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Transcript of Breast Cancer
Lauren Kuta, PharmD Candidate 2015
Rosalind Franklin University of Medicine & Science
Types of Breast Cancer
How to Diagnose
Chest X-ray/CT scan
T N M
0 or 1
Early-small primary tumor, N=0
Early-small primary tumor, regional node involvement
Locally advanced-Large size, extensive node involvement
In 2011, 220,097 women and 2,078 men in the U.S. were diagnosed with breast cancer.
In 2011, 40,931 women and 443 men in the U.S. died from breast cancer
About 11% of all new cases of breast cancer in the U.S. are found in women younger than 45 years of age.
From 2001 to 2010 in the U.S., incidence of breast cancer has remained level among women.
From 2001 to 2010 in the U.S., deaths from breast cancer have decreased significantly by 2.0% per year among women.
Types of Breast Cancer
Used Other Than Medications
mets to liver,
brain, bone & lung
with AC x4 cycles
numerous chemotherapy tried
Due to disease progression
and medication therapies, pt
Osteonecrosis of the jaw
Options are limited...
Parise CA, Caggiano V. Breast Cancer Survival Defined by the ER/PR/HER2
Subtypes and a Surrogate Classification according to Tumor Grade and
Immunohistochemical Biomarkers. J Cancer Epidemiol. 2014;2014:469251. doi:
10.1155/2014/469251. Epub 2014 May 26.
Treon SP, Chabner BA. Concepts in use of high-dose methotrexate therapy. Clin
Chem. 1996 Aug;42(8 Pt 2):1322-9.
Up to Date Database, "Methotrexate". Topic 9630 Version 151.0. Accessed on March 23, 2015. https://www-uptodate-com.ezproxy.rosalindfranklin.edu/contents/methotrexate-drug-information?source=search_result&search=methotrexate&selectedTitle=1~150#references
Discovered in the late 1940s
Tumor regression rates are between 10-30% if used as a single agent
Used mostly in RA
slows purine synthesis
(guanosine & adenosine)
= LESS MATERIAL TO PRODUCE CELLS & CYTOTOXIC
Acute renal failure
Bone marrow suppression
CNS effects: May cause neurotoxicity including seizures
Dermatologic toxicity: SJS, severe skin sloughing
Fertility: May cause impairment of fertility, oligospermia, and menstrual dysfunction (Category X)
Gastrointestinal toxicity: diarrhea and ulcerative stomatitis
Hepatotoxicity: acute or potentially fatal chronic fibrosis or cirrhosis
PRIOR TO ADMINISTRATION...
any hepatotoxic agents
nephrotoxic chemo agents
PPIs & NSAIDS cannot be used-increase of MTX serum levels
CrCl 10 to 50 mL/minute: 50% of dose
CrCl <10 mL/minute: Avoid use
Serum creatinine <1.5 mg/dL: No dosage adjustment necessary
Serum creatinine 1.5 to 2 mg/dL: Administer 75% of dose
Serum creatinine >2 mg/dL: Administer 50% of dose
Bilirubin 3.1 to 5 mg/dL or transaminases >3 times ULN: Administer 75% of dose
Bilirubin >5 mg/dL: Avoid use
3-15g/m2 over 6-24 hours
in cerebrospinal fluid
MTX has a "rescue" agent
Uses passive diffusion
Great for brain mets due to ability to go into CSF
neutropenia can be easily treated with antibiotics
bumps in LFTs are benign and reversible
chance of poor outcomes are increased with age
High Urine Flow
transient bumps in CrCl can delay MTX excretion
24 hours of additional hydration can combat these bumps
80% of MTX appears in the urine unchanged within 12 hours of administration
more acidic urine=
decrease in drug solubility
prevents precipitation of MTX in the urine
use bicarbonate to make urine
***more important than
measured after 24-48 hours to ensure MTX is being cleared from plasma
patients should have a minimum 60ml/min CrCl
preview patient medications to decrease interactions
drainage of all third-space fluids before MTX
competes with MTX using folate pathway to enter cell
should be administered as a 10 fold excess of MTX
Back Up Rescue to Leucovorin:
Glucarpidase: bacterial enzyme which hydrolyzes MTX thus allowing another means for excretion
Weight based: 50 units/ kg
1 vial= 1,000 units
Was LS a good
candidate for MTX?
53 years old
Clinical Take Away
Breast cancer treatment is dependent of drug targets and staging
What Questions Do You Have?
As if that wasn't enough...
tumor suppressor genes
if mutated, increased chance of breast/ovarian cancer
Always re-biopsy with breast cancer recurrence
Not every patient is a candidate for MTX
MTX is useful for mets-especially if brain is involved
Chemotherapy is almost always an option for every type breast cancer
LS presented to her primary care oncologist with the following symptoms:
Sudden onset of memory loss
Has to use a walker now to get around