ION Breast Cancer Clinical Pathways - ION Solutions

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Taxotere (Docetaxel) Paraplatin (Carboplatin) Herceptin (Trastuzumab) EP=Moderate;FN˃20%Docetaxel 75mg/m 2 D1Carboplatin AUC 6 D1Trastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15q 21 Day Cycle x 6 CyclesThen continue:Trastuzumab 6mg/kg D1q 21 Day Cycle to complete 1 year of therapy>> J Clin Oncol 25:18S (June 20 suppl) Abstract 19647, 2007Adriamycin (Doxorubicin) Cytoxan (Cyclophosphamide) Followed by Taxotere(Docetaxel) Herceptin (Trastuzumab) EP=High; FN=10%-20%Doxorubicin 60mg/m2 D1Cyclophosphamide 600mg/m2 D1q 14 or q 21 Day Cycle x 4 CyclesFollowed by:Docetaxel 100 mg/m 2 D1Trastuzumab 4mg/kg D1 (Cycle 1 only)2mg/kgD1, D8, D15q 21 Day Cycle x 4 CyclesThen continue:Trastuzumab 6mg/kg D1q 21 Day Cycle x 13 Cycles>> NEnglJMed2005Oct;353(16):1673-84Taxotere (Docetaxel) Cytoxan (Cyclophosphamide) Herceptin (Trastuzumab)EP=Moderate; FN˃20%Docetaxel 75mg/m2 D1Cyclophosphamide 600mg/m2 D1Trastuzumab 8mg/kg D1 (Cycle 1 only)6mg/kgD1 (or weekly equivalent)q 21 Day Cycle x 4 or 6 CyclesThen continue:Trastuzumab 6mg/kg D1q 21 Day Cycle to complete 1 year of therapy>> JClinOncol2006Dec1;24(34):5381-7Clinical Trial:Screen patient for clinical trial. Check www.clinicaltrials.gov for available trials.Best Supportive Care and/or Hospice:Consider supportive care options and Hospice when appropriate.Page 8 of 39© 2013 by ION Solutions. All rights reserved
Metastatic Breast: HER2/neu NegativeHormone Therapy:Nolvadex (Tamoxifen)Tamoxifen 20mg PO q D>> J Natl Cancer Inst 91:1829-1846, 1999Aromatase Inhibitor (plus ovarian ablation for premenopausal women)Anastrozole 1mg PO q DExemestane 25mg PO q DLetrozole 2.5mg PO q D>> J Clin Oncol 26:1059-1065, 2008Faslodex (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, 2007Afinitor (Everolimus) Aromasin (Exemestane)Everolimus 10mg PO q DExemestane 25mg PO q DNote: only to be used second line after non-steriodal aromatase inhibitor>> NEJM 366:520-29, 2012Chemotherapy:Adriamycin (Doxorubicin) EP=High; FN> J Clin Oncol 17:2341-2454, 1999>> Eur J Cancer Clin Oncol 22:1431-1434, 1986Doxil (Pegylated Liposomal Encapsulated Doxorubicin) EP=Low; FN> Ann Ancol 15(3):440-449, 2004Taxol (Paclitaxel) EP=Low; FN=10%-20%Paclitaxel 80mg/m 2 D1, D8, D15 (or q3wk equivalent)q 21 Day Cycle>> J Clin Oncol 13:2575-2581, 1995>> J Clin Oncol 19:4216-4223, 2001Page 9 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 10 and 11: Taxotere (Docetaxel) EP=Low; FN=10%
Page 12 and 13: Herceptin (Trastuzumab) Followed by
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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