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83 terms

Kim Breast Cancer 166

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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)