Your Breast Cancer Diagnosis Form

Abecma® Abemaciclib Abiraterone Acetate Abraxane® Abstral® Acalabrutinib Actiq® Adagrasib Adcetris® Ado-trastuzumab Emtansine Adriamycin Adrucil® Adstiladrin®- Given into the bladder Afatinib Afinitor® Aldesleukin Alecensa® Alectinib Alemtuzumab Alimta® Aliqopa™ Alkaban AQ Alkeran® Alkeran® All-Trans-Retinoic Acid Aloxi® Alpelisib Altretamine Alunbrig™ Amethopterin Amifostine Amivantamab-vmjw Anandron Anastrozole and Hyaluronidase-zzxf Anti-thymocyte Globulin [Equine] Antithymocyte globulin [rabbit] Apalutamide Aprepitant Oral; Fosaprepitant IV (Emend®); Aprepitant IV (Cinvanti®) Ara-C Aranesp® Aredia® Arimidex® Aromasin® Arranon® Arsenic Trioxide Arzerra® Asciminib Asparaginase Asparaginase Erwinia Chrysanthemi Asparlas® Atezolizumab Atgam® Ativan® ATRA Avapritinib Avastin® Avatrombopag Avelumab Axicabtagene Ciloleucel Axitinib Ayvakit™ Azacitidine Oral Formulation Azacitidine SubQ and IV Formulation Azedra®

Bacillus Calmette-Guerin Balversa™ Bavencio® BCG BCNU Belantamab Mafodotin-blmf Beleodaq® Belinostat Belumosudil Belzutifan Benadryl®- Oral / IV / IM / Topical Bendamustine Hydrochloride Bendeka® Besponsa® Bevacizumab Bexarotene, Oral Formulation Bexarotene Gel Bicalutamide BiCNU® Binimetinib Blenoxane® Blenrep Bleomycin Blinatumomab Blincyto® Bortezomib Bosulif® Bosutinib Braftovi® Brentuximab Vedotin Brexucabtagene autoleucel Breyanzi® Brigatinib Brukinsa™ Busulfan Busulfex®

Cabazitaxel Cabometyx™ Cabozantinib Calaspargase pegol-mknl Calcium Leucovorin Calquence ® Campath® Camptosar® Capecitabine Capmatinib Caprelsa® Carac® Carboplatin Carfilzomib Carmustine Casodex® CCNU CeeNU® Cemiplimab-rwlc Ceritinib Cerubidine® Cetuximab Chlorambucil Cialis® Cisplatin Citrovorum Factor Cladribine Clofarabine Clolar ® Cobimetinib Columvi™ Cometriq® Compazine®- Oral Tablet / IM / IV / Suppository Copanlisib Copiktra® Cosela® Cosmegen® Cotellic® CPT-11 Crizotinib Cyclophosphamide IV Formulation Cyclophosphamide Oral Formulation Cyclosporine Cyramza® Cytarabine Cytosar-U® Cytoxan® Cytoxan®

Dabrafenib Dacarbazine Dacogen® Dacomitinib Dactinomycin Danyelza® Daratumumab Daratumumab and hyaluronidase-fihj Darbepoetin Alfa Darolutamide Darzalex Faspro™ Darzalex® Dasatinib Daunorubicin Daunorubicin and Cytarabine Liposome Daurismo™ Decadron® Decitabine Decitabine and Cedazuridine Degarelix DepoCyt® Dexamethasone Dexrazoxane Dinutuximab Diphenhydramine Hydrochloride- Oral / IV / IM / Topical Diphenoxylate and atropine Docetaxel Doptelet® Dostarlimab-gxly Doxil® Doxorubicin Doxorubicin Liposomal Drogenil® Dronabinol Droxia® DTIC-Dome® DTIC Duragesic® Durvalumab Duvelisib

Efudex® Elacestrant Elahere™ Eligard® - For Men Eligard® - For Women Ellence® Elotuzumab Eloxatin® Elranatamab-bcmm Elrexfio™ Eltrombopag Elzonris® Emcyt® Emend®; Fosaprepitant IV (Emend®); Aprepitant IV (Cinvanti®) Empliciti™ Enasidenib Encorafenib Endoxan® Endoxan® Enfortumab Vedotin-ejfv Enhertu® Entrectinib Enzalutamide Epcoritamab-bysp Epirubicin Epkinly ™ Epoetin Alfa Epogen® Erbitux® Erdafitinib Eribulin Mesylate Erivedge® Erleada® Erlotinib Erwinaze Erwinia Estramustine Ethyol® Etopophos® Etoposide Etoposide Oral Formula Eulexin® Everolimus Evista® Evomela® Exemestane Exkivity™

Fam-trastuzumab deruxtecan-nxki Fareston® Farydak® Faslodex® Fedratinib Femara® Fentanyl Buccal Tablets Fentanyl Citrate Fentanyl IV/IM Formula Fentanyl Sublingual Tablets Fentanyl Transdermal Fentora® Filgrastim Firmagon® Floxuridine Fludarabine Fludara® Fluorodeoxyuridine Fluoroplex Fluorouracil Fluorouracil Topical Flutamide Folex® Folinic Acid Folotyn® Fotivda® FUDR® Fulvestrant Futibatinib Fyarro™

G-CSF Gabapentin Gavreto™ Gazyva® Gefitinib Gemcitabine Gemtuzumab Ozogamicin Gemzar® Gengraf® Gilotrif® Gilteritinib Glasdegib Gleevec® Gleostine™ Glofitamab-gxbm GM-CSF Goserelin Acetate - For Men Goserelin Acetate - For Women Granisetron Transdermal System

Halaven® Herceptin Hylecta™ Herceptin® Hexalen® HMM Horizant® Hycamtin® Hycamtin® Hydrea® Hydroxyurea

Ibrance® Ibritumomab Tiuxetan Ibrutinib Iclusig® Idamycin® Idarubicin Idecabtagene Vicleucel Idelalisib Idhifa® Ifex® Ifosfamide IL-11 IL-2 Imatinib Imbruvica® Imfinzi® Imjudo® Imlygic® Immediate Release Pill Imodium® – Oral Infigratinib Inlyta® Inotuzumab Ozogamicin Inqovi® Inrebic® Interferon Alfa 2B Interleukin-2 Intravenous Immunoglobulin Intravesicular Mitomycin Intron-A® Iobenguane I-131 Ipilimumab Iressa® Irinotecan Irinotecan Liposome Isatuximab-irfc Istodax® IVIG Ivosidenib Ixabepilone Ixazomib Ixempra®

Jakafi® Jaypirca™ Jelmyto®-given through nephrostomy tube Jemperli® Jevtana®

Kadcyla® Kepivance® Ketoconazole Keytruda® Kisqali® Krazati™ Kymriah® Kyprolis®

L-pam L-PAM Lanreotide Lapatinib Larotrectinib Lenalidomide Lenvatinib Lenvima® Letrozole Leucovorin Leukeran® Leukine® Leuprolide Acetate - For Men Leuprolide Acetate - For Women Leustatin® Levitra® Libtayo® Lidocaine HCl Solution Lisocabtagene Maraleucel Lomotil® Lomustine Loncastuximab tesirine-lpyl Lonsurf® Loperamide – Oral Lorazepam Oral / IM / IV Lorbrena® Lorlatinib Lumakras® Lumoxiti™ Lunsumio™ Lupron Depot® - For Men Lupron Depot® - For Women Lupron® - For Men Lupron® - For Women Lurbinectedin Luspatercept-aamt Lynparza® Lysodren® Lytgobi®

Margenza™ Margetuximab-cmkb Marinol® Matulane® Mechlorethamine Mechlorethamine Topical Megace-ES® Megace® Megestrol Mekinist® Mektovi® Melphalan-Oral Melphalan - IV Melphalan Flufenamide Melphalan Oral Mercaptopurine Mesna Mesnex® Methotrexate Methotrexate Oral Formulation Methylprednisolone Sodium Succinate Metoclopramide Oral/ IV / IM Mexate® Midostaurin Mirtazapine Mirvetuximab soravtansine-gynx Mitomycin-C - Given into the bladder Mitomycin-C Mitomycin Mitomycin Mitotane Mitoxantrone Mobocertinib Mogamulizumab-kpkc Monjuvi® Morphine Sulfate - IV Formulation Morphine Sulfate - Long Acting Pill Morphine Sulfate - Short Acting Pill Morphine Sulfate Morphine Sulfate Liquid Morphine Sulfate Oral Mosunetuzumab-axgb Moxetumomab Pasudotox-tdfk Mozobil® MSIR MS Contin MTX MTX Mucosal Coating Rinse MuGard® Mustargen® Mutamycin Mutamycin® Myleran® Mylotarg™

Nadofaragene Firadenovec-vncg Navelbine® Naxitamab-gqgk Necitumumab Nelarabine Neoral® Neosar® Neosar® Neratinib Nerlynx® Neulasta® Neulasta® On-Pro On Body Injector Neumega® Neupogen® Neurontin® Nexavar® Nilandron® Nilotinib Nilutamide Ninlaro® Nipent® Niraparib Nitrogen Mustard Nitrogen Mustard Nivolumab nivolumab and relatlimab-rmbw Nizoral® Nolvadex® Novantrone® Nplate® Nubeqa®

Obinutuzumab Octreotide Odomzo® Ofatumumab Olanzapine Oral / IM Olaparib Olutasidenib Omacetaxine Mepesuccinate Oncaspar Oncovin® Ondansetron Oral and IV Onivyde® Onureg® Opdivo® Opdualag™ Oprelvekin Orgovyx™ Orserdu™ Osimertinib Oxaliplatin Oxycodone/Acetaminophen Oxycodone/Aspirin Oxycodone - Liquid Formulation Oxycodone Oral Immediate Release Pill Oxycodone Oral Liquid Formulation Oxycodone Sustained/Extended Release Pill OxyContin® Oxydose®

Paclitaxel Paclitaxel PADCEV™ Palbociclib Palifermin Palonosetron HCl Pamidronate Panitumumab Panobinostat Paraplatin® Pazopanib Pegaspargase Pegfilgrastim Pegfilgrastim On-Pro Peginterferon Alfa-2b Pemazyre™ Pembrolizumab Pemetrexed Pemigatinib Pentostatin Pepaxto® Percocet® Percodan Percolone® Perjeta® Pertuzumab Pertuzumab Pharmorubicin® Phenergan® Phesgo™ Piqray® Pirtobrutinib Platinol® Plerixafor Polatuzumab Vedotin-piiq Polivy™ Pomalidomide Pomalyst® Ponatinib Portrazza™ Poteligeo® Pralatrexate Pralsetinib Prednisone Prednisone Intensol Procarbazine Prochlorperazine- Oral Tablet / IM / IV / Suppository Procrit® Proleukin® Prolia® - Denosumab Promacta® Promethazine hydrochloride Oral / IV / Suppository / IM Prostap® - For Men Prostap® - For Women Protein Bound Provenge® Purinethol® Purixan®

Qinlock™ Quizartinib

Raloxifene Ramucirumab Reblozyl® Reclast® Reglan® Regorafenib Relugolix Remeron® Restasis® Retevmo™ Retifanlimab-dlwr Revlimid® Rezlidhia™ Rezuroc® Rheumatrex® Rheumatrex® Ribociclib Rifaximin Ripretinib Rituxan Hycela™ Rituxan® Rituximab Rituximab and Hyaluronidase Human Injection Roferon-A® Romidepsin Romiplostim Roxanol® Roxicodone® Rozlytrek™ Rubex Rubraca™ Rucaparib Ruxolitinib Rybrevant® Rydapt®

Sacituzumab govitecan-hziy Sancuso® Sandimmune® Sandostatin LAR® Sandostatin® Sarclisa® Sargramostim Scemblix® Selinexor Selpercatinib Sildenafil Sipuleucel-T Sirolimus Protein-Bound SOLU-MEDROL ® Somatuline® Depot Sonidegib Sorafenib Sotorasib Sprycel® Sterapred® Stivarga® Streptozocin Sublimaze® Sunitinib Sutent® Sylatron Syndros® Synribo®

T-VEC Tabloid® Tabrecta™ Tadalafil Tafasitamab-cxix Tafinlar® Tagraxofusp-erzs Tagrisso® Talazoparib Talimogene Laherparepvec Talquetamab-tgvs Talvey™ Talzenna® Tamoxifen Tarceva® Targretin®, Oral Formulation Targretin® Gel Formulation Tasigna® Taxol® Taxotere Tazemetostat Tazverik™ TECARTUS® Tecentriq® Teclistamab-cqyv Tecvayli™ Telotristat Temodar®, Oral Formulation Temodar® IV formulation Temozolomide, Oral Formulation Temozolomide IV formulation Temsirolimus Teniposide Tepadina® Tepmetko® Tepotinib Thalidomide Thalomid® TheraCys® Thioguanine Thioplex® Thiotepa Thymoglobulin® Tibsovo® TICE® Tisagenlecleucel Tisotumab Vedotin-tftv Tivdak™ Tivozanib Toposar® Topotecan IV Topotecan Oral Toremifene Torisel® Totect® Trabectedin Trametinib Trastuzumab Trastuzumab Trastuzumab and Hyaluronidase-oysk Treanda® Trelstar LA® and Trelstar Depot® Tremelimumab-actl Tretinoin Trexall® Trifluridine and Tipiracil Trilaciclib Triptorelin Trisenox® Trodelvy™ Truseltiq™ Tucatinib Tukysa™ Tykerb®

Ukoniq™ Umbralisib Unituxin® Uridine Triacetate

Valchor® Vandetanib Vanflyta® Vardenafil Hydrochloride VCR Vectibix® Velban® Velcade® Vemurafenib Venclexta™ Venetoclax VePesid® VePesid® Verzenio® Vesanoid® Viadur® - For Men Viadur® - For Women Viagra® Vidaza® Vinblastine Vincasar PFS® Vincristine Vinorelbine Vismodegib Vistogard® Vitrakvi® Vizimpro® VM-26 Vorinostat Votrient® VP-16 VP-16 Vumon® Vyxeos®

Welireg™

Xalkori® Xeloda® Xermelo™ Xgeva® - Denosumab Xifaxan® Xospata® Xpovio™ Xtandi®

Yervoy® Yescarta® Yondelis®

Zaltrap® Zanosar® Zanubrutinib Zejula™ Zelboraf® Zepzelca™ Zevalin® Zinecard® Ziv-aflibercept Zofran® Zoladex® - For Men Zoladex® - For Women Zoledronic Acid Zolinza® Zometa® Zydelig® Zykadia® Zynlonta™ Zynyz™ Zyprexa® Zytiga®

2% Xylocaine® Viscous 2-CDA 5-FU 5-FU 6-MP 6-TG