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PHM 703- Oncology, Hematology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Non-modifiable risk factors for BC

A

female, older age, FMH, PMH, genetics (BRCA1 and BRCA2), breast changes found on biopsy, ionizing radiation, breast density, early menarche (before age 12), late menopause (after age 55)

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2
Q

Modifiable risk factors for BC

A

nulliparity or older age at first childbirth, postmenopausal HRT, postmenopausal obesity, physical inactivity, alcohol consumption

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3
Q

BC patho: in situ BC

A

Stays within the lobular and ductal epithelium and doesn’t spread

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4
Q

BC patho: invasiv BC

A

Spreads outside the epithelium to other parts of the body

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5
Q

Clinical presentation of BC

A

May be asymptomatic if small
Palpable, painless mass
Breast/nipple pain
Nipple discharge, retraction, or dimpling
Skin changes- redness, warmth, edema
Swollen lymph nodes
Signs/symptoms of metastatic disease are dependent on the site of metastasis

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6
Q

BC subtypes: hormone receptor positive (ER/PR+) features

A

Slower growing, more responsive to hormonal therapy

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7
Q

BC subtypes: HER2 positive features

A

Grows faster than ER/PR+, due to overstimulation of the receptors that control cell growth and replication

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8
Q

BC subtypes: triple negative (ER/PR/HER2 negative) features

A

Grows quickly, responds only to chemo

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9
Q

BC staging

A

Uses TNM staging

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10
Q

BC treatment: LCIS

A

No treatment, just regular monitoring

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11
Q

BC treatment: DCIS

A

lumpectomy and radiation OR mastectomy +/- endocrine therapy

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12
Q

Treatment for invasive BC

A

Surgery and radiation
Systemic therapy

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13
Q

BC treatment: if you’re HER2+

A

You get HER2 therapy and chemo

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14
Q

HER2+ chemo regimens

A

Docetaxel/carboplatin/trastuzumab +/- pertuzumab q3w x6 doses
Paclitaxel + trastuzumab qw x12 weeks

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15
Q

Pertuzumab criteria

A

≥T2 or ≥N1, HER2 (+) tumor, high risk of recurrence

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16
Q

HER2+ post-chemo regimens

A

continue trastuzumab or pertuzumab/trastuzumab to complete 1 year of treatment

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17
Q

BC treatment: triple negative patients

A

CHEMO ONLY

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18
Q

Triple negative chemo regimens: neoadjuvant therapy

A

pembrolizumab q3w x4 doses and weekly paclitaxel/carboplatin x12 doses → pembrolizumab and doxorubicin/cyclophosphamide q3w x4 doses

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19
Q

Triple negative chemo regimens: adjuvant therapy

A

pembrolizumab q3w x9 doses, can also add capecitabine if didn’t receive complete response

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20
Q

Hormone-positive BC: premenopausal women

A

Tamoxifen or aromatase inhibitor WITH ovarian suppression with an oophorectomy or LHRH agonist

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21
Q

Hormone-positive BC: postmenopausal women

A

Aromatase inhibitor (preferred) OR tamoxifen (I guess)

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22
Q

BC treatment: ER/PR+ but HER2- and the tumor is >0.5cm

A

Oncotype Dx to determine if you qualify for chemo

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23
Q

BC chemo regimen: ER/PR+, HER2- and tumor is >0.5cm

A

Dose-dense doxorubicin/cyclophosphamide (AC) x4 doses → paclitaxel q2w x4 doses

Dose-dense AC x4 doses → weekly paclitaxel x12 doses

Docetaxel and cyclophosphamide (TC) q3w x4-6 doses

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24
Q

Goal of therapy in Stage IV BC

A

palliation, prolongation of life, maximize QoL

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25
Q

Endocrine therapy for MBC

A

Palbociclib (Ibrance)
Ribociclib (Kisqali)
Abemaciclib (Verzenio)
Everolimus (Afinitor)
Alpelisib (Piqray)

26
Q

When to begin chemo in Stage IV BC

A

Failure of multiple endocrine manipulations, visceral crisis, patient is symptomatic, patient decision
Good performance status needed

27
Q

Stage IV BC treatment: Patients are HER2+ with MBC

A

Pertuzumab + trastuzumab + docetaxel or paclitaxel
Fam-trastuzumab deruxtecan-nxki (Enhertu): Ab-drug conjugate
Ado-trastuzumab emtansine (T-DM1) (Kadcyla): Ab-drug conjugate
Sacituzumab govitecan-hziy (Trodelvy): Ab-drug conjugate
Tucatinib + trastuzumab + capecitabine

28
Q

Stage IV BC treatment: bone metastases

A

Bisphosphonates, denosumab

29
Q

Pertuzumab, trastuzumab AEs

A

Cardiotoxicity (not dose-related and NOT reversible)
Diarrhea with pertuzumab
Infusion reactions

30
Q

Pertuzumab, trastuzumab monitoring

A

ECHO and MUGA at baseline and q3months

31
Q

Paclitazel, docetaxel AEs

A

Neuropathy (pace > doce)
Alopecia
Hypersensitivity reactions- infusion-related
Arthralgias/myalgias
Peripheral edema (docetaxel, use dexamethasone)

32
Q

Doxorubicin AEs

A

Cardiotoxicity: dose-related and REVERSIBLE
Red secretions/urine discoloration
Secondary malignancy
Vesicants- extravasation possible

33
Q

Doxorubicin monitoring

A

ECHO or MUGA at baseline and q3months

34
Q

Cyclophosphamide AEs

A

Hemorrhagic cystitis: significant bladder irritation due to the active metabolite acrolein

Sterility

35
Q

Tamoxifen AEs

A

Menopausal symptoms: hot flashes, night sweats, vaginal dryness
Menstrual changes in premenopausal women
Uterine/endometrial cancer
VTE, stroke
Pregnancy category D- avoid pregnancy

36
Q

Tamoxifen DDIs

A

Avoid strong 2D6 inhibitors like fluoxetine, paroxetine, bupropion

37
Q

Aromatase inhibitor drugs

A

Anastrozole, letrozole, exemestane

38
Q

Aromatase inhibitor AEs

A

Menopausal symptoms
Musculoskeletal symptoms: arthralgia, joint stiffness, bone pain
Increased bone loss → osteoporosis/fractures
Hypercholesterolemia
CV risk

39
Q

LHRH agonists

A

Gosrelin, leuprolide

40
Q

Purpose of LHRH agonists

A

Ovarian suppression

41
Q

Purpose of capecitabine

A

Used in triple-negative patients who haven’t achieved pCR with neoadjuvant therapy

42
Q

Purpose of ado-trastuzumab emtansine

A

Used in HER2+ patients who haven’t achieved pCR with neoadjuvant chemo

43
Q

Neratinib purpose

A

Used in HER2+ patients; don’t have to be hormone positive if they’re not

44
Q

When to initiate neratinib

A

Completion of adjuvant trastuzumab

(Use loperamide as prophy)

45
Q

Olaparib purpose

A

BRCA-mutated cancer

46
Q

Abemaciclib purpose

A

Hormone positive, HER2-, high-risk breast cancer

Adjuvant therapy given with endocrine therapy

47
Q

Bisphosphonate AEs

A

Osteonecrosis of the jaw, arthralgias, fever

48
Q

Purpose of bisphosphonates in BC

A

Postmenopausal patients (zoledronate)

Also helps in MBC to prevent skeletal-related events (SRE) and fractures, surgery, radiation, spinal cord compression

49
Q

Cyclin-dependent kinase 4/6 inhibitors

A

Palbociclib, ribociclib, abemaciclib

50
Q

Cyclin-dependent kinase 4/6 inhibitors purpose in BC

A

Hormone positive, HER2- MBC

Used in combo with an aromatase inhibitor as initial endocrine therapy or fulvestrant with disease progression following endocrine therapy

Abemaciclib can be used as monotherapy after progression following enodcrine therapy and prior chemo

51
Q

Cyclin-dependent kinase 4/6 inhibitors AEs

A

Fatigue
Neutropenia
Anemia
Alopecia

52
Q

Cyclin-dependent kinase 4/6 inhibitors monitoring

A

Ribociclib and abemaciclib: monitor SCr and LFTs

53
Q

mTORi in BC

A

Everolimus

54
Q

Everolimus purpose in BC

A

Hormone positive, HER2- MBC in combo with exemestane or fulvestrant after failure of treatment with aromatase inhibitor

55
Q

Everolimus AEs

A

Metabolic disturbances
Pneumonitis
Stomatitis
Rash

56
Q

PI3Ki drug

A

Alpelisib

57
Q

Alpelisib purpose in BC

A

Hormone positive, HER2-, PIK3CA-mutated MBC in combo with fulvestrant

58
Q

Alpelisib AEs

A

Hyperglycemia
Skin rash
Diarrhea
Nausea
Fatigue
Increased SCr

59
Q

Denosumab purpose in BC

A

Prevention of SREs in MBC

60
Q

Denosumab AEs

A

Hypocalcemia
Fatigue
Dyspnea
Osteonecrosis of the jaw

PHM 703- Oncology, Hematology (15 decks)

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