Breast cancer, drug therapy

Simpson D, Plosker GL. Paclitaxel as adjuvant or neoadjuvant therapy in early breast cancer. Drugs 2004 64 1839 7. 

Weinberg OK, Marquez-Garban DC, Pietras RJ. New approaches to reverse resistance to hormonal therapy in human breast cancer. Drug Resist Update. 2005 8 219-233. 

Poon GK et al (1995) Identification of tamoxifen metabolites in human Hep G2 cell line, human liver homogenate, and patients on long-term therapy for breast cancer. Drug Metab Dispos 23 377-382... 

The CMIA work with steroids marked with Re(CO)3 led to the early recognition of the potential of this class of compounds for the diagnosis and therapy of steroid receptorpositive breast cancer. Complex (184) shows higher binding to estrogen receptors than the parent steroid. Complex (185) also binds to the tamoxyfen receptor and shows an antiproliferative action comparable to hydroxytamoxifen, a potent breast cancer drug. ... 

R. Vlvek, R. Thangam, V. Nipunbabu, T. Ponraj, and S. Kannan, Oxaliplatin-chitosan nanoparticles induced intrinsic apoptotic signaling pathway A smart drug delivery system to breast cancer cell therapy, Int. J. Biol. Macromol, 65,289-297, 2014. 

Similar thermosensitive poly(organo)phosphazenes have also been assessed in combination with camptothecin [178], 5-fluorouracil [179] and silibinin [180], as well as the breast cancer drug 2-m ethoxy estradiol [181], thus proving to be a versatile, effective and safe delivery system. Furthermore, as well as the delivery of standard, lipophilic chemotherapeutic agents, the approach has been extended to other, noncancer therapies, for example, injectable polyplex hydrogels for the localised and long-term delivery of siRNA (discussed in Section 3.2.2) and growth hormone delivery. 

Dene Simpson, Greg L. Plosker, Paclitaxel As Adjuvant or Neoadjuvant Therapy in Early Breast Cancer, Drugs 64 (2004), p. 1839-1847. 

MTX is part of curative therapeutic schedules for acute lymphoblastic leukemias (ALL), Burkitt s lymphoma, and choriocarcinoma. It was also used in adjuvant therapy of breast cancer. High dose MTX with leucovorin rescue can induce about 30% remissions in patients with metastatic osteogenic sarcoma. MTX is one of the few antineoplastic drugs that can be safely administered intrathecally for the treatment of meningeal metastases and leukemic infiltrations (routine prophylaxis in ALL). In addition, MTX can be used as an immunosuppressive agent for the treatment of severe rheumatoid arthritis and psoriasis. 

Exemestane is an irreversible aromatase inactivator that binds to the aromatase enzyme to block the production of estrogen from androgens. Exemestane is absorbed rapidly after oral administration, with a terminal half-life of 24 hours. The drug is eliminated primarily by the liver and feces, with less than 1% of the dose excreted unchanged in the urine. Exemestane is indicated for the treatment of advanced breast cancer in postmenopausal women who have had disease progression following tamoxifen therapy. Side effects include hot flashes, fatigue, osteoporosis/bone fractures, and flulike symptoms. 

Cytotoxic drugs that have been used alone and in combination as adjuvant therapy in breast cancer include doxorubicin, epirubicin, cyclophosphamide, methotrexate, fluorouracil,... 

Cytotoxic chemotherapy is eventually required in most patients with metastatic breast cancer. Patients with hormone-receptor-negative tumors require chemotherapy as initial therapy of symptomatic metastases. Patients who respond initially to hormonal manipulations eventually cease to respond and go on to require chemotherapy. The median duration of response is 5 to 12 months, but some patients will have an excellent response to an initial course of chemotherapy and may live 5 to 10 years or longer without evidence of disease. In general, median survival of patients after treatment with commonly used drug combinations for metastatic breast cancer is 14 to 33 months. The median time to response has ranged from 2 to 3 months in most studies, but this period depends in large part on the site of measurable disease. The median time to appearance of response is between 3 and 6 weeks in patients whose disease is primarily in the skin and lymph nodes, 6 to 9 weeks in patients with metastatic lung involvement, 15 weeks in patients with hepatic involvement, and nearly 18 weeks in patients with bone involvement. Thus it is often the case that an immediate response to therapy is not... 

Based on the information presented, create a care plan for this patient s breast cancer. Your plan should include (1) a statement of the drug-related and non-drug-related needs and/or problems, (2) the goals of therapy, (3) a patient-specific detailed therapeutic plan (including options for local control), and (4) a plan for follow-up to determine whether the goals have been achieved and adverse effects managed adequately. 

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