Systemic Treatment Drugs and Regimens

  • Naziye Ak
  • Adnan Aydiner


This chapter discusses chemotherapy regimens and targeted options for breast cancer treatment. Dose-limiting toxicities for targeted therapies are often markedly different from those of classic cytotoxic chemotherapy agents. The profit/loss ratio of treatment should be adequately evaluated, and toxicity may not cause life-threatening conditions. However, decreasing the dosage under the therapeutic range may cause under-dosing in patients, which may compromise cancer outcomes. It is very important to know how to adjust the dose according to toxicity without changing the effectiveness of the drug.


  1. 1.
    Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0. 2017, National Institutes of Health, National Cancer Institute.Google Scholar
  2. 2.
    Yardley DA, Noguchi S, Pritchard KI, Burris HA, Baselga J, Gnant M, et al. Everolimus plus exemestane in postmenopausal patients with HR+ breast cancer: BOLERO-2 final progression-free survival analysis. Adv Ther. 2013;30(10):870–84.CrossRefGoogle Scholar
  3. 3.
    Child CG III, Turcotte JG. Surgery and portal hypertension. In: Child III CG, editor. The liver and portal hypertension. Philadelphia: W. B. Saunders; 1964. p. 50.Google Scholar
  4. 4.
    Finn RS, Crown JP, Ettl J, Schmidt M, Bondarenko IM, Lang I, et al. Efficacy and safety of palbociclib in combination with letrozole as first-line treatment of ER-positive, HER2-negative, advanced breast cancer: expanded analyses of subgroups from the randomized pivotal trial PALOMA-1/TRIO-18. Breast Cancer Res. 2016;18(1):67. Scholar
  5. 5.
    Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Paluch-Shimon S, et al. Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol. 2018.
  6. 6.
    Goetz MP, Toi M, Campone M, Sohn J, Paluch-Shimon S, Huober J, et al. MONARCH 3: abemaciclib as initial therapy for advanced breast cancer. J Clin Oncol. 2017;35(32):3638–46. Scholar
  7. 7.
    Robson M, Im SA, Senkus E, Xu B, Domchek SM, Masuda N, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med. 2017;377(6):523–33.CrossRefGoogle Scholar
  8. 8.
    Tiwari SR, Mishra P, Abraham J. Neratinib, a novel HER2-targeted tyrosine kinase inhibitor. Clin Breast Cancer. 2016;16(5):344–8.CrossRefGoogle Scholar
  9. 9.
    Chan A, Delaloge S, Holmes FA, Moy B, Iwata H, Harvey VJ, et al. Neratinib after trastuzumab-based adjuvant therapy in patients with HER2-positive breast cancer (ExteNET): a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2016;17(3):367–77.CrossRefGoogle Scholar
  10. 10.
    Cameron D, Casey M, Oliva C, Newstat B, Imwalle B, Geyer CE. Lapatinib plus capecitabine in women with HER-2-positive advanced breast cancer: final survival analysis of a phase III randomized trial. Oncologist. 2010;15(9):924–34.CrossRefGoogle Scholar
  11. 11.
    Bachelot T, Romieu G, Campone M, Diéras V, Cropet C, Dalenc F, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013;14(1):64–71.CrossRefGoogle Scholar
  12. 12.
    Tykerb (lapatinib) [prescribing information]; 2017. East Hanover, NJ: Novartis Pharmaceuticals Corporation.Google Scholar
  13. 13.
    Swain SM, Baselga J, Kim SB, Ro J, Semiglazov V, Campone M, CLEOPATRA Study Group, et al. Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med. 2015;372(8):724–34.CrossRefGoogle Scholar
  14. 14.
    Verma S, Miles D, Gianni L, Krop IE, Welslau M, Baselga J, Pegram M, Oh D-Y, Diéras V, Guardino E, Fang L, Lu MW, Olsen S, Blackwell K. Trastuzumab Emtansine for HER2-Positive Advanced Breast Cancer. N Engl J Med. 2012;367(19):1783–91.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Naziye Ak
    • 1
  • Adnan Aydiner
    • 1
  1. 1.Internal Medicine, Medical Oncology, Istanbul Medical Faculty, Department of Medical Oncology, Institute of OncologyIstanbul UniversityIstanbulTurkey

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