Breast Cancer (Invasive) Treatment Regimens

Share this content:
SEE BELOW THE CHART TO SEE BREAST CANCER DRUG MONOGRAPHS.

BREAST CANCER (INVASIVE) TREATMENT REGIMENS

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced healthcare team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are only provided to supplement the latest treatment strategies.

These Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Neoadjuvant/Adjuvant Chemotherapya,b,c,d,e

NOTE: All recommendations are category 2A unless otherwise indicated.

Preferred Regimens for HER2-negative Disease1,f

REGIMEN

DOSING

Dose-dense AC followed by paclitaxel (Category 1)2

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 14 days for 4 cycles (all cycles are with myeloid growth factor support; refer to NCCN Guidelines for Myeloid Growth Factors), followed by:

Day 1: Paclitaxel 175mg/m2 via 3-hour IV infusion.

Repeat cycle every 14 days for 4 cycles (all cycles are with myeloid growth factor support).

Dose-dense AC followed by weekly paclitaxel (Category 1)2

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 14 days for 4 cycles, followed by:

Day 1: Paclitaxel 80mg/m2 via 1-hour IV infusion weekly for 12 weeks.

TC (Category 1)3

Day 1: Docetaxel 75mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles (all cycles are with myeloid growth factor support).

Other Regimens for HER2-negative Disease1,f

Dose-dense AC (Category 1)2

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 14 days for 4 cycles (all cycles are with myeloid growth factor support).

AC (Category 2B)4

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles.

TAC (Category 1)5

Day 1: Docetaxel 75mg/m2 IV

Day 1: Doxorubicin 50mg/m2 IV

Day 1: Cyclophosphamide 500mg/m2 IV.

Repeat cycle every 21 days for 6 cycles (all cycles are with myeloid growth factor support).

CMF (Category 1)6

Days 1–14: Cyclophosphamide 100mg/m2 orally

Days 1 and 8: Methotrexate 40mg/m2 IV

Days 1 and 8: 5-fluorouracil 600mg/m2 IV.

Repeat cycle every 28 days for 6 cycles.

AC followed by docetaxel (Category 1)7

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Day 1: Docetaxel 100mg/m2 IV.

Repeat cycle every 21 days for 4 cycles.

AC followed by weekly paclitaxel (Category 1)8

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Day 1: Paclitaxel 80mg/m2 by 1-hour IV infusion weekly for 12 weeks.

EC (Category 1)9

Day 1: Epirubicin 100mg/m2 IV

Day 1: Cyclophosphamide 830mg/m2 IV.

Repeat cycle every 21 days for 8 cycles.

Preferred Regimens for HER2-positive Disease1,f,g,h,i

AC followed by paclitaxel + trastuzumab10,j,k

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Paclitaxel 80mg/m2 via 1-hour IV infusion weekly for 12 weeks, with:

Trastuzumab 4mg/kg IV with first dose of paclitaxel, followed by:

Trastuzumab 2mg/kg IV weekly to complete 1 year of treatment.

As an alternative, trastuzumab 6mg/kg IV every 21 days may be used following the completion of paclitaxel, and given to complete 1 year of trastuzumab treatment.

AC followed by paclitaxel + trastuzumab + pertuzumab10,j,k

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Days 1, 8, and 15: Paclitaxel 80mg/m2 IV.

Repeat cycle every 21 days for 4 cycles.

Day 1: Trastuzumab 6mg/kg IV.

Repeat cycle every 21 days to complete 1 year of trastuzumab therapy.

Dose-dense AC followed by paclitaxel + trastuzumab11,j,k

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 14 days for 4 cycles, followed by:

Day 1: Paclitaxel 175mg/m2 via 3-hour IV infusion.

Repeat cycle every 14 days for 4 cycles, plus:

Trastuzumab 4mg/kg IV with first dose of paclitaxel, followed by:

Trastuzumab 2mg/kg IV weekly to complete 1 year of treatment.

As an alternative, trastuzumab 6mg/kg IV every 21 days may be used following the completion of paclitaxel, and given to complete 1 year of trastuzumab treatment.

TCH12,k

Day 1: Docetaxel 75mg/m2 IV

Day 1: Carboplatin AUC 6mg min/mL IV.

Repeat cycle every 21 days for 6 cycles, with:

Trastuzumab 4mg/kg IV week 1, followed by 2mg/kg IV for 17 weeks, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. OR

Trastuzumab 8mg/kg IV week 1, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

TCH chemotherapy + pertuzumab13,k

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Docetaxel 75mg/m2 IV

Day 1: Carboplatin AUC 6mg min/mL IV.

Repeat cycle every 21 days for 6 cycles, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

Other Regimens for HER2-positive Disease1,f,g,h,i

AC followed by docetaxel + trastuzumab12,j,k

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Day 1: Docetaxel 100mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, with:

Trastuzumab 4mg/kg IV week 1, followed by 2mg/kg IV weekly for 11 weeks, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

AC followed by docetaxel + trastuzumab + pertuzumab13,j,k

Day 1: Doxorubicin 60mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Day 1: Docetaxel 75–100mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

Docetaxel + cyclophosphamide + trastuzumab14,k

Day 1: Docetaxel 75mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, with:

Trastuzumab 4mg/kg IV week 1, followed by:

Trastuzumab 2mg/kg IV weekly for 11 weeks, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy. OR

Trastuzumab 8mg/kg IV week 1, followed by:

Trastuzumab 6mg/kg IV every 21 days to complete 1 year of treatment.

FEC followed by pertuzumab + trastuzumab + docetaxel13,j,k

Day 1: Fluorouracil 500mg/m2 IV

Day 1: Epirubicin 100mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Day 1: Docetaxel 75–100mg/m2 IV.

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

FEC followed by pertuzumab + trastuzumab + paclitaxel13,j,k

Day 1: Fluorouracil 500mg/m2 IV

Day 1: Epirubicin 100mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV.

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Days 1, 8, and 15: Paclitaxel 80mg/m2 IV.

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

Paclitaxel + trastuzumab15,k,l

Day 1: Paclitaxel 80mg/m2 IV weekly for 12 weeks, with

Trastuzumab 4mg/kg IV with first dose of paclitaxel, followed by:

Trastuzumab 2mg/kg IV weekly to complete 1 year of treatment.

As an alternative, trastuzumab 6mg/kg IV every 21 days may be used following the completion of paclitaxel, and given to complete 1 year of trastuzumab therapy.

Pertuzumab + trastuzumab + docetaxel followed by FEC16,j,k

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Day 1: Docetaxel 75–100mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by adjuvant therapy:

Day 1: Fluorouracil 600mg/m2 IV

Day 1: Epirubicin 90mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV

Day 1: Trastuzumab 6mg/kg IV

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

Pertuzumab + trastuzumab + paclitaxel followed by FEC16,j,k

Day 1: Pertuzumab 840mg IV followed by 420mg IV

Day 1: Trastuzumab 8mg/kg IV followed by 6mg/kg IV

Days 1, 8, and 15: Paclitaxel 80mg/m2 IV.

Repeat cycle every 21 days for 4 cycles, followed by adjuvant therapy:

Day 1: Fluorouracil 600mg/m2 IV

Day 1: Epirubicin 90mg/m2 IV

Day 1: Cyclophosphamide 600mg/m2 IV

Day 1: Trastuzumab 6mg/kg IV

Repeat cycle every 21 days for 3 cycles, followed by:

Day 1: Trastuzumab 6mg/kg IV every 21 days to complete 1 year of trastuzumab therapy.

a The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Modifications of drug dose and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and individual patient variability, prior treatment, and comorbidity. The optimal delivery of anticancer agents therefore requires a healthcare delivery team experienced in the use of anticancer agents and the management of associated toxicities in patients with cancer.

b Retrospective evidence suggests that anthracycline-based chemotherapy regimens may be superior to nonanthracycline-based regimens in patients with HER2-positive tumors.

c Randomized clinical trials demonstrate that the addition of a taxane to anthracycline-based chemotherapy provides an improved outcome.

d CMF and radiation therapy may be given concurrently, or the CMF may be given first. All other chemotherapy regimens should be given prior to radiotherapy.

e Chemotherapy and endocrine therapy used as adjuvant therapy should be given sequentially with endocrine therapy following chemotherapy.

f Nab-paclitaxel may be substituted for paclitaxel or docetaxel due to medical necessity (ie, hypersensitivity reaction). If substituted for weekly paclitaxel or docetaxel, then the weekly dose of nab-paclitaxel should not exceed 125mg/m2.

g In patients with HER2-positive and axillary node-positive breast cancer, trastuzumab should be incorporated into the adjuvant therapy (category 1). Trastuzumab should also be considered for patients with HER2-positive node-negative tumors ≥1cm (category 1).

h Trastuzumab should optimally be given concurrently with paclitaxel as part of the AC followed by paclitaxel regimen, and should be given for 1 year total duration.

i A pertuzumab-containing regimen can be administered to patients with ≥T2 or ≥N1, HER2-positive, early-stage breast cancer preoperatively. Patients who have not received a pertuzumab-containing regimen can receive adjuvant pertuzumab.

j Trastuzumab given in combination with an anthracycline is associated with significant cardiac toxicity. Concurrent use of trastuzumab and pertuzumab with an anthracycline should be avoided.

k Evaluate left ventricular ejection fraction (LVEF) before and during treatment. Although the optimal frequency of LVEF assessment during adjuvant trastuzumab therapy is not known, the FDA recommends LVEF measurements every 3 months during treatment.

l Paclitaxel + trastuzumab may be considered for patients with low-risk, stage I, HER2-positive disease, particularly those not eligible for other standard adjuvant regimens due to comorbidities.

References

1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer V.2.2017. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed July 17, 2017.

2. Citron ML, Berry DA, Cirrincione C, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol. 2003;21(8):1431–1439. Erratum in: J Clin Oncol. 2003;21(11):2226.

3. Jones S, Holmes F, O'Shaughnessey J, et al. Docetaxel with cyclophosphamide is associated with an overall survival benefit compared with doxorubicin and cyclophosphamide: 7-year follow-up of US Oncology Research trial 9735. J Clin Oncol. 2009;27(8):1177–1183.

4. Fisher B, Brown AM, Dimitrov NV, et al. Two months of doxorubicin-cyclophosphamide with and without interval reinduction therapy compared with six months of cyclophosphamide, methotrexate, and fluorouracil in positive-node breast cancer patients with tamoxifen-nonresponsive tumors: results from NSABP B-15. J Clin Oncol. 1990;8(9):1483–1496.

5. Martin M, Pienkowski T, Mackey J, et al. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005;352(22):2302–2313.

6. Goldhirsch A, Colleoni M, Coates AS, et al. Adding adjuvant CMF chemotherapy to either radiotherapy or tamoxifen: are all CMFs alike? The International Breast Cancer Study Group (IBCSG). Ann Oncol. 1998;9(5):489–493.

7. von Minckwitz G, Raab G, Caputo A, et al. Doxorubicin with cyclophosphamide followed by docetaxel every 21 days compared with doxorubicin and docetaxel every 14 days as preoperative treatment in operable breast cancer: the GEPARDUO study of the German Breast Group. J Clin Oncol. 2005;23(12):2676–2685.

8. Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in adjuvant treatment of breast cancer. N Engl J Med. 2008;358(16):1663–1671.

9. Piccart MJ, Di Leo A, Beauduin M, et al. Phase III trial comparing two dose levels of epirubicin combined with cyclophosphamide with cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer. J Clin Oncol. 2001;19(12):3103–3110.

10. Romond EH, Perez EZ, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2 positive breast cancer. N Engl J Med. 2005;353(16):1673–1684.

11. Dang C, Fornier M, Sugarman S, et al. The safety of dose-dense doxorubicin and cyclophosphamide followed by paclitaxel with trastuzumab in HER-2/neu overexpressed/amplified breast cancer. J Clin Oncol. 2008;26(8):1216–1222.

12. Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011;365(14):1273–1283.

13. Schneeweiss A, Chia S, Hickish T, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline–containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013;24(9):2278–2284.

14. Jones SE, Collea R, Paul D, et al. Adjuvant docetaxel and cyclophosphamide plus trastuzumab in patients with HER2-amplified early stage breast cancer: a single-group, open-label, phase 2 study. Lancet Oncol. 2013;14(11): 1121–1128.

15. Tolaney S, Barry W, Dang C, et al. A phase II study of paclitaxel (T) and trastuzumab (H) (APT trial) for node-negative, HER2-positive breast cancer (BC). Abstract presented at: 36th Annual CTRC-AACR San Antonio Breast Cancer Symposium; December 10-14, 2013; San Antonio, TX. Abstract S1-04.

16. Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomized multicentre, open-label, phase 2 trial. Lancet Oncol. 2012;13(1):25–32.

(Revised 7/2017)

© 2017 Haymarket Media, Inc.

 

Breast Cancer Drug Monographs

Breast Cancer

ABRAXANE AFINITOR ARIMIDEX
AROMASIN Cyclophosphamide CYTOXAN INJECTION
DELATESTRYL Doxorubicin HCl Doxorubicin HCl Solution
ELLENCE ESTRACE EVISTA
FARESTON FASLODEX FEMARA
Fluorouracil Fluoxymesterone GEMZAR
HALAVEN HERCEPTIN IBRANCE
IXEMPRA KADCYLA KISQALI
Megestrol acetate Methotrexate for injection Methotrexate injection
Pamidronate disodium Injection PERJETA PREMARIN
SOLTAMOX ORAL SOLUTION Tamoxifen TAXOL
TAXOTERE Thiotepa TREXALL
TYKERB Vinblastine for injection Vinblastine injection
XELODA ZOLADEX

Data provided by MPR.

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs

Sign Up for Free e-newsletters