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444-Oncology and Neurology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

each breast has _____ lobes

A

15-20

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2
Q

breast cancer is most common in the ___ > ____ > _____

A

ducts > lobes > other

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3
Q

list 3 RF for breast cancer

A

increasing age, female, personal and family hx, estrogen exposure (endogenous and exogenous), radiation exposure to chest at a young age, alcohol, obesity, dense breast tissue

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4
Q

genetic RF for breast cancer

A

BRCA1 and 2

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5
Q

BRCA genes are

A

tumor suppressor genes

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6
Q

what ancestry is more prone to breast cancer

A

ashkenazi jew

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7
Q

what is the recommended age range for breast cancer screening
1. 40-49
2. 50-74
3. 40-74
4. >75

A

2

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8
Q

should those who have had top surgery still get a mammogram?

A

yes

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9
Q

should trans women with feminizing surgery get a mammogram?

A

yes if >5yrs of hormone therapy

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10
Q

stage 0 breast cancer is

A

in situ

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11
Q

stage 1 breast cancer is

A

<2cm and no spread to lymph nodes

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12
Q

stage 2 breast cancer is

A

2-5cm or <2cm and spread to lymph nodes

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13
Q

stage 3 breast cancer is

A

> 5cm or lots of lymph node involvement

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14
Q

stage 4 breast cancer is

A

metastasis present in other areas

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15
Q

which has a worse prognosis?
1. ductal carcinoma
2. lobular carcinoma

A

ductal

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16
Q

pathology of BC conosiders

A

subtypes (lobular or ductal)
lymphovascular invasion
grade
Ki67
HR
HER2

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17
Q

hormone receptors are

A

transcriptional factors that activate signal transduction upon hormone binding

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18
Q

HER2 is an ____

A

oncogene encoding protein

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19
Q

what is oncotype Dx

A

assigns recurrence score to predict which pts are most likely to benefit from chemo

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20
Q

oncotype Dx is only for

A

stage 0 or 1, HR+, HER2-

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21
Q

prosigna classifies

A

tumors into 4 intrinsic subtypes based on expression measures of 50 genes

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22
Q

removes breast tumor without removal of remaining surrounding tissue

A

lumpectomy

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23
Q

removes entire breast

A

simple/ total mastectomy

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24
Q

removes entire breast + axillary lymph nodes

A

modified radical mastectomy

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25
Q

removes entire breast tissue along with some muscles of chest + more extensive axillary node dissection

A

radical mastectomy

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26
Q

Sentinel nodes are

A

first lymph nodes reached by metastasizing cancer cells from tumor

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27
Q

what is a sentinel lymph node biopsy

A

Inject radioactive material into breast - trace lymph drainage to first lymph node- if sentinel node free of cancer = unlikely to have spread = don’t need to remove additional lymph nodes

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28
Q

when should radiation therapy be done in stage 1-3

A

pts with breast conserving surgery, close or + margins, high risk features (large tumor, high grade, LVI, younger, metastasis)

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29
Q

how to sequence radiation therapy in a pt who will have adjuvant chemo

A

chemo, then radiation

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30
Q

when should radiation be done in a post op pt who will not undergo adjuvant chemo

A

after post op healing done

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31
Q

T or F: radiation can not be concurrent with trastuzumab and endocrine therapies

A

F- can be concurrent, just not with chemo

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32
Q

most breast cancer chemos combos

A

anthracycline + taxanes

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33
Q

-rubicin are

A

anthracyclines

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34
Q

-taxel are

A

taxanes

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35
Q

anthracyclines MOA

A

binds to DNA via intercalation and inhibits DNA repair by inhibiting TP2
also chelates with iron and binds to DNA and cell membrane, producing free radicals that cleave the DNA and cell mem

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36
Q

list 3 AEs for anthracyclines

A

myelosuppression
N/V
mucositis
alopecia
secondary malignancies
cardiotoxicity- cumulative
vesicant- causes necrosis of surrounding tissues

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37
Q

what are the 2 major issues with anthracyclines

A

cumulative cardiotoxicity = reduced LVEF or CHF
is a vesicant

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38
Q

cyclophosphamide MOA

A

alkylating agent that binds to DNA = breakage and repair inhibition

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39
Q

T or F: cyclophosphamide is a prodrug

A

T- requires activation by liver

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40
Q

cyclophosphamide AEs

A

hemorrhagic cystitis
N/V
myelosuppression
alopecia
fertility suppression

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41
Q

taxanes MOAs

A

disrupts MT network essential for mitotic and interphase cellular functions

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42
Q

hypersensitivity reactions to taxanes are due to _____ and most commonly seen in _______

A

diluent
first 2 cycles within first minutes of infusion

43
Q

when can a taxane induced hypersensitivity not be rechallenged

A

if it is severe- bronchospasm, HPTN, rash/erythema, anaphylaxis

44
Q

what are some issues with taxane diluents

A

cause hypersensitivity reactions
has enough ethanol to cause intoxication

45
Q

AEs from taxanes

A

fluid retention (more with docetaxel) = pleural and pericardial effusion, ascites, dyspnea
myelosuppression
hypersensitivity
alopecia
nail changes
lacrimation
severe fatigue
peripheral neuropathy
acute intoxication

46
Q

why might dex be given before docetaxel

A

to reduce freq of hypersensitivity rxn and fluid retention
+ antiemetic

47
Q

dexamethasone dosing pre docetaxel

A

8mg PO BID starting day before docetaxel
must have at least 3 doses before infusion, or can give by IV right before

48
Q

carboplatin MOA

A

covalently binds to DNA and disrupts DNA dunction

49
Q

carboplatin dosing is based on the

A

calvert formula

50
Q

what is the calvert formula and what is it used for?

A

dose (mg) = AUC x (CrCL +25)
for carboplatin

51
Q

___% of breast cancer has HER2 overexpression

A

20%

52
Q

HER2 is a

A

oncogene- transmembrane protein that stimulates growth

53
Q

trastuzumab is a __MAb that blocks ___ by targeting _____

A

humanized MAb
blocks HER2
targets extracellular domain

54
Q

trastuzumab is used in ____ and ____ breast cancer

A

early (adjuvant)-stage+
metastatic

55
Q

pertuzumab is given with ___ and ____ in metastatic breast cancer

A

trastuzumab and taxane chemo

56
Q

lapatinib is a

A

oral small molecule dual kinase inhibitor

57
Q

lapatinib is given with ______ in ___ breast cancer

A

capecitabine
in metastatic breast cancer

58
Q

trastuzumab emtansine MOA

A

attached to cytotoxic drug DM1 that inhibits tubulin polymerization and MT dynamics

59
Q

trastuzumab deruxtecan MOA

A

HER2 MAb and TP1 inhibitor

60
Q

which 2 HER2i are commonly given together

A

pertuzumab and trastuzumab (synergistic)

61
Q

why are pertuzumab and trastuzumab given together

A

tras = inhibits ligand independent HER2 signaling and activates ADCC
pertuz = inhibits ligand dependent HER2 dimerization and signalling + activates ADCC

62
Q

trastuzumab AEs

A

cardiotoxicity - decreased LVEF and CHF, arrhthmias
not dose related and mostly reversible

63
Q

are trastuzumab cardiotoxicities reversible

A

yes

64
Q

T or F: trastuzumab cardiotoxicities are dose dependent

A

F

65
Q

lapatinib AE

A

diarrhea

66
Q

what is the rationale behind hormone/ endocrine therapies

A

to deprive estrogen for cancer cells that rely on it for growth/ prolfieration

67
Q

tamoxifen is most commonly seen as ___ therapy of ____ disease

A

adjuvant
early

68
Q

what are the 4 endocrine therapies for BC

A

tamoxifen
aromatase inhibitors
fulvestrant
CDK 4/6 inhibitors

69
Q

MOA of tamoxifen

A

SERM mixed agonist (E) and antagonist (antiE) activity depending on tissue. Competitively binds to E receptors for (ER+/PR+) = produces nuclear complex that reduces DNA synthesis = antiE effect

70
Q

tamoxifen is an estrogen antagonist on

A

breast and breast cancer cells

71
Q

tamoxifen is an estrogen receptor agonist on

A

endometrium, bone, lipids

72
Q

why is tamoxifen kind of a prodrug

A

it is metabolized to NDM-TAM and 4-OH-TAM, then NDM-TAM is metabolzied to CYP2D6 to endoxifen which is 30-100x more potent

73
Q

which CYP enzyme is important for endoxifen’s antiE potency

A

CYP2D6

74
Q

how much tamoxifen is given daily

A

20mg po daily

75
Q

tamoxifen AEs

A

hot flashes, menopausal sx (80%), depression, amenorrhea if premenopausal, decreased libido, vaginal dryness, arthralgia/ myalgia, tumor pain/ flare (if metastatic setting)

76
Q

serious risks of tamoxifen

A

DVT/PE
uterine cancers

77
Q

tamoxifen interacts with

A

strong 2D6 inhibitors (fluoxetine, paroxetine, bupropion), warfarin

78
Q

aromatase inhibitors are for _____ pts

A

post menopausal pts or those with induced menopause

79
Q

what medications can induce ovarian suppression

A

goserelin or leuprolide

80
Q

aromatase inhibitors used in the adjuvant setting are adminstered ________ yrs or up to ___ yrs after ____

A

5 yrs, 5 yrs
after tamoxifen therapy

81
Q

aromatase inhibitors AEs

A

arthralgias/ myalgia, hot flashes, peripheral edema, vaginal dryness

82
Q

what to monior for with aromatase inhibiors

A

bone loss, hypercholestrolemia

83
Q

aromatase inhibitors used in metastatic/ palliative settings have durations based on

A

pt tolerance or disease

84
Q

how can aromatase inhibitors be used if the cancer is HER2-

A

give with CDK4/6 inhibitors

85
Q

what is an estrogen receptor antagonist with no partial agonist effects?

A

fulvestrant

86
Q

fulvestrant MOA

A

competitive binding with estrogen receptors with affinity comparable to estradiol

87
Q

fulvestrant place in therapy

A

HR+, HER2-
post menopausal or induced
metastatic disease

88
Q

fulvestrant AEs

A

injection site reaction, hypersensitivity reaction, headache, hepatotoxicity, bleeding/ hematoma at injection site if on anticoagulants or severe thrombocytopenia

89
Q

CDK is ___ from estrogen receptor signaling

A

downstreak

90
Q

CDK4/6 facilitates __________ allowing progression from G1 to S

A

phosphorylation of retinoblastomas

91
Q

what is overactive in cancer cells so there is uncontrolled cell cycle progression + is targeted by an endocrine therapy

A

CDK4/6 - use inhibitors

92
Q

palbociclib is a

A

CDK4/6 inhibitor

93
Q

what blocks signal process that is downstream from estrogen receptor?

A

CDK4/6 inhibitors

94
Q

CDK4/6 inhibitors has synergism with

A

antiestrogen therapies

95
Q

what are CDK 4/6i first line for?

A

metastatic breast cancer that is ER/PR+ and hER2- in combination with an aromatse inhibitor

96
Q

what is a ribociclib combo that is second line for HR+, HER2- BC

A

ribociclob with fulvestrant

97
Q

CDK4/6i AEs

A

bone marrow suppression, fatigue, infections ,pulmonary embolism, QTc prolongation

98
Q

T or F: NHPs for menopausal sx from chemo is recommended
why or why not?

A

F- generally not recommended as products containing phytoestrogens can encourage growth of HR+ breast cancers

99
Q

CDK4/6i is a CYP ___ substrate

A

3A4

100
Q

what NHPs may be recommended for breast cancer and chemo

A

multivitamin
vit D 1000U for bone health (if serum calcium lvl not elevated)

101
Q

T or F: antioxidants are generally recommended during chemo

A

F

102
Q

exemestane is a

A

aromatase inhibitor

103
Q

anastrozole is an

A

aromatase inhibitor

104
Q

letrozole is an

A

aromatase inhibitor

444-Oncology and Neurology (22 decks)

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