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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.
is a selective estrogen receptor modulator
and the aromatase inhibitors anastrozole,
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
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.
patients commonly get a different drug
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
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.