Breast cancer: metastatic disease

8. Metastatic disease
a. Preferred single agents
i. Anthracyclines:
- doxorubicin 60-75mg/m2 IV D1 cycled every 21 days or 20mg/m2 IV weekly
- epirubicin 60-90 mg/m2 IV D1 cycled every 21 days
- pegylated liposomal doxorubicin 50mg/m2 IV D1 cycled every 28 days

ii. Taxanes
- paclitaxel 175mg/m2 IV D1 cycled every 21 days or 80mg/m2 IV weekly
- docetaxel 60-100mg/m2 IV D1 cycled every 21 days or 40mg/m2 IV weekly for 6 wks followed by a 2 week rest then repeat
- albumin-bound paclitaxel 100mg/m2 or 150mg/m2 D1, 8 and 15 IV cycled every 28 days or 260mg/m2 IV cycled every 21 days

iii. Anti-metabolites
- capecitabine 1000-1250 mg/m2 PO bd D1-14 cycled every 21 days
- gemcitabine 800-11200mg/m2 IV D1, 8 and 15

iv. Other microtubule inhibitors
- vinorelbine 25mg/m2 IV weekly

b.Other single agents
- cyclophosphamide
- mitoxantrone
- cisplatin
- etoposide po
- vinblastine
- fluorouracil Cl
- ixabepilone

c. Preferred agents with Bevacizumab
- paclitaxel 90mg/m2 by 1h IV D1, 8 & 15
- bevacizumab 10mg/kg IV D1 & 15
- cycled every 28 days

d. Preferred chemotherapy combinations
- CAF
Cyclophasphamide 100mg/m2 PO D1-14
Doxorubicin 30mg/m2 IV D1 & 8
5FU 500mg/m2 IV D1 & 8
Cycled every 28 days
- FAC
5FU 500m/m2 IV D1 & 8 or D1 & 4
Doxorubicin 50mg/m2 IV D1
Cyclophosphamide 500mg/m2 IV D1
Cycled every 21 days

- FEC
Cyclophasmide 400mg/m2 IV D1 & 8
Epirubicin 50mg/m2 IV D1 & 8
5FU 500mg/m2 IV D1 & 8
Cycled every 28 days

- AC
Doxorubicin 60mg/m2 IV D1
Cyclophasphamide 600mg/m2 IV D1
Cycled every 21 days

- EC
Epirubicin 75mg/m2 IV D1
Cyclophosphamide 600mg/m2 IV D1
Cycled every 21 days

- AT
Doxorubicin 60mg/m2 IV D1 or 50mg/m2 IV D1
Paclitaxel 125-200 mg/m2 IV D1 or Docetaxel 75mg/m2 IV D1
Cycled every 21 days

- CMF
Cyclophosphamide 100mg/m2 PO D1-14
Methotrexate 40mg/m2 IV D1 & 8
5FU 600mg/m2 Iv D1 & *
Cycled every 28 days

- docetaxel/capecitabine
Docetaxel 75mg/m2 IV D1
Capecitabine 950mg/m2 PO bd 1-14
Cycled every 21 days

- GT
Paclitaxel 175mg/m2 IV D1
Gemcitabine 1250 mg/m2 IV D1 & 8 (following paclitaxel on D1)
Cycled every 21 days

e. Other combinations
- ixabepilone + capecitabine
Ixabepilone 40mg/m2 IV D1
Capecitabine 2000mg/m2 PO D1-14
Cycled every 21 days

f. Preferred first line agents for Her-2 positive disease: Trastuzumab 4 mg/kg IV D1 followed by 2mg/kg IV weekly or 8mg/kg IV D1 followed by 6mg/kg IV every 3 wks with:

- paclitaxel + carboplatin (PCH)
Carboplatin AUC of 6 IV D1
Paclitaxel 175mg/m2 IV D1
Cycled every 21 days

- weekly TCH chemotherapy
Paclitaxel 80mg/m2 IV D1, 8 & 15
Carboplatin AUC of 2 IV D1, 8 & 15
Cycled every 28 days

- paclitaxel 175mg/m2 IV D1 cycled every 21 days or 80-90mg/m2 IV weekly
- docetaxel 80-100mg/m2 IV D1 cycled every 21 days or 35mg/m2 IV infusion weekly
- vinorelbine 25mg/m2 IV weekly
- capecitabine 1000-1250mg/m2 PO bd D1-14 cycled every 21 days

g. Preferred agents for trastuzumab-exposed Her2-positive disease
- lapitinib 1250mg PO daily D1-21 + capecitabine 1000mg/m2 PO bd D1-14 cycled every 21 days
- trastuzumab + other first line agents
- trastuzumab + capecitabine
- trastuzumab + lapatinib (without cytotoxic therapy) 1000mg PO daily

(trastuzumab 4mg/kg IV D1 followed by 2mg/kg IV weekly or 8mg/kg IV D1 followed by 6mg/kg Iv every 3 wks)