ION Breast Cancer Clinical Pathways - ION Solutions

Herceptin (Trastuzumab) Followed by Nolvadex (Tamoxifen) or Aromatase InhibitorTrastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15q 21 Day CycleFollowed by one of the following:Tamoxifen 20mg PO q DAnastrozole 1mg PO q DExemestane 25mg PO q DLetrozole 2.5mg PO q D>> N Engl J Med 353:1659-1672, 2005Faslodex (Fulvestrant)Fulvestrant 500mg IM D1, D15, D29 then Monthly>> J Clin Oncol 28:4594-4600, 2010Zoladex (Goserelin)Goserelin 3.6 mg SQ q MonthNote: Ovarian suppression>> Lancet 369: 1711, 2007Chemotherapy:Herceptin (Trastuzumab) Paraplatin (Carboplatin) Taxol (Paclitaxel) EP=Moderate;FN˃20%Trastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15 (or q3wk equivalent)Carboplatin AUC 6 D1Paclitaxel 175mg/m 2 D1q 21 Day Cycle>> J Clin Oncol 24:2786-2792, 2004Herceptin (Trastuzumab) Taxol (Paclitaxel) EP=Low; FN=10%-20%Trastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15 (or q3wk equivalent)Paclitaxel 80-90mg/m 2 D1, D8, D15 (or q3wk equivalent)q 21 Day Cycle>> N Engl J Med 344:783-792, 2001>> J Clin Oncol 26:1642-1649, 2008Herceptin (Trastuzumab) Taxotere (Docetaxel) EP=Low; FN˃20%Trastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15 (or q3wk equivalent)Docetaxel 35mg/m 2 D1, D8, D15 (or q3wk equivalent)q 21 Day Cycle>> J Clin Oncol 23:4265-4274, 2005>> J Clin Oncol 20:1800-1808, 2002Page 12 of 39© 2013 by ION Solutions. All rights reserved