Metastatic breast cancer

Breast cancer, metastatic (for palliation) - 10 mg 3 times/day for at least 3 months. 

Trastuzumab Her2/neu Overexpressed in 25%-30% of primary breast cancer Metastatic breast cancer (overexpressing Her2/neu) Hypersensitivity cardiac dysfunction... 

CA 15-3 is detected by a murine monoclonal antibody (MAb) DF3 produced against a membrane-enriched extract of a human breast cancer metastatic to fiver. Another monoclonal antibody, 115D8, was developed against human milk fat globule membrane. The circulating DF3-reactive... 

Gyorffy S, Palmer K, Gauldie J. Adenoviral vector expressing murine Angiostatin inhibits a model of breast cancer metastatic growth in the lungs of mice. Am J Pathol 2001 159 1137-1147. 

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. 

Aminooglutethimide was the fust aromatase inhibitor to be used in patients with metastatic breast cancer, where response rates of up to 30% have been reported. Unfortunately, due to its lack of selectivity for aromatase, it induced a medical adrenelectomy that resulted in suppression of aldosterone and cortisol. With the development of more selective aromatase... 

Anastrazole is a nonsteroidal, type H, aromatase inhibitor that is 200 times more potent than aminoglutethimide. It is eliminated primarily via hqDatic metabolism, has a terminal half life of 50 h with steady state concentrations achieved approximately 10 days with once daily dosing regimens. It is administered orally at a dose of 1 mg/day that achieves near maximal aromatase inhibition and hence estrogen suppression in breast cancer patients. No effect on adrenal steroidogenesis has been observed at up to ten times the daily recommended dose. When used in the metastatic setting, anastrozole has been shown... 

Trastuzumab (Herceptin ) Roche mAb HER-2 HER-2 overexpressing breast cancer in the adjuvant and metastatic settings... 

The uses of the various anabolic steroids include management of anemia of renal insufficiency, control of metastatic breast cancer in women, and promotion of weight gain in those with weight loss after surgery, trauma, or infections. Stanozolol is used prophylactically... 

The usual metastatic sites for solid tumors are the brain, the bone, the lung, and the liver. It is important to realize and educate patients that breast cancer cells may metastasize to the brain, so the individual doesn t have brain and breast cancer but breast cancer metastases to the brain. 

Toremifene is an estrogen receptor antagonist. The pharmacokinetics of toremifene are best described by a two-compartment model, with an a half-life of 4 hours and an elimination half-life of 5 days. Peak plasma concentrations are achieved approximately 3 hours after an oral dose. Toremifene is metabolized extensively, with metabolites found primarily in the feces. Toremifene is used for the treatment of metastatic breast cancer in postmenopausal women with estrogen-receptor-positive or unknown tumors. Toremifene causes hot flashes, vaginal bleeding, thromboembolism, and visual acuity changes. 

Determine the treatment goals for early-stage, locally advanced, and metastatic breast cancer. 

Determine appropriate indications for endocrine therapy, chemotherapy, and biologic therapy for patients with metastatic breast cancer. 

Evaluate available chemotherapy options for patients with metastatic breast cancer based on pertinent patient and disease-state characteristics. 

Initial therapy of metastatic breast cancer in women with hormone-receptor-positive tumors should consist of hormonal therapy. 

Women with metastatic breast cancer who have hormone-receptorpositive tumors and respond to an initial hormonal manipulation usually will respond to a second hormonal manipulation. 

The taxanes (e.g., paclitaxel and docetaxel) are a newer class of agents that rival the anthracyclines in their activity in metastatic breast cancer, becoming (arguably) the most active class of chemotherapy for this disease. 

Toremifene is a recently marketed antiestrogen whose primary advantage is a lower estrogenic antiestrogenic ratio than tamoxifen (based on laboratory data).41 Toremifene (60 mg orally daily) has been found to have efficacy similar to that of tamoxifen in metastatic disease and a generally similar side-effect profile.42 Currently, toremifene is indicated as an alternative to tamoxifen in patients with metastatic breast cancer, but studies are ongoing that evaluate its safety and efficacy in the adjuvant setting. 

The goal of therapy with early and locally advanced breast cancer is to cure the disease. Breast cancer is currently incurable after it has advanced beyond local-regional disease. The goal of treatment of metastatic breast cancer is to improve symptoms, maintain quality of life, and extend survival. Thus it is important to choose therapy with good activity while minimizing toxicities. Treatment of metastatic breast cancer with either cytotoxic or endocrine therapy often results in regression of disease and improvements in quality of life. 

TABLE 86-8. Endocrine Therapies Used for Metastatic Breast Cancer... 

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