Trastuzumab, commonly known by its brand name Herceptin (innovator) and Hertraz (biosimilar), is a groundbreaking medication in the field of cancer treatment. It is primarily used in the management of breast cancer, particularly when the cancer cells overexpress a protein called human epidermal growth factor receptor 2 (HER2). HER2-positive breast cancer tends to be more aggressive, but trastuzumab has provided significant benefits for patients. Here are some key points about cancer and trastuzumab: 1. Targeted Therapy: Trastuzumab is a monoclonal antibody that specifically targets HER2-positive cancer cells. It interferes with the signaling pathways that promote cancer cell growth and division. 2. Improved Survival Rates: Clinical trials have shown that adding trastuzumab to standard chemotherapy regimens can significantly improve survival rates and reduce the risk of cancer recurrence in HER2-positive breast cancer patients. 3. Adjuvant and Neoadjuvant Treatment: Trastuzumab can be administered as adjuvant therapy after surgery to reduce the risk of cancer returning or as neoadjuvant therapy before surgery to shrink tumors and make them easier to remove. 4. Cardiac Monitoring: Trastuzumab can have side effects on the heart, so close cardiac monitoring is crucial during treatment to manage potential heart-related issues. 5. Expanding Applications: Over time, trastuzumab’s use has expanded to other HER2-positive cancers, such as stomach (gastric) cancer, broadening its impact on cancer treatment. Overall, trastuzumab has been a transformative drug in the management of HER2-positive breast cancer and is emblematic of the advancements in targeted therapies for cancer. It has offered hope and improved outcomes for many patients facing this aggressive form of cancer.

Anastrozole ● The innovator drug refers to the initial, branded medication that a pharmaceutical company originally created and introduced to the market. The innovative drug of anastrozole is Arimidex, which was developed and marketed by AstraZeneca. BIOSIMILAR ● A biosimilar is a biological product that is highly similar to the reference (innovator) product in terms of quality, safety, and efficacy. Some of the biosimilars of anastrozole are Aremed, Anatero, and Anarom. USES ● Anastrozole is a medication used in the treatment of breast cancer, particularly in postmenopausal women. It is an aromatase inhibitor, which means it works by reducing the production of estrogen in the body. This is important in the treatment of hormone receptor-positive breast cancer because it helps to slow the growth of cancer cells that rely on estrogen for their growth. DRUG CLASS ● It is a selective aromatase inhibitor. o Inhibits the action of the enzyme aromatase, which is responsible for converting androgens into estrogen. DOSAGE STRENGTH AND FORM ● It is available as a 1 mg tablet o No dose adjustment necessary for patients with renal or liver impairment, or for elderly patients. ADVERSE EFFECTS ● Ulcers and blisters o Common skin manifestations ● Allergic reactions o Swelling of the face, as well as throat, lips, and tongue o Could result to difficulty in swallowing ● Liver function abnormality with or without jaundice o Results from liver inflammation ● Bone loss due to estrogen deficiency with long-term use ● Hot flashes ● Asthenia ● Arthritis/arthralgia ● Osteoporosis ● Fractures ● Bone pain ● Back pain ● Sexual dysfunction ● Dyspareunia ● Uterine atrophy ● Hyperlipidemia ● Thromboembolic disease ● Cardiac and cerebrovascular events ● Insomnia ● Nausea CONTRAINDICATIONS ● Hypersensitivity: AIs are contraindicated in patients with hypersensitivity reactions to AI. o Could cause anaphylaxis, urticaria, angioedema ● Pregnancy and premenopausal women: AIs could cause harm to the fetus or loss of pregnancy to the mother. o In premenopausal women, the mechanism of action of AIs does not have reported benefits to them. MONITORING ● Patients who are undergoing Aromatase inhibitor (AI) therapy should have: o Initial routine lab work ▪ Complete blood count (CBC) ▪ Lipid profile test ▪ Serum calcium ▪ Vitamin D levels ▪ Liver function test ● Patients should also have a baseline bone mineral density test before undergoing Aromatase Inhibitor treatment. OVERDOSE ● Based from clinical trials, aromatase inhibitors are well-tolerated even at high doses. ● For aromatase inhibitors, there is no established treatment for overdosage, however it is recommended to employ the standard treatment of care, including induced emesis, frequent vital sign checks, and management of symptoms.

Bevacizumab, sold under the brand name Avastin, is a medication that has played a significant role in cancer treatment. It belongs to a class of drugs known as angiogenesis inhibitors. Bevacizumab works by inhibiting the formation of new blood vessels, a process called angiogenesis, which is essential for the growth and spread of cancerous tumors. This drug is used in the treatment of various types of cancer, including colorectal cancer, lung cancer, kidney cancer, and glioblastoma (a type of brain cancer). Bevacizumab is typically administered intravenously and is often combined with chemotherapy or other cancer treatments. By blocking the formation of new blood vessels, Bevacizumab helps reduce the blood supply to tumors, thereby slowing their growth and sometimes causing them to shrink. This can be particularly beneficial in cases where tumors are highly vascular and dependent on a robust blood supply. However, it's important to note that Bevacizumab is not without side effects, which can include high blood pressure, bleeding, and increased risk of certain serious conditions. The use of Bevacizumab in cancer treatment is determined by the specific type and stage of cancer, and it is typically prescribed by oncologists who carefully weigh the potential benefits against the risks for each individual patient.

Zoledronic acid Zoledronate, alternatively referred to as zoledronic acid, is commonly administered for the treatment of metabolic bone conditions. Bisphosphonates like zoledronic acid inhibit the activity of farnesyl diphosphate synthase (FPPS) in the osteoclasts leading to the reduction of bone resorption and loss. Thus, zoledronic acid promotes bone formation. This ultimately results in an increase in bone mass and density as bone formation surpasses resorption. In relation to this, zoledronic acid is also used in the treatment of Paget’s disease in males and females. It can also be used in the management of osteoporosis for men and postmenopausal women. It is also used to decrease the likelihood of other fractures for those who have experienced a hip fracture. These are important points regarding zoledronic acid: ● Targeted Therapy: It facilitates the inhibition of increased osteoclastic activity and skeletal calcium release caused by tumors. Zoledronic acid blocks the osteoclastic resorption of mineralized bone and cartilage through its binding to bone. ● Improved Survival Rate: The combination of zoledronic acid and chemotherapy given to patients with NSCLC with bone metastasis aids in reducing bone pain thus it improves the quality of life of patients. It also improves the long-term survival rate and reduces the incidence of SREs. ● Adjuvant and Neoadjuvant Therapy: It can be used as an adjuvant therapy for patients with breast cancer because it reduces the fracture rate and reduces the risk of breast cancer spreading to the bones. ● Cardiac Monitoring: Close monitoring is advised since patients undergoing zoledronic acid treatment have an elevated chance of experiencing atrial fibrillation. ● Expanding Applications: Studies have shown that zoledronic acid can potentially be used in the treatment of other conditions like osteoporosis, malignant bone disease, and other types of cancers metastasizing to the bone.

Palonosetron

Letrozole