, less extensive plasma protein binding. Renal adjustments.

Carboplatin

uses the calvert EQ. AUC X (GFR+25)

Carboplatin

BMS is dose limiting

Trastuzumab

Herceptin

Trastuzumab

myocardial toxicity, LVEF needs to be monitored q3mo. Some injection site reaction, need to pretreat with Benadryl, dexamethasone, and/or epinephrine

Lapatinib

Tykerb

Lapatinib

advanced or metastatic breast cancer, failed anthracycline, taxane, Herceptin

Lapatinib

can be used with 5FU (capecitabine too) for additive effect, synergistic effect with trastuzumab

Lapatinib

needs to be taken 1 hour before or 1 hour after a meal

Lapatinib

cardiac effects, severe diarrhea, pulmonary tox

Eribulin

Halaven, for metastatic breast cancer

Eribulin

nontaxane microtubule inhibitor, halichondrin B analog

Eribulin

not compatible with dextrose

Eribulin

BMS (DLT), Peripheral neuropathy, QT prolongation, GI tox

Pamidronate

Aredia

Pamidronate

90 mg IV over 2 hr q 3-4 weeks

Zoledronate

Zometa

Zoledronate

Renally adjusted (crCl 30-39 3 mg, 40-49 3.3, 50-59 3.5, 60+ 4mg)

Zoledronate

4 mg IV over 15 minutes q 3-4 weeks

Zoledronate

5 mg IV over 15 minutes (Reclast). Or 4 mg IV over 15 minutes q 6 months

Pamidronate

osteonecrosis of jaw, tumor flare, myalgias

Zoledronate

osteonecrosis of jaw, tumor flare, myalgias

Denosumab

Xgeva (solid tumor), Prolia (osteoporosis) - antibody targeting RANKL

Denosumab

prevention of aromatase inhibitor-induced osteoporosis

Denosumab

nephrotoxicity, hypoPhos, hypoCa, osteonecrosis of jaw

Denosumab

120 mg SQ q 4 weeks (Xgeva)

Denosumab

60 mg SQ q 6 months (Prolia)

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