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Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

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Years

Fig. 21-3. Event-free survival comparing pathologic response at (A) less than 10% residual viable tumor versus > residual viable tumor and (B) less than 2% residual viable tumor versus >2% residual viable tumor. Numbers on the curves represent patients still at risk. (From Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ,Grier HE, Link MP. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for non-metastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol 2003;21[8]:1574-80, with permission.)

Fig. 21-3. Event-free survival comparing pathologic response at (A) less than 10% residual viable tumor versus > residual viable tumor and (B) less than 2% residual viable tumor versus >2% residual viable tumor. Numbers on the curves represent patients still at risk. (From Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ,Grier HE, Link MP. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for non-metastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol 2003;21[8]:1574-80, with permission.)

An alternative treatment plan is outlined in Figure 21-5 as per Rizzoli's 4th protocol. This regimen consists of high-dose methotrexate, cisplatin, doxorubicin, and ifosfamide. The 5-year EFS and overall survival rates are 56% and 71%, respectively, for patients with localized disease. Patients with metastatic disease have an EFS of 17% and overall survival of 24%.

The use of high-dose methotrexate with citrovorum rescue requires the following precautions to avoid serious toxicity:

1. Normal creatinine clearance, CBC, and liver profile

2. Measurement of serum methotrexate levels at 24, 48, and 72 hours after administration

3. Vigorous hydration with alkalinization for 72 hours to keep the urine pH above 7.0.

Administration of High-Dose Methotrexate

The dose of methotrexate (MTX) is calculated at 12 g/m2 with a maximum dose of 20 grams. All doses are rounded up to the next highest full gram of methotrexate.

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