Welcome to Dr. Hamid Sanatinia's Virtual Headquarters
Breast (adjuvant)

Home

Should we treat or not???
Performace Status
Antiemetics
Growth Factors
Calculations
Chemo Precautions
TOXICITY CRITERIA
Antidepressants
Chemoprotection
MESNA
Dexrazoxane
Radioprotectants
Hypercalcemia of malignancy
Mucositis
Neutropenic Fever
Palliative Care
Radiation Oncology
<<<<<<<<<>>>>>>>>>
ALL
AML
Anal
Bladder Cancer
Brain Cancer
Breast (risk category)
Breast (adjuvant)
Breast (metastatic)
Breast (Xeloda)
Breast (hormonal)
Breast Cancer Genetics
Carcinoid
CLL
CML
COLON CANCER
Endometrial
Esophagous
Gastric
Gestational Trophoblastic Disease
Germ Cell (Ovary)
Hairy Cell Leukemia
Head/Neck
Head/Neck: ChemoRT abstracts
Head/Neck: Larynx
Head/Neck:Nasopharyngeal
Hodgkins
Islet Cell Tumors
Kidney
Liver
LUNG, NSC
Stage III Unresectable NSC Lung Cancer
Lung, SC
Lymphoma, Aggressive
Lymphoma, AIDS
Lymphoma, Burkitts
Lymphoma, CNS
Lymphoma, Cutaneous
Lymphoma, Indolent
Lymphoma, MALT
Lymphoma, Mantle cell
Lymphoma, Mediastinal B-Cell
Lymphoma, Refractory NHL
Melanoma
Mesothelioma
Multiple Myeloma
MDS
NHL
Ovarian
Pancreas
Prostate
Prostate (Hormonal)
Rectal Cancer
Sarcoma
Sarcoma, Ewing's
Sarcoma, Osteogenic
Skeletal Metastasis
Testicular Cancer
Thymoma
Thyroid Cancer
Waldenstrom's
Unknown Primary
<<<<<<<<<>>>>>>>>>
Molecular Genetics
Oncogenes, the list!
Immunoperoxidase stains
Tumor Markers
Bleomycin
Cisplatin
Etoposide
Ifosfamide
Methotrexate
Temazolamide
Mechanism of Action
Dose Modifications (Renal)
Dose Modifications (hepatic)
MDR

CMF
AC-T
CAF
FEC 100
CEF 120
-------
EPIRUBICIN DOSING INSTRUCTIONS
____________________________________________________________

CMF Cyclophosphamide 600 mg/m2 Methotrexate 40 mg/m2 5-FU 600 mg/m2 Repeat Q21days Cyclophosphamide 100 mg/m2 PO DAYS 1-14 (or 600 mg/m2 IV DAYS 1 & 8) Methotrexate 40 mg/m2 IV DAYS 1,8 5-FU 600 mg/m2 DAYS 1,8 Repeat Q28days REF: NCI Mamograph 1:45-9, 1986 NEJM 332:901, 1995 _________________________________________________________ AC Cylophosphamide 600 mg/m2 Doxorubicin 60 mg/m2 Repeat cycle every 21 days. REF: Fisher B., et al.: JCO 1990; 8:1483 This regimen has been studied using 4 cycles in the adjuvant setting for Breast Cancer. _________________________________________________________ CAF Regimen (Q 21 DAYS) CYCLOPHOSPHAMIDE 500 mg/m2 IV DAY 1 DOXORUBICIN 50 mg/m2 IV DAY 1 5-FU 500 mg/m2 IV DAY 1 REPEAT Q 21 DAYS RESPONSE RATE 64% (20% CR) REF: Cancer 40:625-632, 1977 _________________________________________________________ CAF (Q28 days) CYCLOPHOSPHAMIDE 100 mg/m2 PO DAY 1-14 DOXORUBICIN 30 mg/m2 IV DAYS 1 & 8 5-FU 500 mg/m2 IV DAYS 1 & 8 REPEAT Q 28 DAYS Response rate: 53% (CR=17%), 69% if <50 years old, 70% in ER negative patients REF: JCO 3:932-940, 1985 _________________________________________________________ FEC 100 CYCLOPHOSPHAMIDE 500 mg/m2 IV DAY1 EPIRUBICIN 100 mg/m2 IV DAY1 5-FU 500 mg/m2 IV DAY1 Repeat Q21days X 6 cycles 1. If during the previous cycle, patient experienced platelets <50,000/mm3, ANC<250/mm3, neutropenic fever, or grade 3/4 non-hematological toxicity, decrease subsequent dose of epirubicin to 75% of day 1 dose. 2. If on DAY 1 of subsequent course, platelets<100,000/mm3, ANC<1500/mm3, or non-hematological toxicity>grade 1, then delay administering the dose. REF: JCO 16(8):2651, 1998 JCO 18(17):3115, 2000 _________________________________________________________ CEF 120 CYCLOPHOSPHAMIDE 75 mg/m2 PO QD X 14 days start day-1 EPIRUBICIN 60 mg/m2 IV on DAYS 1 & 8 5FU 500 mg/m2 IV on DAYS 1 & 8 Repeat Q 28 days for 6 cycles. 1. Recommend giving bactrim or cipro prophylactically. 2. If on Day 8 platelets are between 75,000-100,000/mm3 or ANC 1,000-1499/mm3, then decrease the DAY 8 epirubicin dose to 75% of the DAY 1 dose. 3. If during the previous cycle, patient experienced platelets <50,000/mm3, ANC<250/mm3, neutropenic fever, or grade 3/4 non-hematological toxicity, decrease subsequent dose of epirubicin to 75% of day 1 dose. 4. If on DAY 1 of subsequent course, platelets<100,000/mm3, ANC<1500/mm3, or non-hematological toxicity>grade 1, then delay administering the dose. REF CEF vs CMF: Journal of Clinical Oncology, Vol 16, 2651-2658. 169 of the 359 CMF pts developed recurrence vs 132 of the 351 CEF patients. The corresponding 5-yr relapse-free survival rates were 53% & 63%, respectively (P = .009). 107 CMF patients died vs 85 CEF patients. The corresponding 5-year actuarial survival rates were 70% & 77%, respectively (P = .03). The rate of hospitalization for febrile neutropenia was 1.1% in the CMF group compared with 8.5% in the CEF group. There was 1 case of CHF in a CMF patient vs none in the CEF group. Acute leukemia occurred in five patients in the CEF group. CONCLUSION: The results of this trial show the superiority of CEF over CMF in terms of both disease-free and overall survival in premenopausal women with axillary node-positive breast cancer.

Link to Breast Cancer Web Site at CancerNet PDQ


____________________________________________________________
EPIRUBICIN DOSING INSTRUCTIONS
BONE MARROW: Severe myelosuppression may occur. Consideration should be given to administration of lower starting doses (75-90 mg/m2) for heavily treated patients, patients with preexisting bone marrow depression, or in the presence of neoplastic bone marrow infiltration.

HEPATIC: If bilirubin 1.2-3 mg/dL or AST 2 to 4 times upper limit of normal, the give 1/2 of the recommended dose. If bilirubin>3 mg/dL or AST>4 times upper limit of normal, give 1/4 of recommended dose.

RENAL Lower doses should be considered in patients with serum creatinine>5 mg/dL. Data on renal dysfunction limited.

CHF The risk of developing CHF increases rapidly with increasing total cumulative doses of Eipirubicin in excess of 900 mg/m2. This cumulative dose should only be exceeded with extreme caution. Patients shoul dbe assessed for drops in LVEF during therapy.

DRUG INTERACTIONS. CIMETIDINE-increases the AUC of epirubicin by 50%. Cimetidine treatments should be stopped during treatment with epirubicin.
____________________________________________________________