breast cancer

Question 1

zolendronic acid dosing

Answer 1

after a year of monthly zomeda, switch to 3 months

ensure calcium and vitamin D on board

Question 2

percentage of receptor change on subsequent biopsy

Answer 2

about 1/3 or 30%

Question 3

Cleopatra trial

Answer 3

docetaxel + trastuzumab (+ pertuzumab) showed OS benefit 56 vs 40 (16%) in HER2 + metastatic breast cancers

Question 4

TDM-1 Katcyla

Answer 4

TCP is common

Question 5

Destiny-breast 003 trial

Answer 5

Enher2 vs Katcyla favors Enher2 in second line

ORR Enhertu was more than twice as high as that for Kadcyla: 79.7% versus 34.2%. For patients without brain metastases, 12-month PFS was 76.5% for the Enhertu group and 37.4% for Kadcyla. OS 72 vs 20%.

Enhertu attaches eight molecules of anti-cancer medicine to each HER2-antibody (versus Kadcyla’s three or four)

10% pneumonitits risk

Question 6

Compare CDK 4/6 inhibitors

Answer 6

abemeciclib is continuous, rest 3 weeks on 1 week off

abemeciclib penetrates CNS and others do not

abemeciclib causes worse nausea/diarrhea

abemeciclib causes the least cytopenias of the three

ribocyclib prolongs Qtc

Question 7

Brain mets in HER2, good drug choices

Answer 7

tucatinib/neratinib/lapatinib
capecitabine
enher2

Question 8

paclitaxel monotherapy dosing in metastatic breast cancer

Answer 8

weekly 80 mg/m2 OS 24 vs 12 mo versus Q3 week dosing