Breast cancer chemotherapy regimens are complex and complicated, and what are the characteristics of each of these chemotherapy drugs? How to use them? What kind of drug education is needed for patients? Read this diary on the use of first-line chemotherapy drugs for breast cancer to get the key points at a glance. How to use chemotherapy drugs? 1. Doxorubicin needs to be protected from light when administered, and the vein needs to be flushed with saline after administration. Because of its unique cardiotoxicity, the maximum cumulative dose is 450-550mg/m?In order to prevent cardiotoxicity, dexrazoxane should be used 30 minutes before the first use in a dose ratio of 1:20. In addition, because it is a herpetogenic agent, once extravasated, it may cause severe local tissue necrosis, if it occurs, the infusion should be stopped immediately, while local subcutaneous infiltration of hydrocortisone, followed by local application of betamethasone/gentamicin ointment and bandage with elastic bandage (replaced every 12h for the first 2 days, then every 24h until healing). 2. When cyclophosphamide is administered in high doses, acrolein, a metabolite, can irritate the bladder and cause hemorrhagic cystitis, so the urinary tract protector sodium mescaline should be administered at 20% of the cyclophosphamide dose at 0h, 4h and 8h. In addition, since the injection is unstable after dilution, it should be used within 2-3h after dilution. 3. There is no special requirement for the choice of paclitaxel medium, but it should be diluted to 0.3-1.2 mg/ml and administered for 3h. In addition, because of the presence of polyoxyethyl castor oil, pretreatment is required to prevent allergic events: dexamethasone 20mg orally 12h and 6h before dosing, benadryl 40mg intramuscularly 30-60 minutes before dosing, and cimetidine 400mg/ranitidine 50mg intravenously. Cardiac monitoring is recommended before the first dose to monitor the patient’s condition. 4. Preclinical studies have found that docetaxel has a higher affinity for microtubules and a longer plasma half-life than paclitaxel. It should be dissolved in the solution provided and then diluted with saline or glucose injection to a concentration of not more than 0.9 mg/ml and administered for 1h. To avoid fluid retention, dexamethasone 8mg should be given orally three times a day for 3 days prior to treatment. 5. Carboplatin is not allowed to be dispensed in saline. During the drip period, a black cloth should be used to wrap the vessel for light-proof infusion, and the drip should be completed within 6-8 hours, and patients are also encouraged to drink more water to keep the urine volume above 2000ml. What should I pay attention to when using chemotherapy drugs for the treatment of recurrent or metastatic breast cancer? 1. Liposomal doxorubicin is encapsulated in polyethylene glycol-coated liposomes. The microspheres can deliver high concentrations of doxorubicin to tumor tissues through abnormal blood vessels in the tumor tissues, improving its anti-tumor targeting and efficacy, while cardiotoxicity is significantly reduced. It must be diluted with 5% dextrose injection in 250 ml of solvent for doses <90 mg and 500 ml of solvent for doses ≥90 mg. To reduce the risk of infusion reaction, the initial drip rate should be ≤1mg/min: if there is no infusion reaction, the drip can be completed within 60 minutes; if there is infusion reaction, 5% of the total dose should be dosed slowly within the first 15 minutes, and if tolerated, the drip rate can be doubled within the next 15 minutes and still tolerated, and the drip can be completed within the next 1h, and the total drip time is 90 minutes. 2. Capecitabine should be taken orally twice in the morning and evening, and the patient should swallow it half an hour after meals. Capecitabine's unique adverse effect is hand-foot syndrome, mainly manifested by numbness and dullness of sensation in the hands and feet, and in severe cases, the skin may be erythematous or erythematous, desquamated, and hard nodular blisters, to prevent hand-foot syndrome, 30mg of vitamin B6 can be taken orally three times a day. In addition, patients are advised to avoid frequent friction and excessive pressure on the hands and feet, and avoid heavy physical labor and intense exercise, pay attention to wearing loose and comfortable writing, and strengthen foot care. 3.Gicitabine should be injected into at least 25ml of physiological saline (concentration ≤ 40mg/ml) per 1g of gemcitabine to make it dissolve, after which it can be further diluted with physiological saline. 4.Vincristine is 40-60% effective in the treatment of breast cancer. The drug must be dissolved in saline and rapidly administered intravenously (10 minutes), and if necessary, dexamethasone 5 mg should be used after administration and the vein should be flushed with appropriate amount of saline to reduce the irritation to the blood vessels. If extravasation occurs, it can lead to local tissue necrosis and ulceration. In case of extravasation, stop the infusion immediately, leave the needle in place temporarily, confirm the site and volume of extravasation, avoid squeezing the extravasation site, and remove the needle afterwards. Mark the border of the exudate site, keep the wound dry, apply hot compresses for 20 minutes, 4 times a day for 1-2 days, or inject 150-900 IU of hyaluronidase subcutaneously into the exudate site if the symptoms are severe. 5. Eribulin is used for new metastatic breast cancer patients who have received at least 2 chemotherapy regimens, including anthracyclines and paclitaxel. It can be used directly or diluted with 0.9% sodium chloride injection 100ml, not diluted with glucose injection, and stored at room temperature for no more than 4h and refrigerated (4℃) for no more than 24h after dilution. 6. Compared with the common dosage form, albumin-conjugated paclitaxel has no toxic solvents such as polyoxyethylene castor oil and ethanol, which makes the intravenous infusion time shorter and the incidence of allergic reactions lower, and no pretreatment is required. Each 100mg of powder injection should be dissolved in 20ml of 0.9% sodium chloride injection. 7.Cisplatin is mainly excreted by glomerular filtration through the kidney, so it is more damaging to the kidney and needs to be fully hydrated and diuretic when administered. The standard method is to give 2000ml of 5% glucose injection by sedation 1 day before the drug (12h), and 3000-3500ml of saline or 5% glucose injection on the day of the drug, and keep the fluid input or ask the patient to drink more water within 6h after the end of the drug, and give mannitol and furosemide at the same time to ensure the daily urine volume of 2000-3000ml, and pay attention to maintain the electrolyte balance of potassium and magnesium. 8. Epirubicin needs to be protected from light when administered, and the veins need to be flushed with saline after administration. Because of its unique cardiotoxicity, the maximum cumulative dose is 900-1000mg/m. To prevent cardiotoxicity, use dexrazoxane 30 minutes before the first use with a dose ratio of 1:10. In addition, because it is a herpetogenic agent, once extravasated, it may cause serious local tissue necrosis, if it occurs, the infusion should be stopped immediately, while local subcutaneous infiltration of hydrocortisone, followed by local application of betamethasone After that, apply betamethasone/gentamicin ointment and bandage with elastic bandage (change every 12h for the first 2 days, then every 24h until healing). 9. Ixabepilone is used for metastatic or locally advanced breast cancer resistant to anthracyclines, paclitaxel and capecitabine. The drug box contains 1 box of powder and 1 box of dilution solution, the powder must be dissolved with its own dilution solution, then the solution is further diluted to 0.2-0.6mg/ml with lactic acid Ringer's solution and used after 3h drip. This drug contains polyoxyethylene ether castor oil and requires pretreatment before administration: H1 receptor antagonist such as Benadryl 50mg and H2 receptor antagonist such as Remitidine 150-300 mg orally 1h before administration, and close observation of allergic reactions during administration. Since grapefruit juice inhibits CYP3A4-mediated metabolism of this drug, it may increase the blood concentration of this drug, so patients should be advised not to take grapefruit juice during the drug administration. Note: Please refer to the doctor's consultation for specific dosage.