Treatment Options - CancerInsight SG

Breast Cancer Treatment

89%

5-Year Survival (All Stages)

99%

Localized Stage

86%

Regional Stage

First-Line Treatment by Stage

Surgery Options

Lumpectomy (Breast-Conserving Surgery) - Removes tumor with margin of healthy tissue
Mastectomy - Total removal of breast tissue
Sentinel Lymph Node Biopsy - Check for spread

Adjuvant Therapy

Subtype	Treatment	Duration
HR+/HER2-	Endocrine therapy (Tamoxifen or Aromatase Inhibitor)	5-10 years
HER2+	Trastuzumab + Chemotherapy	1 year (Trastuzumab)
Triple Negative	Chemotherapy (AC-T or TC regimen)	4-6 months

Radiation

Required after lumpectomy; 3-6 weeks of daily treatment

Neoadjuvant (Before Surgery)

Subtype	Regimen	Cycles
HER2+	TCHP (Docetaxel, Carboplatin, Trastuzumab, Pertuzumab)	6 cycles
Triple Negative	Pembrolizumab + Chemotherapy	8 cycles
HR+/HER2-	AC-T (Doxorubicin, Cyclophosphamide, Paclitaxel)	8 cycles

Surgery

Modified radical mastectomy with axillary dissection typically recommended

Post-Surgery

Radiation therapy + continued systemic therapy based on subtype

Treatment Goals

Focus on disease control, symptom management, and quality of life

Subtype	First-Line Regimen	Response Rate
HR+/HER2-	CDK4/6 inhibitor + Aromatase Inhibitor	40-55%
HER2+	Trastuzumab + Pertuzumab + Docetaxel	80%
Triple Negative	Pembrolizumab + Chemotherapy (if PD-L1+)	45%
BRCA mutated	PARP inhibitor (Olaparib/Talazoparib)	60%

Second-Line & Progression Treatment

After Progression On	Second-Line Options	Third-Line Options
CDK4/6i + AI (HR+)	Fulvestrant + Alpelisib (if PIK3CA+) Everolimus + Exemestane	Sacituzumab govitecan Chemotherapy
Trastuzumab-based (HER2+)	T-DM1 (Ado-trastuzumab emtansine) Trastuzumab deruxtecan	Tucatinib + Trastuzumab + Capecitabine Lapatinib combinations
Chemotherapy (TNBC)	Sacituzumab govitecan Different chemo regimen	Clinical trials Palliative chemotherapy

Brain Metastases

HER2+: Tucatinib + Trastuzumab + Capecitabine (crosses blood-brain barrier)
Stereotactic radiosurgery for limited metastases
Whole brain radiation for extensive disease

Complete Drug Reference - Breast Cancer

Chemotherapy Agents

Drug	Class	Route	Common Side Effects	CDL Status
Doxorubicin (Adriamycin)	Anthracycline	IV	Cardiotoxicity, hair loss, nausea	✓ Listed
Cyclophosphamide	Alkylating	IV/Oral	Low blood counts, nausea, bladder irritation	✓ Listed
Paclitaxel (Taxol)	Taxane	IV	Neuropathy, hair loss, muscle pain	✓ Listed
Docetaxel (Taxotere)	Taxane	IV	Neuropathy, fluid retention, nail changes	✓ Listed
Capecitabine (Xeloda)	Antimetabolite	Oral	Hand-foot syndrome, diarrhea, fatigue	✓ Listed
Carboplatin	Platinum	IV	Low blood counts, nausea, kidney effects	✓ Listed

Targeted Therapy - HER2+

Drug	Mechanism	Route	Side Effects	CDL Status
Trastuzumab (Herceptin)	HER2 antibody	IV/SC	Cardiotoxicity, infusion reactions	✓ Listed
Pertuzumab (Perjeta)	HER2 dimerization inhibitor	IV	Diarrhea, rash, cardiotoxicity	✓ Listed
T-DM1 (Kadcyla)	Antibody-drug conjugate	IV	Thrombocytopenia, liver toxicity	✓ Listed
Trastuzumab deruxtecan (Enhertu)	Antibody-drug conjugate	IV	Lung toxicity, nausea, fatigue	✓ Listed
Tucatinib (Tukysa)	HER2 TKI	Oral	Diarrhea, hand-foot syndrome, liver toxicity	✓ Listed
Lapatinib (Tykerb)	HER2/EGFR TKI	Oral	Diarrhea, rash, liver toxicity	✓ Listed

Endocrine Therapy (HR+)

Drug	Class	Patient	Side Effects	CDL Status
Tamoxifen	SERM	Pre/Post-menopausal	Hot flashes, blood clots, uterine cancer risk	✓ Listed
Letrozole (Femara)	Aromatase Inhibitor	Post-menopausal	Joint pain, bone loss, hot flashes	✓ Listed
Anastrozole (Arimidex)	Aromatase Inhibitor	Post-menopausal	Joint pain, bone loss, fatigue	✓ Listed
Exemestane (Aromasin)	Aromatase Inhibitor	Post-menopausal	Joint pain, hot flashes, fatigue	✓ Listed
Fulvestrant (Faslodex)	SERD	Post-menopausal	Injection site pain, hot flashes	✓ Listed

CDK4/6 Inhibitors (HR+/HER2-)

Drug	Dose	Schedule	Key Side Effects	CDL Status
Palbociclib (Ibrance)	125mg	21 days on, 7 days off	Neutropenia, fatigue, nausea	✓ Listed
Ribociclib (Kisqali)	600mg	21 days on, 7 days off	Neutropenia, QT prolongation, liver toxicity	✓ Listed
Abemaciclib (Verzenio)	150mg	Continuous twice daily	Diarrhea, neutropenia, fatigue	✓ Listed

PARP Inhibitors (BRCA-mutated)

Drug	Dose	Indication	Key Side Effects	CDL Status
Olaparib (Lynparza)	300mg twice daily	gBRCA+ metastatic	Anemia, fatigue, nausea	✓ Listed
Talazoparib (Talzenna)	1mg daily	gBRCA+ metastatic	Anemia, fatigue, nausea	✓ Listed

Immunotherapy

Drug	Mechanism	Indication	Key Side Effects	CDL Status
Pembrolizumab (Keytruda)	PD-1 inhibitor	TNBC (PD-L1+ or high-risk early stage)	Immune-related adverse events	✓ Listed

Antibody-Drug Conjugates

Drug	Target	Indication	Key Side Effects	CDL Status
Sacituzumab govitecan (Trodelvy)	Trop-2	TNBC, HR+/HER2- after multiple lines	Neutropenia, diarrhea, nausea	✓ Listed

Colorectal Cancer Treatment

65%

5-Year Survival (All Stages)

91%

Localized Stage

72%

Regional Stage

First-Line Treatment by Stage

Surgery (Curative Intent)

Polypectomy - For cancers in polyps during colonoscopy
Colectomy - Surgical removal of affected colon segment

Adjuvant therapy: Not typically required for Stage I

Surgery

Colectomy with adequate lymph node sampling (≥12 nodes)

Adjuvant Chemotherapy

Consider for high-risk features:

T4 tumors
Poorly differentiated histology
Lymphovascular invasion
Perineural invasion
<12 lymph nodes examined

Regimen	Duration	Notes
Capecitabine alone	6 months	Oral option
5-FU/Leucovorin	6 months	IV option
CAPOX (high-risk)	3 months	If high-risk features

Surgery

Colectomy with lymph node dissection

Adjuvant Chemotherapy (Required)

Risk Level	Preferred Regimen	Duration
Low-risk (T1-3, N1)	CAPOX or FOLFOX	3 months
High-risk (T4 or N2)	FOLFOX	6 months

For Rectal Cancer - Add Radiation

Short-course: 5 Gy x 5 fractions, then surgery
Long-course: 50.4 Gy over 5-6 weeks with concurrent chemo
Total Neoadjuvant Therapy (TNT) increasingly used

Molecular Testing Required

RAS/BRAF mutation status
MSI/MMR status
HER2 amplification

Molecular Status	First-Line Regimen	Response Rate
RAS wild-type, Left-sided	FOLFOX/FOLFIRI + Cetuximab or Panitumumab	60-65%
RAS wild-type, Right-sided	FOLFOX/FOLFIRI + Bevacizumab	50-55%
RAS mutant	FOLFOX/FOLFIRI + Bevacizumab	45-50%
MSI-High/dMMR	Pembrolizumab (preferred) or Nivolumab + Ipilimumab	45%
BRAF V600E mutant	FOLFOXIRI + Bevacizumab	40%

Resectable Liver Metastases

Surgical resection + perioperative chemotherapy can achieve 5-year survival of 40-50%

Second-Line & Progression Treatment

After Progression On	Second-Line Options	Later-Line Options
Oxaliplatin-based (FOLFOX)	FOLFIRI ± targeted agent Switch biological if applicable	Regorafenib TAS-102 (Trifluridine-tipiracil)
Irinotecan-based (FOLFIRI)	FOLFOX ± targeted agent	Fruquintinib Clinical trials
BRAF V600E mutant	Encorafenib + Cetuximab	Clinical trials
HER2 amplified	Trastuzumab + Lapatinib or Pertuzumab	Trastuzumab deruxtecan

Complete Drug Reference - Colorectal Cancer

Chemotherapy Agents

Drug	Class	Route	Key Side Effects	CDL Status
5-Fluorouracil (5-FU)	Antimetabolite	IV	Mucositis, diarrhea, hand-foot syndrome	✓ Listed
Capecitabine (Xeloda)	Antimetabolite (oral 5-FU prodrug)	Oral	Hand-foot syndrome, diarrhea	✓ Listed
Oxaliplatin	Platinum	IV	Neuropathy (cold sensitivity), nausea	✓ Listed
Irinotecan	Topoisomerase I inhibitor	IV	Diarrhea, low blood counts	✓ Listed
TAS-102 (Lonsurf)	Nucleoside analog	Oral	Neutropenia, anemia, fatigue	✓ Listed

Targeted Therapy - Anti-EGFR

Drug	Type	Requirement	Key Side Effects	CDL Status
Cetuximab (Erbitux)	EGFR antibody	RAS wild-type only	Acneiform rash, hypomagnesemia	✓ Listed
Panitumumab (Vectibix)	EGFR antibody	RAS wild-type only	Acneiform rash, hypomagnesemia	✓ Listed

Targeted Therapy - Anti-VEGF

Drug	Type	Route	Key Side Effects	CDL Status
Bevacizumab (Avastin)	VEGF antibody	IV	Hypertension, bleeding, proteinuria	✓ Listed
Aflibercept (Zaltrap)	VEGF trap	IV	Hypertension, proteinuria, bleeding	✓ Listed
Ramucirumab (Cyramza)	VEGFR2 antibody	IV	Hypertension, bleeding	✓ Listed

Multi-Kinase Inhibitors

Drug	Targets	Line	Key Side Effects	CDL Status
Regorafenib (Stivarga)	Multiple kinases	3rd line+	Hand-foot syndrome, fatigue, liver toxicity	✓ Listed
Fruquintinib	VEGFR 1/2/3	3rd line+	Hypertension, hand-foot syndrome	✓ Listed

BRAF-Targeted (BRAF V600E mutant)

Drug	Target	Used With	Key Side Effects	CDL Status
Encorafenib (Braftovi)	BRAF inhibitor	+ Cetuximab	Fatigue, nausea, diarrhea	✓ Listed

Immunotherapy (MSI-H/dMMR only)

Drug	Mechanism	Indication	Key Side Effects	CDL Status
Pembrolizumab (Keytruda)	PD-1 inhibitor	MSI-H/dMMR, 1st line preferred	Immune-related adverse events	✓ Listed
Nivolumab (Opdivo)	PD-1 inhibitor	MSI-H/dMMR	Immune-related adverse events	✓ Listed
Ipilimumab (Yervoy)	CTLA-4 inhibitor	MSI-H/dMMR (with Nivolumab)	Immune-related adverse events	✓ Listed

Lung Cancer Treatment

25%

5-Year Survival (All Stages)

63%

Localized Stage

35%

Regional Stage

First-Line Treatment - Non-Small Cell Lung Cancer (NSCLC)

~85% of lung cancers are NSCLC. Molecular testing is essential.

Required Molecular Testing

EGFR mutations
ALK rearrangement
ROS1 rearrangement
BRAF V600E mutation
KRAS G12C mutation
MET exon 14 skipping
RET rearrangement
NTRK fusion
PD-L1 expression

Surgery

Lobectomy - Preferred for adequate lung function
Segmentectomy/Wedge - For small tumors or limited function
Pneumonectomy - Rarely needed

Adjuvant Therapy

Stage	Recommendation	Duration
IB (≥4cm)	Consider cisplatin-based chemotherapy	4 cycles
II	Cisplatin-based chemotherapy	4 cycles
IB-IIIA, EGFR+	Osimertinib after chemo	3 years
II-IIIA	Atezolizumab after chemo (PD-L1≥1%)	1 year

Resectable Stage IIIA

Surgery with adjuvant therapy, or neoadjuvant chemo-immunotherapy followed by surgery

Unresectable Stage III

Approach	Regimen	Duration
Concurrent chemoradiation	Cisplatin/Etoposide or Carboplatin/Paclitaxel + RT	6-7 weeks
Consolidation	Durvalumab (if PD-L1≥1% and no progression)	Up to 1 year

Mutation	First-Line Therapy	Response Rate
EGFR (common mutations)	Osimertinib	80%
EGFR exon 20 insertion	Amivantamab + Chemotherapy	73%
ALK rearrangement	Alectinib or Lorlatinib	83-92%
ROS1 rearrangement	Crizotinib or Entrectinib	72-77%
BRAF V600E	Dabrafenib + Trametinib	64%
KRAS G12C	Sotorasib or Adagrasib	37-43%
MET exon 14	Capmatinib or Tepotinib	68%
RET fusion	Selpercatinib or Pralsetinib	85%
NTRK fusion	Larotrectinib or Entrectinib	75%

PD-L1 Level	First-Line Regimen	Median Survival
≥50%	Pembrolizumab alone OR Pembrolizumab + Chemotherapy	26-30 months
1-49%	Pembrolizumab + Platinum + Pemetrexed (non-squamous) Pembrolizumab + Carboplatin + Paclitaxel (squamous)	22 months
<1%	Pembrolizumab + Chemotherapy OR Nivolumab + Ipilimumab + Chemotherapy	15-18 months

Small Cell Lung Cancer (SCLC)

Stage	Treatment	Notes
Limited Stage	Concurrent chemoradiation (Cisplatin/Etoposide + RT)	Prophylactic cranial irradiation if response
Extensive Stage	Carboplatin/Etoposide + Atezolizumab or Durvalumab	Maintenance immunotherapy

Second-Line & Progression Treatment

NSCLC - After Targeted Therapy Progression

Initial Therapy	Resistance Mechanism	Next Options
Osimertinib (EGFR)	Various	Platinum doublet ± Bevacizumab Clinical trials
Alectinib/Lorlatinib (ALK)	Various	Different ALK inhibitor based on mutation Chemotherapy
Sotorasib (KRAS)	Various	Chemotherapy + Immunotherapy Clinical trials

NSCLC - After Chemo-Immunotherapy Progression

Scenario	Options
No prior docetaxel	Docetaxel ± Ramucirumab
No prior pemetrexed (non-squamous)	Pemetrexed
General	Gemcitabine, Vinorelbine, or Clinical trials

SCLC - After First-Line Progression

Timing of Relapse	Options
≥6 months (sensitive)	Re-challenge with platinum/etoposide
<6 months (resistant)	Topotecan, Lurbinectedin, Clinical trials

Complete Drug Reference - Lung Cancer

EGFR Inhibitors

Drug	Generation	Mutations Covered	Key Side Effects	CDL Status
Osimertinib (Tagrisso)	3rd	Common + T790M	Rash, diarrhea, interstitial lung disease	✓ Listed
Gefitinib (Iressa)	1st	Common mutations	Rash, diarrhea, liver toxicity	✓ Listed
Erlotinib (Tarceva)	1st	Common mutations	Rash, diarrhea	✓ Listed
Afatinib (Gilotrif)	2nd	Common + uncommon	Diarrhea, rash, paronychia	✓ Listed
Amivantamab (Rybrevant)	Bispecific antibody	Exon 20 insertion	Infusion reactions, rash, paronychia	✓ Listed

ALK Inhibitors

Drug	Generation	CNS Activity	Key Side Effects	CDL Status
Alectinib (Alecensa)	2nd	Excellent	Constipation, edema, myalgia	✓ Listed
Lorlatinib (Lorbrena)	3rd	Excellent	Hyperlipidemia, edema, cognitive effects	✓ Listed
Brigatinib (Alunbrig)	2nd	Good	Pneumonitis, hypertension, diarrhea	✓ Listed
Crizotinib (Xalkori)	1st	Limited	Vision changes, edema, liver toxicity	✓ Listed
Ceritinib (Zykadia)	2nd	Moderate	GI toxicity, liver toxicity	✓ Listed

Other Targeted Therapies

Drug	Target	Key Side Effects	CDL Status
Sotorasib (Lumakras)	KRAS G12C	Diarrhea, liver toxicity, nausea	✓ Listed
Adagrasib (Krazati)	KRAS G12C	Diarrhea, nausea, fatigue	✓ Listed
Dabrafenib + Trametinib	BRAF V600E	Fever, fatigue, rash	✓ Listed
Selpercatinib (Retevmo)	RET	Dry mouth, hypertension, edema	✓ Listed
Capmatinib (Tabrecta)	MET exon 14	Edema, nausea, fatigue	✓ Listed
Entrectinib (Rozlytrek)	ROS1/NTRK	Fatigue, dysgeusia, dizziness	✓ Listed
Larotrectinib (Vitrakvi)	NTRK	Fatigue, dizziness, nausea	✓ Listed

Immunotherapy

Drug	Target	Approved Setting	CDL Status
Pembrolizumab (Keytruda)	PD-1	First-line (alone or + chemo)	✓ Listed
Nivolumab (Opdivo)	PD-1	First-line (+ Ipilimumab ± chemo)	✓ Listed
Atezolizumab (Tecentriq)	PD-L1	First-line, adjuvant, SCLC	✓ Listed
Durvalumab (Imfinzi)	PD-L1	Stage III consolidation, SCLC	✓ Listed
Ipilimumab (Yervoy)	CTLA-4	First-line (with Nivolumab)	✓ Listed

Chemotherapy

Drug	Class	Key Side Effects	CDL Status
Cisplatin	Platinum	Nausea, kidney toxicity, neuropathy	✓ Listed
Carboplatin	Platinum	Low blood counts, nausea	✓ Listed
Pemetrexed (Alimta)	Antifolate	Fatigue, low blood counts, rash	✓ Listed
Docetaxel	Taxane	Low blood counts, neuropathy	✓ Listed
Paclitaxel	Taxane	Neuropathy, low blood counts	✓ Listed
Gemcitabine	Antimetabolite	Low blood counts, flu-like symptoms	✓ Listed
Etoposide	Topoisomerase II inhibitor	Low blood counts, hair loss	✓ Listed
Vinorelbine	Vinca alkaloid	Low blood counts, neuropathy	✓ Listed

Prostate Cancer Treatment

98%

5-Year Survival (All Stages)

>99%

Localized Stage

32%

Distant Stage

Treatment by Stage and Risk

Gleason 6, PSA <10, T1-T2a

Options

Active Surveillance - Preferred for most patients; regular PSA and biopsies
Radical Prostatectomy - If patient prefers treatment
Radiation Therapy - EBRT or brachytherapy

Active surveillance is increasingly recommended to avoid overtreatment.

Gleason 7, PSA 10-20, T2b-T2c

Risk Group	Treatment Options
Favorable Intermediate	Active surveillance (select patients) Radical prostatectomy EBRT ± short-term ADT (4-6 months)
Unfavorable Intermediate	Radical prostatectomy + lymph node dissection EBRT + ADT (4-6 months)

Gleason 8-10, PSA >20, T3-T4

Approach	Details
Surgery-based	Radical prostatectomy + extended lymph node dissection Consider adjuvant RT for adverse features
Radiation-based	EBRT + long-term ADT (2-3 years) May add abiraterone or docetaxel

First-line treatment for newly diagnosed metastatic disease

Volume	Recommended Regimen
High Volume	ADT + Docetaxel + Darolutamide/Abiraterone OR ADT + Abiraterone OR ADT + Enzalutamide OR ADT + Apalutamide
Low Volume	ADT + ARSI (Abiraterone/Enzalutamide/Apalutamide) Consider RT to primary

Castration-Resistant Prostate Cancer (CRPC)

Progression despite testosterone at castrate levels (<50 ng/dL)

Non-Metastatic CRPC (nmCRPC)

Option	Details
If PSA doubling time ≤10 months	Add: Enzalutamide, Apalutamide, or Darolutamide to ADT
If PSA doubling time >10 months	Continue ADT with observation

Metastatic CRPC (mCRPC)

Prior Therapy	Options
No prior novel hormonal agent	Abiraterone + Prednisone Enzalutamide Docetaxel
Prior Abiraterone/Enzalutamide	Docetaxel Cabazitaxel (if prior docetaxel)
BRCA/ATM mutated	Olaparib, Rucaparib, or Talazoparib
MSI-High	Pembrolizumab
Bone-predominant	Radium-223 (if symptomatic, no visceral mets)
PSMA-positive	Lutetium-177-PSMA-617

Complete Drug Reference - Prostate Cancer

Androgen Deprivation Therapy (ADT)

Drug	Class	Route	Key Side Effects	CDL Status
Leuprolide (Lupron)	GnRH agonist	IM/SC injection	Hot flashes, osteoporosis, fatigue	✓ Listed
Goserelin (Zoladex)	GnRH agonist	SC implant	Hot flashes, osteoporosis	✓ Listed
Degarelix (Firmagon)	GnRH antagonist	SC injection	Injection site reactions, hot flashes	✓ Listed
Relugolix (Orgovyx)	Oral GnRH antagonist	Oral	Hot flashes, fatigue, diarrhea	✓ Listed

Androgen Receptor Signaling Inhibitors (ARSI)

Drug	Mechanism	Dose	Key Side Effects	CDL Status
Abiraterone (Zytiga)	CYP17 inhibitor	1000mg daily + prednisone	Hypertension, hypokalemia, liver toxicity	✓ Listed
Enzalutamide (Xtandi)	AR antagonist	160mg daily	Fatigue, hypertension, falls/fractures	✓ Listed
Apalutamide (Erleada)	AR antagonist	240mg daily	Rash, fatigue, hypothyroidism	✓ Listed
Darolutamide (Nubeqa)	AR antagonist	600mg twice daily	Fatigue, pain in extremities	✓ Listed

Chemotherapy

Drug	Setting	Dose	Key Side Effects	CDL Status
Docetaxel	mHSPC, mCRPC	75mg/m² q3w x 6 cycles	Neutropenia, neuropathy, fatigue	✓ Listed
Cabazitaxel (Jevtana)	mCRPC post-docetaxel	25mg/m² q3w	Neutropenia, diarrhea, fatigue	✓ Listed

PARP Inhibitors (HRR-mutated)

Drug	Indication	Mutations	CDL Status
Olaparib (Lynparza)	mCRPC	BRCA1/2, ATM, others	✓ Listed
Rucaparib (Rubraca)	mCRPC	BRCA1/2	✓ Listed
Talazoparib (Talzenna)	mCRPC (+ Enzalutamide)	HRR gene alterations	✓ Listed

Radiopharmaceuticals

Drug	Target	Indication	CDL Status
Radium-223 (Xofigo)	Bone (calcium mimetic)	Symptomatic bone mets, no visceral	✓ Listed
Lutetium-177-PSMA-617 (Pluvicto)	PSMA	PSMA+ mCRPC after ARSI and taxane	✓ Listed