Adjuvant Therapy

in
Breast Ca
Hassan Mohammad AlShehri
2051040006
Basics
What is adjuvant therapy?
What is neoadjuvant therapy?
Adjuvant therapy

Treatment that is given after primary therapy to

increase the chance of long-term disease-free survival.
Neoadjuvant therapy
Treatment given before primary therapy
Rational for neoadjuvant therapy
to shrink a tumor that is inoperable in its current
state, so it can be surgically removed.

A woman whose tumor can be removed by

mastectomy neoadjuvant therapy

breast-conserving surgery
who needs adjuvant therapy?
Not all women with breast cancer need adjuvant
therapy. Patients at higher risk of cancer recurrence
are more likely to need adjuvant therapy.
Recurrence Depend on what?
Stage of the cancer
Grade
Hormone receptor status: The cells of many breast
tumors express receptors for the hormones estrogen
and progesterone. Tumors with cells that do not
express hormone receptors are more likely to recur.
HER2/neu status
Adjuvant Chemotherapy
Chemotherapeutic classes
There are five chemotherapeutic classes:

Alkylating agents;
Anthracyclines;
Taxanes;
Vinca alkaloids; and
Anti-metabolites.
Classification of cytotoxic agents

Alkylating Anti- Mitotic

Antibiotics Others
Agents Metabolites Inhibitors

Busulfan Cytosine Etoposide Bleomycin L-asparaginase

Carmustine Arabinoside Teniposide Dactinomycin Hydroxyurea

Chlorambucil Floxuridine Vinblastine Daunorubicin Procarbazine

Cisplatin Fluorouracil Vincristine Doxorubicin

Cyclophosphamide Mercaptopurine Vindesine Mitomycin-c

Ifosfamide Methotrexate Taxoids Mitoxantrone

Melphalan Plicamycin
Cell Cycle
Alkylating agents
Alkylating agents cause cell death by interacting
with DNA during cell synthesis.

Side effects of alkylating agents

depress bone marrow function and cause
gastrointestinal disturbances such as nausea and
vomiting.
Sterility and secondary malignancies have been
reported with prolonged use of alkylating agents.  
Anthracyclines
Anthracyclines are cytotoxic antibiotics that are non-
cell-cycle specific chemotherapy agents.

Side effects include:

Myelosuppression (bone marrow suppression)
Toxicity to the heart which may lead to arrhythmias
Severe local reactions, including tissue necrosis or
extravasation
Secondary malignancies; Alopecia
Nausea and vomiting and Oral ulceration. 
Taxanes
Taxanes are cytotoxic agents that work on a protein
called tubulin found in the cytoplasm of cells.
Tubulin is needed for the production of microtubules
which are essential in cell division.

Taxanes are generally used when other chemotherapy

regimens have failed.
Taxanes
Side effects:
bone marrow suppression
Nausea and vomiting:
Diarrhoea, Mouth sores, joint and muscle aches;
Alopecia , Paraesthesia, Mild allergic reactions
Anaphylactic reactions.
Vinca alkaloids
Vinca alkaloids act on M phase of cell cycle. They are
another class of anti-tubulin agents (along with the
taxanes)

Side effects of vinca alkaloids

Bone marrow supression
Nausea and vomiting;
Hair loss;
Mouth sores;
Headache;
Constipation.
Adjuvant Chemotherapy
Non-Trastuzumab Containing Regimens
AC Doxorubicin(Adriamycin)60 CMF Cyclophosphamide 100 mg/m2
mg/m2 Methotrexate 40 mg/m2
Cyclophosphamide 600 mg/m2 5-Fluorouracil 600 mg/m2
FAC 5-Fluorouracil 500 mg/m2 AC X 4 →T x 4 Doxorubicin 60 mg/m2
Doxorubicin 50 mg/m2 Cyclophosphamide 600 mg/m2
Cyclophosphamide 500 mg/m2 Paclitaxel 80 mg/m2 or Doxetaxel
100 mg/m2
CAF 5-Fluorouracil 500 mg/m2 EC Epirubicin 100 mg/m2
Doxorubicin 30 mg/m2 Cyclophosphamide 830 mg/m2
Cyclophosphamide 100 mg/m2
FEC Cyclophosphamide 75 mg/m2 TAC Docetaxel 75 mg/m2
Epirubicin 60 mg/m2 Doxorubicin 50 mg/ m2
5-Fluorouracil 500 mg/m2 Cyclophosphamide 500 mg/m2

Adapted from NCCN Practice Guidelines in Oncology v2.2007.

HER-2/neu
HER2/neu stands for "Human Epidermal growth
factor Receptor 2“
The HER2 gene is a proto-oncogene?

20-30 % of breast cancers over express HER2/neu

Importance of HER-2/neu
Over expression of this receptor in breast cancer is
associated with:
- More aggressive
- More resistant to chemotherapy
- Recurrence

Target of the monoclonal antibody trastuzumab

(Herceptin) . . Effective only in breast CA
Side Effect
Can include nausea, vomiting, hot flashes, joint pain
and also increase the risk of heart problems
Good Luck