Table 1 Systemic treatment in breast cancer

Chemotherapy

Anthracycline (doxorubicin and epirubicin)

Inhibits DNA and RNA synthesis

Cardiotoxicity, typhlitis, bone marrow suppression

Taxanes (paclitaxel and docetaxel)

Inhibits mitosis by stabilization of microtubule polymer

Fluid retention, neutropenic enterocolitis and typhlitis, drug-associated pneumonitis

Cyclophosphamide

Interferes with DNA replication by forming intrastrand and interstrand DNA cross-links

Hemorrhagic cystitis, Drug associated pneumonitis, diarrhoea

Capecitabine

Irreversibly inhibits thymidylate synthase

Neurotoxicity, mucositis, hand-foot syndrome

Eribulin

Inhibits mitosis by interfering with growth of microtubule

Neutropenia, diarrhoea, anaemia, peripheral nHER2athy

Tamoxifen

Selectively blocks estrogen receptor blockage

Hepatic steatosis and hepatotoxicity, hypercoagulability, endometrial proliferative changes

Aromatase inhibitors

(anastrozole, letrozole, and exemestane)

Blocks estrogen production

Osteoporosis, arthralgia

Fulvestrant

Estrogen receptor antagonist

Elevation of liver enzymes, oedema

Molecular-targeted therapy

Trastuzumab, pertuzumab

Interferes with the HER2/neu receptor

Cardiotoxicity, pulmonary toxicity

Lapatinib

Interrupts the HER2/neu and epidermal growth factor receptor (EGFR) pathways

Rash, diarrhoea, liver dysfunction,

Bevacizumab

Inhibits vascular endothelial growth factor (VEGF)

Hepatic steatosis, pancreatitis, cholecystitis, infection

Trastuzumab emtansine

Antibody-drug conjugate binds to HER2 receptors and enters the cell and releases the cytotoxic agent emtansine

Hepatotoxicity, thrombocytopenia