Paget's disease of the breast medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
[[Chemotherapy]] and [[radiotherapy]] are indicated for Paget's disease of the breast as [[adjuvant therapy]] or [[Palliative care|palliative]] treatment in patients with underlying [[ductal carcinoma]] or [[invasive breast cancer]]. [[Surgery]] is the mainstay of treatment for Paget's disease of the breast.


OR
==Medical Therapy==
 
The mainstay of treatment for Paget's disease of the breast is [[surgery]]. Non-operative management is reserved for a very small proportion of patients. <ref name="pmid21607019">{{cite journal |vauthors=Michou L, Brown JP |title=Emerging strategies and therapies for treatment of Paget's disease of bone |journal=Drug Des Devel Ther |volume=5 |issue= |pages=225–39 |date=2011 |pmid=21607019 |pmc=3096538 |doi=10.2147/DDDT.S11306 |url=}}</ref>
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.


OR
=== Non-operative management===
*The mainstay of therapies for Paget's disease of the breast are divided into 2 groups: [[hormonal]] therapy and targeted therapy.
*The primary goal of [[medical therapy]] is to reduce the [[risk]] of ipsilateral or contralateral [[breast]] invasion and also decreases the risk of [[recurrence]].<ref name="pmid12115309">{{cite journal |vauthors=Kothari AS, Beechey-Newman N, Hamed H, Fentiman IS, D'Arrigo C, Hanby AM, Ryder K |title=Paget disease of the nipple: a multifocal manifestation of higher-risk disease |journal=Cancer |volume=95 |issue=1 |pages=1–7 |date=July 2002 |pmid=12115309 |doi=10.1002/cncr.10638 |url=}}</ref><ref name="pmid26770622">{{cite journal |vauthors=Song Q, Jin Y, Huang T, Zhang JH |title=Diagnosis and treatment of Paget's disease of the breast: an analysis of 72 cases |journal=Int J Clin Exp Med |volume=8 |issue=10 |pages=19616–20 |date=2015 |pmid=26770622 |pmc=4694522 |doi= |url=}}</ref><ref name="pmid20071685">{{cite journal |vauthors=Virnig BA, Tuttle TM, Shamliyan T, Kane RL |title=Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes |journal=J. Natl. Cancer Inst. |volume=102 |issue=3 |pages=170–8 |year=2010 |pmid=20071685 |doi=10.1093/jnci/djp482 |url=}}</ref>
'''Corticosteroids'''
*Temporary resolution of [[eczematous]] changes of [[nipple]]-[[areolar]] complex is possible with the application of topical [[corticosteroids]] but this may cause delay in diagnosis.
*Paget’s disease must be considered in all cases of [[eczematous]] breast lesions that persist for more than three weeks despite [[topical treatment]].


The mainstay of treatment for [disease name] is [therapy].
'''Hormonal Therapy'''
*Selective [[Estrogen receptor|estrogen receptor modulators]], such as:
*[[Tamoxifen]]  
*[[Raloxifene]]


OR
'''Targeted Therapy'''
 
*[[HER2/neu]]/c-erb-B2-directed therapy
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
*[[Trastuzumab]]  


OR


[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]

Latest revision as of 15:39, 27 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

Chemotherapy and radiotherapy are indicated for Paget's disease of the breast as adjuvant therapy or palliative treatment in patients with underlying ductal carcinoma or invasive breast cancer. Surgery is the mainstay of treatment for Paget's disease of the breast.

Medical Therapy

The mainstay of treatment for Paget's disease of the breast is surgery. Non-operative management is reserved for a very small proportion of patients. [1]

Non-operative management

  • The mainstay of therapies for Paget's disease of the breast are divided into 2 groups: hormonal therapy and targeted therapy.
  • The primary goal of medical therapy is to reduce the risk of ipsilateral or contralateral breast invasion and also decreases the risk of recurrence.[2][3][4]

Corticosteroids

Hormonal Therapy

Targeted Therapy


References

  1. ↑ Michou L, Brown JP (2011). "Emerging strategies and therapies for treatment of Paget's disease of bone". Drug Des Devel Ther. 5: 225–39. doi:10.2147/DDDT.S11306. PMC 3096538. PMID 21607019.
  2. ↑ Kothari AS, Beechey-Newman N, Hamed H, Fentiman IS, D'Arrigo C, Hanby AM, Ryder K (July 2002). "Paget disease of the nipple: a multifocal manifestation of higher-risk disease". Cancer. 95 (1): 1–7. doi:10.1002/cncr.10638. PMID 12115309.
  3. ↑ Song Q, Jin Y, Huang T, Zhang JH (2015). "Diagnosis and treatment of Paget's disease of the breast: an analysis of 72 cases". Int J Clin Exp Med. 8 (10): 19616–20. PMC 4694522. PMID 26770622.
  4. ↑ Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010). "Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes". J. Natl. Cancer Inst. 102 (3): 170–8. doi:10.1093/jnci/djp482. PMID 20071685.

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