Download Adjuvant Treatment of Newly Diagnosed Breast Cancer

Level 3
Organ System: Endocrine / Integumentory / Reproductive
Disease State: Gastrointestinal / Infectious / Mental / Oncological
Curriculum Topic: Pharmacotherapy / Pharmacy Practice / Social & Behavioral Aspects of Practice
Adjuvant Treatment of Newly Diagnosed
Breast Cancer
John Bossaer, PharmD, BCPS
Assistant Professor of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy
Christan M. Thomas, PharmD Candidate
East Tennessee State University Gatton College of Pharmacy
Family History
Key Learning Objectives
1. Identify patient- and tumor-specific factors to consider
when treating breast cancer.
2. Describe the different treatment options for breast cancer,
considering appropriate indications for chemotherapy,
hormonal therapy, and targeted therapy.
3. Describe the risks and benefits of chemotherapy and
hormonal therapy in breast cancer.
4. List specific tests and monitoring parameters given a
specific chemotherapy regimen for breast cancer.
Case Presentation
History of Present Illness
TM is a 50-year-old premenopausal white female who presented to
the cancer clinic following an abnormal mammogram and needle core
biopsy that revealed ductal carcinoma in situ of the right breast. Following the biopsy, TM underwent a lumpectomy. During the surgery, a
2.2-cm tumor with negative margins was removed. Cytology revealed
the tumor to be invasive ductal carcinoma, grade II, estrogen receptor
(ER) positive, progesterone receptor (PR) positive, human epidermal
growth factor receptor 2 (HER2) negative. Sentinel lymph node biopsy
was negative. TM’s cancer was staged as IIA.
After her lumpectomy, TM developed a staph infection of the surgical
site and was treated as an inpatient with IV antibiotics (vancomycin).
At the time of her clinic visit she was on day 7 of a 10-day course of
clindamycin 600 mg PO TID.
TM presents to the cancer clinic today in order to discuss treatment
options for her breast cancer. She also complains of some slight diarrhea that has developed over the past several days.

Father died at age 78 of cerebrovascular accident. He also had a
history of Alzheimer’s disease.

Mother was diagnosed with ductal carcinoma in situ of the breast
at age 77 for which she was treated via lumpectomy. Mother is still
living.

Patient has four siblings who are all living. One sister has a history
of diabetes.
Social History

Married with three adult children

Husband is in poor health and is suffering from metastatic renal cell
carcinoma.

Denies use of alcohol, tobacco, and drugs

Walks approximately three times per week and performs all of her
activities of daily living, in addition to providing basic care to her
husband.
Allergies

No known drug allergies
Medications

Ramipril 20 mg PO daily

Paroxetine 40 mg PO daily
Non-prescription Medications

Multivitamin 1 tab PO daily

Vitamin D 1000 units PO daily

Probiotic supplement 1 tab PO daily
Vi tals : A dmission
Temp.
HRBP
RR
(°C)
(beats/min)
(mmHg)
(breaths/min)
37°
88
143/85
18
Past Medical History

Hypertension

Obesity

Iron-deficiency anemia

Depression

Anxiety
R emington P harmacy C omplete C ases
•
november 2011 / case presentation: Bossaer, page 1
w w w . p h a r m pres s .com/casestudies
©Pharmaceutical Press 2011
Assessment Questions
1. What factors should be examined when considering a
treatment regimen for breast cancer?
2. Name possible treatments for TM, including specific
agents, when applicable.
3. Should this patient be offered adjuvant chemotherapy?
4. Should this patient be offered hormonal therapy?
5. Should this patient be offered HER-2 targeted therapy
with trastuzumab?
6. Given TM’s history of present illness, when would it be
appropriate to start any additional treatment?
7. TM is concerned about the possibility of facing chemotherapy while caring for her ailing husband. What is a tool
that can be used to help TM make an informed decision on
whether or not she will benefit from chemotherapy?
8. TM’s oncologist recommended chemotherapy and chose
to administer ACT (four cycles of doxorubicin plus cyclophosphamide, followed by 12 cycles of weekly paclitaxel).
What tests should be performed and what, if any, unique
pre-medications should be given before this regimen is
started?
9. After completing chemotherapy, TM will begin hormonal
treatment with tamoxifen for 5 years, followed by anastrozole for 5 years. What main adverse effects of each of
these agents should TM be counseled about?
10. What, if any, other issues with TM’s current medications
need to be addressed before starting hormonal therapy
with tamoxifen. Why?
11. When TM presented to the clinic she was also complaining of diarrhea. What could be the cause of this symptom
and what treatment should be recommended?
(answers on page 12)
Please visit www.pharmpress.com/casestudies to register for
electronic versions of the cases and to receive updates about
Remington: The Science and Practice of Pharmacy.
R emington P harmacy C omplete C ases
©Pharmaceutical Press 2011
•
november 2011 / case presentation: Bossaer, page 2
w w w . p h a r m pres s .com/casestudies