From the Guidelines
Treatment for locally advanced breast cancer and Hodgkin lymphoma typically involves a multimodal approach, with the most recent and highest quality study 1 guiding the treatment approach.
Locally Advanced Breast Cancer
- The treatment approach for locally advanced breast cancer involves neoadjuvant chemotherapy, surgery, and radiation therapy, as recommended by the international expert panel on the use of primary systemic treatment of operable breast cancer 1.
- Neoadjuvant chemotherapy regimens such as dose-dense AC-T or TC are often used to shrink the tumor before surgery.
- Surgical removal of the tumor, either through mastectomy or breast-conserving surgery with axillary lymph node evaluation, is followed by radiation therapy.
- Additional treatments depend on tumor characteristics, with trastuzumab and pertuzumab added for HER2-positive disease, and endocrine therapy given for hormone receptor-positive disease.
Hodgkin Lymphoma
- The standard treatment for Hodgkin lymphoma is combination chemotherapy with ABVD for 2-6 cycles, depending on the stage, followed by involved-field radiation therapy for early-stage disease, as recommended by the ESMO clinical recommendations for diagnosis, treatment, and follow-up 1.
- For advanced stages, more intensive regimens like escalated BEACOPP may be used.
- PET-CT scans are typically performed after 2 cycles to assess response and guide further treatment.
- Both diseases require regular follow-up to monitor for recurrence and manage treatment side effects, with supportive care including anti-nausea medications, growth factors for neutropenia, and cardiac monitoring during treatment.
Key Considerations
- The treatment approach should prioritize minimizing morbidity, mortality, and improving quality of life, as emphasized by the American Society of Clinical Oncology clinical practice guideline 1.
- The use of PET-CT scans to assess response and guide further treatment is a key consideration in the management of both locally advanced breast cancer and Hodgkin lymphoma.
- Regular follow-up and supportive care are essential to monitor for recurrence and manage treatment side effects.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adjuvant Breast Cancer Adriamycin (DOXOrubicin HCl) for Injection, USP is indicated as a component of multi-agent adjuvant chemotherapy for treatment of women with axillary lymph node involvement following resection of primary breast cancer [see Clinical Studies (14.1)]. 1.2 Other Cancers Doxorubicin is indicated for the treatment of acute lymphoblastic leukemia acute myeloblastic leukemia Hodgkin lymphoma non-Hodgkin lymphoma (NHL) metastatic breast cancer metastatic Wilms’ tumor metastatic neuroblastoma metastatic soft tissue sarcoma metastatic bone sarcoma metastatic ovarian carcinoma
INDICATIONS AND USAGE: Vinblastine Sulfate Injection is indicated in the palliative treatment of the following: I Frequently Responsive Malignancies Generalized Hodgkin’s disease (Stages III and IV, Ann Arbor modification of Rye staging system) Lymphocytic lymphoma (nodular and diffuse, poorly and well differentiated) Histiocytic lymphoma Mycosis fungoides (advanced stages) Advanced carcinoma of the testis Kaposi’s sarcoma Letterer-Siwe disease (histiocytosis X) II Less Frequently Responsive Malignancies Choriocarcinoma resistant to other chemotherapeutic agents Carcinoma of the breast, unresponsive to appropriate endocrine surgery and hormonal therapy
The treatment approach for locally advanced breast cancer is multi-agent adjuvant chemotherapy, which may include Adriamycin (DOXOrubicin HCl) 2. For Hodgkin lymphoma (Hodgkin's lymphoma), the treatment approach includes vinblastine sulfate as a single agent or in combination with other antineoplastic drugs, such as in the MOPP program or alternative therapies 3. Key points:
- Multi-agent chemotherapy is used for locally advanced breast cancer
- Vinblastine sulfate is used for Hodgkin lymphoma, alone or in combination with other agents
- Combination therapy is often used to produce a greater percentage of response without additive toxicity
From the Research
Treatment Approach for Locally Advanced Breast Cancer and Hodgkin Lymphoma
- The treatment approach for locally advanced breast cancer is not directly addressed in the provided studies, but the treatment for Hodgkin lymphoma is discussed in several studies 4, 5, 6.
- For advanced-stage Hodgkin lymphoma, conventional treatment options include ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) 4, 5, 6.
- The choice of treatment regimen depends on various factors, including the patient's overall health, disease stage, and prognostic factors 5, 6.
- Interim positron emission tomography (PET) evaluation can be used to guide the modulation of treatment intensity, with patients who remain PET-positive after 2 months potentially benefiting from escalated BEACOPP 6.
- For patients with primary breast lymphoma, treatment outcomes vary depending on the histologic subtype, with indolent lymphoma often treated with radiotherapy alone and aggressive lymphoma treated with chemotherapy, alone or combined with radiotherapy 7.
- The treatment approach for breast cancer in patients with a history of Hodgkin lymphoma is complex and requires a multidisciplinary discussion, taking into account the risk of second malignancy and the feasibility of breast-conserving surgery 8.
Treatment Regimens for Hodgkin Lymphoma
- ABVD chemotherapy: doxorubicin, bleomycin, vinblastine, dacarbazine 4, 5, 6
- Escalated BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone 4, 5, 6
- Stanford V: vinblastine, doxorubicin, vincristine, bleomycin, mustard, etoposide, and prednisone 5