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Breast (adjuvant)

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


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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.
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