Breast Cancer Flashcards
What is the magic number for “high risk” in the Gail Model
> 1.66 yearly risk
6 breast cancer predisposition syndromes
BRCA mutation Li-Fraumeni Cowden's (PTEN) Peutz-Jeghers (STK11 mutation) CDH1 mutation (lobular breast cancer) PALB2
Approved medication(s) for breast cancer prevention in premenopausal women
Tamoxifen
Approved Medications for breast cancer prevention in Post menopausal women
Tam
Raloxifene
Exemestane
Anastrazole
Recommended Breast cancer Screening rec for BRCA mutants or first degree relatives with BRCA mutants as long as life time breast cancer risk is 20-25% based on BRCAPRO
MRI starting annually at age 25
Mammo starting at age 30
What stage does pre-op staging become indicated without symptoms in breast cancer?
T3N1 (IIIa)-> CT chest/abd/pelvis and Bone Scan
Margin needed for DCIS
2 mm
Who needs adjuvant Tam in DCIS? (3)
ER+
Premenopausal
2 breasts at risk
Absolute contraindications to breast conserving therapy (6)
- Pregnancy that can’t be completed in tim efor RT
- Diffuse calcifications on mammogram
- Multifocal disease not amenable to removal with single incision
- Grossly pos margins
- Inflammatory breast cancer(regardless of response to NACT)
- Homozygous ATM mutation
Who can omit RT after BCT? (4)
Age >/=70
Tumor <2 cm
Clinically node negative
ER+ and able to take endocrine therapy
indications for post-mastectomy radiation (3)
Tumor > 5 cm
Tumor <5 cm and close margins
Positive axillary LNs
Which ER pos groups need adjuvant Chemo?
Postmenopausal-> RS >25, LN +/-
Premenopausal-> Node +, Node - with RS >25
What is adjuvant treatment for Stage I (T1b-c, N0) Her2+ breast cancer
12 weeks fo TH with 1 year of total Trastuzumab
What is adjuvant therapy for Her2+ disease who gets path CR following NACT?
H or HP x 1 year
1st line treatment for de novo ER+ MBC
AI + CDKi
2nd Line treatment for ER+ MBC
Fulvestrant + Palbo or Ribo or Abema
Only CDK4/6i with approval for monotherapy after ET and CT
Abemaciclib
CDK4/6i with CNS penetration
Abema
CDK4/6i with least cytopenias
Abema
CDK4/6i with most nausea/Diarrhea
abema
CDK4/6i with QTc Prolongation
Ribociclib
Approved in 2nd line HR+ MBC with PIK3CA mutation
Fulvestrant + Alpelisib
What are the dose limiting toxicities for TDM1
Thrombocytopenia
LFT elevation
Her2 +-> IHC 2+ -> Positive if:
- Her2/CEP17 ratio >/=_______ and any copy #
- Her2/CEP17 ratio < ____ and copy # >/= ______
- Her2/CEP17 ratio >/= 2 and any copy #
- - Her2/CEP17 ratio < 2 and copy # >/= 6
Which PARPi are approved in breast cancer?
gBRCA mutants only
Olaparib and Talazoparib
CPS cutoff for pembro + chemo in breast cancer
CPS >/=10
Pregnancy associated breast cancer typically present with which biomarkers?
TNBC.
30% are Her2 pos
Scans not to do on preggos (3)
Breast MRI
Bone Scan
CT scans
What kind of SLN identification technique do you use with preggos
No Isosulfan blue dye
Which chemo combination has most data in pregnant population
AC or FAC
What is the complication associated with trastuzumab in pregnancy?
oligohydramnios
What is recommended wait time for consideration of pregnancy after breast cancer? Any increase in mortality?
2 years
No
What kind of surgery is needed for Phyllodes tumor
Wide excision without axillary staging or adjuvant treatment
What biomarker profile does metaplastic breast cancer usually have?
TNBC
