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Key considerations for cancer pharmacotherapy 2
Published on May 29, 2017 28 min
Other Talks in the Series: Cancer Therapies in the Personalized Medicine Era
Key considerations for cancer pharmacotherapy 1
- Prof. Christine M. Walko
- H. Lee Moffitt Cancer Center, Tampa, USA
A systems approach to implementation of personalized cancer therapy
- Prof. Gordon B. Mills
- MD Anderson Cancer Center, USA
Now that we've introduced you to a variety of the different agents that we see in clinical practice, how does this actually translate into a treatment plan for a patient?
Let's take the example of breast cancer and look at the different modalities and sequencing of therapy that we can utilize. So we have traditional cytotoxic chemotherapy that is still a big part of the treatment of breast cancer. We commonly will use taxanes like paclitaxel and docetaxel, and anthracyclines like doxorubicin. We have a subset of breast cancers that are estrogen or progesterone receptor positive and so we didn't talk too much about hormonal therapy here but in breast cancer and prostate cancer and a few others, we do use hormonal therapy a lot. Tamoxifen is a selective estrogen receptor modulator and the aromatase inhibitors anastrozole, letrozole, exemestane, all inhibit estrogen in different ways. And then we also have our targeted therapy that I started to introduce. So again HER2 is expressed on about 20% to 30% of breast cancers, and we can target it with a monoclonal antibody trastuzumab. Pertuzumab is another monoclonal antibody that actually works to prevent the dimerization of HER2 with a family member that will cause an activating pathway. And then we also have lapatinib which is a tyrosine kinase inhibitor that binds on the inside of the cell directed towards HER2 as well.
And so, an example treatment regimen for an estrogen receptor positive, HER2 positive patient with localized breast cancer may look something like this, where the patient gets either a lumpectomy that will remove the breast cancer from the breast or a mastectomy followed by adjuvant chemotherapy. So again, this is given after the definitive therapy which is surgery so doxorubicin and cyclophosphamide is typically given for four cycles, this can be given in a dose-dense manner where it's given every two weeks with growth factor support as I talked about before, or it can be given every three weeks. Following that, patients commonly get a different drug called paclitaxel with a targeted therapy because the tumor is HER2 positive, so paclitaxel is given in combination with a monoclonal antibody to target HER2. And then after that is completed, radiation may be given depending on the surgery and the stage of the disease, tamoxifen because the patient is estrogen receptor positive, will be given daily for five to ten years, and then trastuzumab our targeted therapy against HER2 is also continued out for a year. So you can see that these treatment regimens can combine a lot of the modalities we just talked about between surgery, radiation, traditional chemotherapy, and targeted therapy, and can also last for quite a long time but this is part of the reason why we have been so successful at curing a lot of localized breast cancer as well.