Pharmacotherapeutics of breast cancer

1. Breast Cancer
Dr. V. S. Swathi
Assistant Professor

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

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

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

13. P
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14. 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

16. 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

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

20. Non Pharmacological Treatment
• Life style changes
• Radiation therapy
• Surgical therapy
Lumpectomy
Mastectomy

22. Treatment
Algorithm

23. 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

24. 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

25. 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/m2 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/m2 IV  Bone marrow suppression
 GI disturbances
 Infections
 Opportunistic infections
 Fluid retention
 Myalgia
Cyclophosphomide Alkylating agent Inhibit DNA replication 600 mg/m2 IV  Bone marrow suppression
 GI disturbances
 Infections
 Opportunistic infections
 Alopecia
 Amenorrhea

26. Methotrexate Antimetabolites Inhibit DNA synthesis 600 mg/m2 IV  Bone marrow suppression
 GI disturbances
 Hyperurecemia
 Renal failure
 Mucositis
Fluorouracil Antimetabolites Inhibit DNA synthesis 500-600mg/m2 IV  Bone marrow suppression
 GI disturbances
 Alopecia
 Hand and Foot syndrome
 Photosensitivity
Doxorubicin Antitumor antibiotic Inhibit DNA synthesis 60-75mg/m2 IV  Bone marrow suppression
 GI disturbances
 Alopecia
 Cardiomyopathy
 Red urine
Epirubicin Antitumor antibiotic Inhibit DNA synthesis 100mg/m2 IV  Bone marrow suppression
 GI disturbances
 Amenorrhea
 Hyperpigmentation
 Amenorrhea

27. 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

28. Resources
• http://www.indianjcancer.com/article.asp?issn=001509X;year=201
9;volume=56;issue=1;spage=45;epage=49;aulast=Reddy
• http://www.indianjcancer.com/article.asp?issn=0019509X;year=20
18;volume=55;issue=1;spage=16;epage=22;aulast=Nair
• http://www.ijmpo.org/article.asp?issn=09715851;year=2017;volum
e=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