Breast cancer

Pharmacotherapeutics of breast cancer

1. Breast Cancer Dr. V. S. Swathi Assistant Professo r

2. Definition It is the most common type of cancer which affects cells of breast

3. Epidemiology In the world, 2.1 million in each year affected with breast cancer In India, it affects more than 17, 97, 900 women by 2020

4. Metastatic breast cancer It is also called stage IV cancer It spreads all other parts of the body along with breasts

5. Ductal Carcinoma In Situ (DCIS) It is early stage non invasive cancer It affects ducts of breast milk Generally it is treatable, if untreated it spreads to all other parts

6. Invasive Ductal Carcinoma IDC) It also called infiltrative ductal carcinoma It starts at milk ducts of breast and also spreads to all other parts

7. Triple Negative Breast Cancer Breast cancer cells shows negative for: Hormone epidermal growth factor Estrogen receptor Progesterone receptor

8. Inflammatory Breast Cancer (IBC) It is aggressive and fast growing breast cancer It affects skin and lymph vessels of the breast

9. Risk factors Age greater than 50 Early menarche and menopause Obesity Family history of breast cancer Exposure to radiation

10. Etiology Mutations in genes responsible for breast cell production and growth

11. Pathogenesis

12. Clinical Presentation Swelling of all parts of breast Skin dimpling Breast or nipple pain Nipple retraction Dry, red, thickened skin of breast Nipple discharge other than breast Swollen lymph nodes

13. Complications Cancer related pain Spinal compression Hypercalcemia Lung tumor Pleural effusion Weight loss Blockage of bile ducts Brain tumor Psychological problems like anxiety and depression

14. Diagnosis Medical and family history Clinical presentation Computed Tomography Magnetic resonance imaging Positron Emission Tomography Ductogram Hormone receptor test

15. Non Pharmacological Treatment Life style changes Radiation therapy Surgical therapy Lumpectomy Mastectomy

16. Treatment Algorithm

17. Regimen for HER2 negative breast cancer TC- Docetaxel , Cyclophosphomide AC- Doxorubicin , Cyclophosphomide AC-T- Doxorubicin , Cyclophosphomide, Paclitaxel TAC- Docetaxel , Doxorubicin, Cyclophosphomide Oral CMF- Oral Cyclophosphomide, Methotrexate, Fluorouracil IV CMF- IV Cyclophosphomide, Methotrexate, Fluorouracil FEC- Fluorouracil , Epirubicin, Cyclophosphomide

18. Regimen for HER2 positive breast cancer TH- Paclitaxel , Trastuzumab TCH- Docetaxel , Carboplatin, Trastuzumab TCHP- Docetaxel , Carboplatin, Trastuzumab, Pertuzumab AC-TH- Doxorubicin , Cyclophosphomide, Paclitaxel, Trastuzumab AC-THP- Doxorubicin , Cyclophosphomide, Paclitaxel, Trastuzumab, Pertuzumab

19. Drugs used in treatment of Breast Cancer Drug Category Mode of action Dose Adverse effects Paclitaxel Mitotic inhibitor Arrest cell division by arresting microtubule formation 175mg/m 2 IV Bone marrow suppression GI disturbances Infections Peripheral neuropathy Opportunistic infections Arthralgia Docetaxel Mitotic inhibitor Arrest cell division by arresting microtubule formation 60-100 mg/m 2 IV Bone marrow suppression GI disturbances Infections Opportunistic infections Fluid retention Myalgia Cyclophosphomide Alkylating agent Inhibit DNA replication 600 mg/m 2 IV Bone marrow suppression GI disturbances Infections Opportunistic infections Alopecia Amenorrhea

20. Methotrexate Antimetabolites Inhibit DNA synthesis 600 mg/m 2 IV Bone marrow suppression GI disturbances Hyperurecemia Renal failure Mucositis Fluorouracil Antimetabolites Inhibit DNA synthesis 500-600mg/m 2 IV Bone marrow suppression GI disturbances Alopecia Hand and Foot syndrome Photosensitivity Doxorubicin Antitumor antibiotic Inhibit DNA synthesis 60-75mg/m 2 IV Bone marrow suppression GI disturbances Alopecia Cardiomyopathy Red urine Epirubicin Antitumor antibiotic Inhibit DNA synthesis 100mg/m 2 IV Bone marrow suppression GI disturbances Amenorrhea Hyperpigmentation Amenorrhea

21. Trastuzumab Anti HER2 drug Inhibit tumor cell growth which over expresses HER2 4mg/kg over 90 min and then 2mg/kg over 30 min Pain Asthenia GI disturbances Dyspnoea Anorexia Pertuzumab Anti HER2 drug Inhibit tumor cell growth which over expresses HER2 840mg IF and then 420 mg IF Bone marrow suppression GI disturbances Alopecia Peripheral neuropathy Asthenia Tamoxifen Estrogen receptor antagonist Inhibit actions of estrogen on cells of breast 20-40mg/day-PO Hot flashes Vaginal discharge Amenorrhea Menstrual changes Cataracts

22. Resources http ://www.indianjcancer.com/article.asp?issn=001509X;year=2019;volume=56;issue=1;spage=45;epage=49;aulast=Reddy http://www.indianjcancer.com/article.asp?issn=0019509X;year=2018;volume=55;issue=1;spage=16;epage=22;aulast=Nair http://www.ijmpo.org/article.asp?issn=09715851;year=2017;volume=38;issue=1;spage=18;epage=21;aulast=Bajpai https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajco.12661 https://www.icmr.nic.in/sites/default/files/guidelines/Breast_Cancer.pdf