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PHARMACOTHERAPY OF

MALIGNANT DISEASE
PHMP 4162
CASE STUDY

STUDENTS NAME : SITI AIZAN ANIS BINTI MOHD ZORKANINE


MATRIC NO. : 1219718
LECTURERS NAME : BR. MOHAMED HASSAN ELNAEM
DATE OF SUBMISSION : 13th November 2015

Case Questions
1. Create a list of potential drug therapy problems in the patients medication
regimen.

Patient is resistance to aromatase inhibitor and capecitabine.

The dose of aromatese inhibitor and capecitabine may underdose.

Tamoxifen should be administered to the patient first (5 years) before


changing to aromatase inhibitor.

Patient also should be given adjuvant chemotherapy to kill cancer cells


that may metastasize.

2. What is the primary goal for cancer treatment in this patient?

To prolong the survival rate and maintaining patients quality of life.

To provide palliative care with relief of symptoms such as pain.

To make the tumor bulk smaller through the treatment that may have
greater potential to be cured.

3. In addition to the stage of disease, what other factors are important for
determining the prognosis for breast cancer?

Patient age: younger than 35 (poor prognosis)

Tumor size: larger size (poor prognosis)

Hormone receptor status (hormone are necessary for cancer development)

HER-2 expression (faster growth and spread)

4. List the treatment modalities available for this patients breast cancer and
discuss their advantages and disadvantages.
Treatment Modalities
Neoadjuvant chemotherapy

Advantages
Can reduce size of tumor and

Disadvantages
Treatment delay, over-treatment,

facilitate surgical removal

residual intraductal component


may be left behind after breast

Surgery

Radiation

Reduce size of tumor to

conserving surgery
Only for solid tumors and cannot

improve effectiveness of

for metastasize tumor

radiation
Can cure cancer, reduce

Damage surrounding tissues,

symptoms of tumor, reduce

increase wound complication

size of tumor for surgery,

and poor healing,

prevent re-occurrence of
Adjuvant hormonal therapy

tumor after surgical removal


Can be used in both pre and

used for all patients with ER

post menopausal women,

positive only, not to cure the

can be as chemoprevention

cancer but can keep the cancer

to reduce the risk of

under control

developing breast cancer in


high risk women

5. Design an appropriate plan for treating this patients breast cancer, focusing
on pharmacologic and non-pharmacologic measures. If the plan includes
chemotherapy, identify the specific regimen and provide your rationale for
selecting it.
Non-pharmacologic
Having good diets such as monounsaturated

Rationale
May suppress HER 2 cell growth, reduce risk of

fatty acids, flax seed meal and green tea

breast cancer and reduce cancer cell growth

Exercise

To control weight, improve immunity, improve


balance with decrease in falls and improves
vasomotor instability in menopause.

Pharmacologic

Specific regimen

Rationale

(chemotherapy)
Tamoxifen

20 mg daily for 5 years

Instead of aromatase inhibitor, patient should


receive tamoxifen first, then can use
aromatase inhibitor (Letrozole) after 5 years
of tamoxifen.

CMF (classic) =
(cycle 28 days)

Should be given after the radiation to kill the

Cyclophosphamide

100 mg/m2 (PO)

remaining cancer cells that may metastasize to

Methotrexate

40 mg/m2 (IV)

other organ

5-Fluorouracil
Vinorelbine

600 mg/m2 (IV)


20-30 mg/m2 (IV)

Since the cancer already metastasizes to bone,

(cycle 21 days)

patient should be given chemotherapy for


metastatic breast cancer. As capecitabine is
the first choice for this patient and the
treatment is fail, vinorelbine is next good
choice for this patient.

6. What parameters should be monitored to evaluate the efficacy and adverse


effects of the therapy you recommended?
Therapy
Tamoxifen

Monitoring parameters
Platelets count, liver profile, serum

Adverse effects
Flush, amenorrhea, altered menses

Cyclophosphamide

calcium, abnormal vaginal bleeding


Renal profile, input and output fluid

Hemorrhagic cystitis, delayed nausea

Methotrexate

Folate level, renal profile

and vomiting
Dose limiting thrombocytopenia,

Serum level, renal and liver profile,

pulmonary pneumonitis, stomatitis


Dose limiting thrombocytopenia,

complete blood count

anemia, dose limiting hand-foot and

5-Fluorouracil

Vinorelbine

Liver profile, bilirubin level,

diarrhea
Neurologic toxicity, constipation, dose

complete blood count

limiting thrombocytopenia

7. Since the patient has developed bone metastases, what other medication
should be added to her treatment plan? At what dose and schedule?
Drugs
Doxorubicin
Cisplatinum

Cycle Length (days) = 21


Dose (mg/m2)
Route
25
IV
100
IV

Anti-emetic = 4
Infusion Time
Days
Bolus
1-3
2 Hours
1

Reference:
Systemic Therapy of Cancer Second Edition (2011), Ministry of Health and Ministry
of Higher Education, Malaysia, page 13-22