Epirubicin 90 / Cyclophosphamide 600, Breast Cancer, adjuvant
Protocol-ID: 579 V1.1 (Short), EC (EPIR90/CYCL600), Breast Ca, adj.Indication(s)
- Breast Cancer; ICD-10 C50.-
Protocol classification
- Classification: alternative
- Intensity: Standard dose
- Therapy phase:
- Therapy intention: curative
Cycles
Cycle length 21 days, recommended cycles: 4
Protocol sequences
- EC (EPIR90/CYCL600), Breast Ca, adj. (PID579) -|- PACL80, Breast Ca, adj. (PID581)
- Neoadjuvant WSG-TP-II (Paclitaxel)
- Neoadjuvant WSG-TP-II (Letrozole)
- Neoadjuvant WSG-TP-II (Tamoxifen) -|- PERT840/TRAS8/TMXF20, Breast Ca, adj., C1 (PID2450)
Risks
- Emetogenicity (MASCC/ESMO): moderate (30-90%)
- Neutropenia: very high (>41%)
- Febrile Neutropenia: intermediate (10-20%)
- Thrombocytopenia below 50 000/µl: low (<10%)
- Anemia Hb below 8g/dl: low (<5%)
- Dyspnea: CTC AE °3-4: 5%
Therapy
HYD Hydration: Balanced Crystalloid Solution | |||||||
Access: peripheral venous | |||||||
Hydration before, during, or after antitumor therapy | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
1 | Balanced Crystalloid Solution | 500 ml | i.v. | 30 min | 30 min before Epirubicin (d1) | ||
AE Antiemesis: Emetogenicity high (AC), FOSAP, GRAN i.v., DEXA i.v | |||||||
Access: peripheral venous | |||||||
DGHO 2016, DKG 2016, MASCC/ESMO 2016, on combinations of anthracycline and cyclophosphamide | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
1 | Fosaprepitant | 150 mg | NaCl 0.9% 150 ml | i.v. | 20 min | 30 min before Epirubicin (d1) | |
1 | Dexamethasone | 12 mg | NaCl 0.9% 50 ml | i.v. | 5 min | 30 min before Epirubicin (d1) | |
1 | Granisetron | 1 mg | NaCl 0.9% 50 ml | i.v. | 5 min | 15 min before Epirubicin (d1) | |
or other 5-HT3 receptor antagonist |
SUP Supportive therapy: Mesna i.v., hour 0 (pre), p.o. 2 h, 6 h after onset Cyclophosphamide | |||||||
Access: peripheral venous | |||||||
Mesna 0h,2h,6h, prophylaxis of urinary tract toxicity by cyclophosphamide. At the time of oxazaphosphorin injection, 20% of the oxazaphosphorin dose is injected simultaneously as mesna. 2 and 6 h after onset, oral intake of 40% of the oxazaphosporin dose. | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
1 | Mesna | 120 mg/m² BSA | i.v. | 1 min | 1 min before Cyclophosphamide (d1) | ||
1 | Mesna | 240 mg/m² BSA | p.o. | 90 min after Cyclophosphamide (d1) | |||
1 | Mesna | 240 mg/m² BSA | p.o. | 5 h after Cyclophosphamide (d1) | |||
It is to be taken 6 hours after the start of the cyclophosphamide infusion. |
CTX Medical tumor therapy: EPIR/CYCL Breast Carcinoma (EC) | |||||||
Access: central venous, port | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
1 | Epirubicin | 90 mg/m² BSA | Dextrose 5% 500 ml | i.v. | 45 min | Sequence | |
1 | Cyclophosphamide | 600 mg/m² BSA | NaCl 0.9% 500 ml | i.v. | 30 min | Sequence |
HW Hematopoietic growth factors: FN risk 10-20%, G-CSF long-acting, pegylated | |||||||
Access: - none - | |||||||
Risk of febrile neutropenia (FN) 10-20% and 1 risk factor: age > 65 y, laboratory parameters (anemia, lymphocytopenia < 700/µl, hypalbuminemia, hyperbilirubinemia) previous chemotherapy, comorbidities, low performance status, advanced symptomatic tumor disease (DKG 2016) | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
2 | Pegfilgrastim | 6 mg | subc | Bolus | 24 h after Cyclophosphamide (d1) | ||
Use at risk: FN 10-20% and 1 risk factor, other long-acting G-CSF possible. |
Warnings
Epirubicin: cardiac toxicity, maximum cumulative dose 900-1000 mg/m² KOF. For EPIR extravasation: dry cold (not just before or after Dexrazoxane infusion) on day of extravasation. Dexrazoxane i.v. for 3 days: 2 days 1000 mg/m², 3rd day 500 mg/m², do not use in parallel with DMSO. First infusion as soon as possible and within the first 6 hours.
References
- Sparano JA, Weekly paclitaxel in the adjuvant treatment of breast cancer., N Engl J Med 2008 Apr 17;358(16):1663-71 [PMID]
- von Minckwitz G, Capecitabine in addition to anthracycline- and taxane-based neoadjuvant treatment in patients with primary breast cancer: phase III GeparQuattro study., J Clin Oncol 2010 Apr 20;28(12):2015-23 [PMID]
- De Laurentiis M, Taxane-based combinations as adjuvant chemotherapy of early breast cancer: a meta-analysis of randomized trials., J Clin Oncol 2008 Jan 1;26(1):44-53 [PMID]
- Smith LA, Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials., BMC Cancer 2010;10:337 [PMID]
- Khasraw M, Epirubicin: is it like doxorubicin in breast cancer? A clinical review., Breast 2012 Apr;21(2):142-9 [PMID]
Recommendations
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Valid since: 18.09.2023