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Therapeutics P3 Spring > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Invasive Ductal Carcinoma

A

Characteristic “lump”
Metastatic sites: bone, liver, lung, brain

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2
Q

Invasive lobular carcinoma

A

Ill defined thickening of the breast
Metastatic sites: leptomeninges, peritoneal surfaces, retroperitoneum, GI tract, reproductive organs

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3
Q

Inflammatory breast cancer

A

characterized by skin edema, redness, warmth, and induration of underlying tissue
rapid onset
poor prognosis

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4
Q

Non-modifiable risk factors

A

Female
older age
family history
personal history
BRCA1 and BRCA2
breast changes found on biopsy
Ionizing radiation
breast density
early menarche (before 12)
late menopause (after 55)

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5
Q

Modifiable risk factors

A

first child after 30
postmenopausal HRT
postmenopausal obesity
physical inactivity
alcohol consumption

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6
Q

Tumor grade

A

cell differentiation
Grade 1 = normal looking cells
Grade 3 = very abnormal looking cells

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7
Q

Effect of tumor size on prognosis

A

tumor > 2 cm = poorer prognosis

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8
Q

Treatment for Lobular Carcinoma in situ (LCIS)

A

regular monitoring
no treatment

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9
Q

Treatment for Ductal carcinoma in situ (DCIS)

A

lumpectomy + radiation
mastectomy

+/- endocrine therapy

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10
Q

Treatment for invasive disease

A

Surgery and radiation
Mastectomy +/- radiation
Systemic therapy
- Chemo
- targeted therapy
- endocrine therapy

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11
Q

Treatment plan options:
ER/PR+ HER2+

A

Chemotherapy +
HER2 therapy +
Endocrine therapy +

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12
Q

Treatment plan options:
ER/PR+ HER2-

A

Chemotherapy +
Endocrine therapy

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13
Q

Treatment plan options:
ER/PR- HER2+

A

Chemotherapy +
HER2 therapy

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14
Q

Treatment plan options:
ER/PR- HER2-

A

Chemotherapy

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15
Q

Preferred Chemo Neoadjuvant/Adjuvant
HER2 (-) disease

A

Dose dense doxorubicin/cyclophosphamide x 4 doses -> paclitaxel every 2 weeks x 4 doses

Dose dense doxorubicin/cyclophosphamide x 4 doses -> weekly paclitaxel x 12 doses

Docetaxel and cyclophosphamide every 3 weeks x 4-6 doses

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16
Q

Preferred Chemo Neoadjuvant/Adjuvant
Triple negative

A

Neoadjuvant
- pembrolizumab every 3 weeks x 4 doses + weekly paclitaxel/carboplatin x 12 doses -> pembrolizumab + doxorubicin/cyclophosphamide every 3 weeks x 4 doses

Adjuvant
- pembrolizumab every 3 weeks x 9 doses

17
Q

Preferred Chemo Neoadjuvant/Adjuvant
HER2 (+)

A

docetaxel/carboplatin/trastuzumab +/- pertuzumab every 3 weeks x 6 doses

Paclitaxel + trastuzumab weekly x 12 weeks

18
Q

Pertuzumab criteria

A

> /= T2 or >/= N1
HER2 (+) tumor
High risk recurrence

19
Q

HER2 targeted therapy

A

Pertuzumab
Trastuzumab

20
Q

Pertuzumab

A

Inhibits HER2 dimerization
ADE:
- cardiotoxicity (reversible, not dose related)
- diarrhea (pertuzumab)
- infusion reactions
Monitor:
- ECHO at baseline then every 3 months during treatment

Must be co-administered with Trastuzumab

21
Q

Trastuzumab

A

Inhibits HER2 dimerization
ADE:
- cardiotoxicity (reversible, not dose related)
- diarrhea (pertuzumab)
- infusion reactions
Monitor:
- ECHO at baseline then every 3 months during treatment

Can be given alone or with pertuzumab

22
Q

Chemotherapy Agents
Taxanes (Paclitaxel/Docetaxel)

A

Neuropathy
Alopecia
Hypersensitivity reactions - infusion related
Arthralgias/myalgias
Peripheral edema (docetaxel)
- dexamethasone prevention

23
Q

Chemotherapy Agents
Doxorubicin

A

ADE:
Cardiotoxicity (irreversible, dose related)
Red urine
Secondary malignancies
Extravasation
- give with port

Monitor:
- ECHO or MUGA at baseline and every 3 months throughout treatment

24
Q

Chemotherapy Agents
Cyclophosphamide

A

ADE:
- Hemorrhagic cystitis
- sterility

25
Q

Endocrine therapy agents

A

Tamoxifen
Aromatase inhibitors

26
Q

Tamoxifen

A

MOA:
- Inhibits growth of tumors by competitively antagonizing estrogen at its receptor site
DDI:
- avoid strong CYP2D6 inhibitors: fluoxetine, paroxetine, bupropion
ADE:
- Menopausal sx
- Menstrual changes
- Uterine or endometrial cancer
- VTE, stroke
Avoid in therapy

27
Q

Aromatase Inhibitors

A

MOA: inhibit/inactivate the enzyme that is responsible for the synthesis of estrogen
ADE:
- menopausal sx
- Musculoskeletal symptoms (arthralgia, joint stiffness, bone pain
- Osteoporosis/fractures
- Hypercholesterolemia
- CVD risk

28
Q

Additional adjuvant therapy

A

Capecitabine
- Triple negative patients

Ado-trastuzumab emtansine
- HER2 (+)

Neratinib
- HER2 (+)
- use prophylactic loperamide

Olaparib
- BRCA +

Abemaciclib
- ER/PR (+), HER2 (-) high risk breast cancer

Zoledronic acid
- postmenopausal patients

29
Q

Endocrine Therapy for Metastatic Disease

A

Palbociclib (Ibrance)
- MOA: CKD 4/6 inhibitor
- for ER/PR (+), HER2 (-) MBC
- ADE: fatigue, neutropenia, anemia, alopecia

Ribociclib
- CDK 4/6 inhibitor
- combo with AI as initial endocrine therapy or with fulvestrant as 2nd line therapy
- Monitor: QT interval and livr function tests

Abemaciclib
- CDK 4/6 inhibitor
- monitor: liver function tests and serum Cr

Everolimus
- MOA: inhibits mTOR
- for ER/PR (+), HER2 (-) MBC
- ADE: metabolic disturbances, pneumonitis, stomatitis, rash

Alpelisib
- MOA: PI3K inhibitor
- ER/PR (+), HER2 (-) PIK2CA mutated MBC
- given in combo with fulvestrant
- ADE: hyperglycemia, skin rash, diarrhea, nausea, fatigue, increased serum creatinine

30
Q

Chemotherapy in MBC

A

indication:
- failure of multiple endocrine agents
- visceral crisis
- patient is symptomatic
- patient decision

31
Q

MBC chemo therapy regimens

A

Preferred single agent
- doxorubicin
- paclitaxel
- capecitabine
- for triple negative or HR + -> sacituzumab govitecan-hziy
- for triple negative, PDL1 positive (pembrolizumab + chemo)
Combinations:
- Doxorubicin/cyclophosphamide
- Carboplatin/paclitaxel
- Gemcitabine/carboplatin

32
Q

HER2 (+) MBC

A

Chemotherapy:
- pertuzumab + trastuzumab + [docetaxel-or-paclitaxel ]

Other agents:
- Fram-trastuzumab deruxtecan-nxki
- Ado-trastuzumab ematansine (T-DM1)
- Tucatinib + trastuzumab + capecitabine

33
Q

MBC bone metastases treatment

A

Zoledronic acid
Pamidronate
Denozumab

Therapeutics P3 Spring (32 decks)

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