ION Breast Cancer Clinical Pathways - ION Solutions

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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
Herceptin (Trastuzumab) Navelbine (Vinorelbine) EP=Minimal; FN> Cancer 110:965-972, 2007Herceptin (Trastuzumab) Xeloda (Capecitabine) EP=Low; FN> J Clin Oncol 25:3853-3858, 2007Xeloda (Capecitabine) Tykerb (Lapatinib)Capecitabine 1000mg/m 2 PO BID D1-14Lapatinib 1250mg PO D1-21q 21 Day Cycle>> N Engl J Med 355:2733-2743, 2006Herceptin (Trastuzumab) Tykerb (Lapatinib) EP=Low; FN> J Clin Oncol 26 (May 20 suppl): Abstract 1015, 2008Herceptin (Trastuzumab) EP=Minimal; FN> AmJHealthSystPharm2008May15;65(10Suppl3):S4-9Herceptin (Trastuzumab) Gemzar (Gemcitabine) Paraplatin (Carboplatin)EP=Moderate; FN=10%-20%Trastuzumab 8mg/kg D0 (Cycle 1 only)6mg/kgD1Gemcitabine 1000mg/m2 D1, D8Carboplatin AUC 4-5 D1q 21 Day Cycle>> ClinBreastCancer2008;8(5):425-431Page 13 of 39© 2013 by ION Solutions. All rights reserved
Page 1 and 2: ION SolutionsNational Physician Net
Page 3: Best Supportive Care and/or Hospice
Page 6 and 7: Chemotherapy:Taxotere (Docetaxel) A
Page 8 and 9: Taxotere (Docetaxel) Paraplatin (Ca
Page 10 and 11: Taxotere (Docetaxel) EP=Low; FN=10%
Page 14 and 15: Herceptin (Trastuzumab) Taxotere (D
Page 16 and 17: Colon: First Line MetastaticChemoth
Page 18 and 19: 5-FU (5-Fluorouracil) Leucovorin +/
Page 20 and 21: Note: Wild Type KRAS documentation
Page 22 and 23: Camptosar (Irinotecan) Avastin (Bev
Page 24 and 25: Adjuvant Non-Small Cell Lung (NSCL)
Page 26 and 27: Paraplatin (Carboplatin) Taxotere (
Page 28 and 29: Best Supportive Care and/or Hospice
Page 30 and 31: Clinical Trial:Screen patient for c
Page 32 and 33: Small Cell Lung: Extensive Disease
Page 34 and 35: Paraplatin (Carboplatin) VP-16 (Eto
Page 36 and 37: Anti-EmeticsEmetogenic Risk:High Em
Page 38 and 39: Lung CancerPage 38 of 39© 2013 by

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