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PHRM 864: Therapeutics IV > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the epidemiology of Breast Cancer?

A
  • MOST common in woman
  • 2nd MOST common cause of death
  • INCREASES with age
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2
Q

What are some of the risk factors for Breast Cancer?

A
  • Age:
  • Family Hx: 1st & 2nd degree relatives
  • Personal Hx
  • Radiation: Prior treatment
  • Estrogen Exposure
  • Alcohol: Decrease metabolism of estrogen
  • Prior Breast biopsies
  • First child born
  • Body Mass Index: adipose increases estrogen
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3
Q

In what way does genetics play a role in Breast Cancer?

A
  • 5-10% are familial: BRAC 1 [stops DNA repair = increase cancer risk] & BRAC 2 [males]
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4
Q

What are the type of Breast Cancer?

A
  • Invasive [ductal & lobular carinoma]
  • Non-invasive [ductal & lobular in situ]
  • Inflammatory
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5
Q

What is Invasive Breast Cancer?

A
  • Has invaded beyond the basement membrane of the DUCT or LOBULE
  • MOST common is DUCTAL
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6
Q

What is Non-Invasive Breast Cancer?

A
  • Has NOT invaded beyond the basement membrane of the DUCT or LOBULE and is pre-malignant
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7
Q

What is Inflammatory Breast Cancer?

A
  • RAPID onset and AGGRESSIVE form of Breast Cancer
  • Signs: Edema, Redness, Warmth, Inflammation, Peau D’Ornage
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8
Q

What is the presentation of Breast Cancer?

A
  • > 90% is painless BUT <10% can be stabby or achy
  • 10% might be metastatic
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9
Q

What is FISH testing within Breast Cancer?

A
  • Tests for HER2 by: Immunohistochemistry & FISH [if it detects gene amp]
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10
Q

What is Oncotype DX?

A
  • A genetic test of 21 genes to see if you are likely to get Breast Cancer
  • Low Risk < 26 = Hormonal Therapy
  • High Risk > 26 = Chemo + Hormonal Therapy
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11
Q

What are some fo the sites of Metastasis in Breast Cancer?

A
  • Bone, Liver, Lungs, Brain, Distant Lymph
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12
Q

What are some fo the modalities of treatment in Breast Cancer?

A
  • Surgey, Radiation, Chemotherapy, Hormonal, Biologics, Immunorherapy
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13
Q

What are some of the general treatment strategies for Breast Cancer?

A
  • Stage I, II, IIIA: GOAL is to CURE [Lumpectomy or Mastectomy +/- XRT; may get neoadjuvant or adjuvant treatment]
  • Stage IIIB or IIIC: GOAL is to CURE [neoadjuvant + MRM/Lumpectomy & XRT]
  • Stage IV: GOAL to stabilize/pallitate [Chemotherapy, Hormonal, +/- Biologics, +/- immountherapy…]
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14
Q

What are some of the Systemic Adjuvant Therapy regimens [Hormone +, Lymph +/-, HER2 -] for Breast Cancer?

A
  • Small Tumor [<0.5] = Hormonal
  • Large Tumor [>0.5] = 21 genes assay [if N/A: Hormonal or Chemo; if < 26: Hormonal; if >26 Chemo then Hormonal]
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15
Q

What are some of the Systemic Adjuvant Therapy Regimens [Hormone +, Lymph +/-, HER2 +] for Breast Cancer?

A
  • Small Tumor [<0.5]: Hormonal +/- Chemo WITH HER2 Therapy
  • Large Tumor [>0.5]: Chemo WITH HER2 Therapy
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16
Q

What are some of the Hormonal Therapies used in Breast Cancer?

A
  • SERM
  • GnRH Analogs
  • Aromatase Inhibitors
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17
Q

What is the Selective Estrogen Receptor Modulators [SERM] used in Breast Cancer?

A
  • Tamoxifen
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18
Q

What is important to know about Tamoxifen in Breast Cancer?

A
  • Against [endometrial & Bones] and Antagonist [Breast]
    PRE- & POSTmenopausal
  • Causes: Hot Flashes, DVT, Endometrial Cancer
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19
Q

What are the GnRHs used in Breast Cancer?

A
  • Leuprolide & Goserelin
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20
Q

What is important to know about Leuprolide & Goserelin in Breast Cancer?

A
  • Cause MAJOR release of LH and FSH = inhibition of LH and FSH = inhibition of estrogen
  • POSTmenopausal
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21
Q

What are the Aromatase Inhibitors that are used in Breast Cancer?

A
  • Anastorzole and Letrozole [Non-steroidal]
  • Exementane [Steroidal]
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22
Q

What is important to know about Hormonal Therapy in PREmenopausal Breast Cancer?

A
  • Tamoxifen x 5y +/- OS OR AI x 5y + OS
  • PRE: Tamoxifen x 5y to = 10y
  • POST: AI x 5y to = 10y OR Tamoxifen x 5y to = 10
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23
Q

What is important to know about Hormonal Therapy in POSTmenopausal diagnosis of
Breast Cancer?

A
  • AI x 5y THEN AI x 5y OR
  • Tamoxifen x 2-3y THEN AI to = 5y OR
  • Tamoxifen x 4-6y THEN AI x 5y or Tamoxifen x 5y to = 10y
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24
Q

What are some of the most common chemotherapy agents that are used as adjuvant therapy?

A
  • Doxorubicin, Epirubicin, Cyclophosphamide, Methotrexate, 5-FU, Carboplatin, Paclitaxel, Docetaxel
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25
Q

What are the two Adujvant Chemotherapy Regimens that are used in HER2 - Breast Cancer?

A
  • Dose Dense AC –> Paclitaxel
  • TC
26
Q

What is in Dose Dense AC –> Paclitaxel in HER2 - Breast Cancer?

A
  • Doxorubicin [60mg/m2], Cyclophosphamide [600mg/m2] repeating every 14 d x4 [MUST BE GIVEN GROWTH FACTOR]
  • Followed by: Patlitaxel [175mg/m2] every 14d x 4
27
Q

What is important to know about the Dose Dense AC –> Paclitaxel in HER2- Breast Cancer?

A
  • Doxorubicin = Cardiotoxicities
  • Cyclophosphamide = Nephrotoxicities
  • Paclitaxel = Neurotoxicites
28
Q

What is in TC in HER2 - Breast Cancer?

A
  • Docetaxel [75mg/m2], Cyclophosphamide [600mg/m2] repeating every 21d x4 [MUST BE GIVEN GROWTH FACTOR]
29
Q

What is important to know about TC in HER2- Breast Cancer?

A
  • CAN be used in a patient that has Heart related issues [no doxorubicin]
30
Q

What is the CALBG trail?

A
  • It shoed the importance of dose density VS chemptherapy [basically what the Dose Dense AC –> Paclitaxel is]
31
Q

When giving Paclitaxel to a patient, what should they recieve as pre-medication and why?

A
  • Dexamethasone, Antihistamine, H2 Blocker
  • BECAUSE: causes hypersensitivity reaction with Cremophor
32
Q

What are the three Adjuvant Chemotherapy Regimens for HER2+ in Breast Cancer?

A
  • APT
  • TCH
  • TCH + Pertuzumab [Best one]
33
Q

What is in APT for HER2+ Breast Cancer?

A
  • Paclitaxel [80mg/m2], Trastuzumab [4mg/kg with first dose]
  • Followed by: Trastuzumab [2mg/kg x11w –> 6mg/kg every 3w to =1y]
34
Q

What is in TCH for HER2+ Breast Cancer?

A
  • Docetaxel [75mg/m2], Carboplatin, Trastuzumab [8mg/kg] repeating every 21d x6
  • Followed by: Trastuzumab [6mg/kg every 21d to = 1y]
35
Q

What is in TCH + Pertuzumab in HER2+ Breast Cancer?

A
  • Docetaxel [75mg/m2], Carboplatin, Trastuzumab [8mg/kg], Pertuzumab [840mg] repeating every 21d x6
  • Followed by: Trastuzumab & Pertuzuamb to = 1y
36
Q

What was the trail that show the effectiveness of Traztuzumab & Pertuzuamb together?

A
  • HERA [Herceptin Adjuvant Trail]
  • STANDARD OF CARE
37
Q

What is residual disease in Breast Cancer?

A
  • Any invasive Breast Cancer that remains in the body after therapy
37
Q

What would you use in a patient that has Residual Disease in Breast Cancer?

A
  • IF has: Ado-Trastuzuamb Emtansine [TDM1]
  • IF no: Trastuzumab +/- Pertuzumab for 1y
38
Q

What is Triple Negative Breast Cancer?

A
  • ER-
  • PR-
  • HER2-
39
Q

What are the Adjuvant Chemotherapy Regimens for Triple Negative Disease in Breast Cancer?

A
  • AC –> Paclitaxel with Pembrolizumab
40
Q

What is in AC –> Paclitaxel for Triple Negative Breast Cancer?

A
  • Doxorubicin [60mg/m2] Cyclophosphamide [600mg/m2], Pembrolizumab [200mg] repeating for 21d x4
  • Followed by: Paclitaxel [80mg/m2] with Pembrolizumab [200mg] every 3w to = 1y
41
Q

EXAMPLE: if a patient was HER2+ what chemotherapy regimen would be given?

A
  • Trastuzuamb + Pertuzuamb, Carboplatin, Doxetaxel
  • IF RESIDUAL = Ado-traztuzuamb emtansine
42
Q

What is the goal of metastatic disease?

A
  • GOAL is Palliation
  • If symptomatic = Chemotherapy
43
Q

How do we decide what to give to a patient with Metastatic Breast Cancer?

A
  • Hormonal: ER/PR+, Slow growth, Prior Therapy, Bone ONLY
  • Chemotherapy: ER/PR-, Fast Growth, Cant do Hormonal
44
Q

What are some of the options for Chemotherapy in Metastatic Breast Cancer?

A
  • Single VS Combo
  • TNBC
  • PD-L1?
  • HER2+
  • BRAC?
45
Q

What are the most common Single Agents that are used in Metastatic Breast Cancer?

A
  • Doxorubicin, Paclitaxel
46
Q

What is the HER2+ targeted regiemen for Metastatic Breast Cancer?

A
  • Tratuzuamb, Pertuzumab, Docetaxel
47
Q

What is the NEW Chemotherapy + HER2 treatment for Metastatic Breast Cancer?

A
  • Fam-trastuzumab Deruxtecan-nxki
48
Q

In what setting is Fam-trastuzumab Deruxtecan-nxki used?

A
  • HER2 Low Patients [when HER2 expression is +1 or +2]
49
Q

What is important about using Fam-trastuzumab Deruxtecan-nxki?

A
  • DESTINY-Breast04: show 12.1% Lung Disease???
50
Q

What is the recommended treatment for Metastatic Triple Negative Breast Cancer?

A
  • Platinum Agents [Carboplatin or Cisplatin]
51
Q

What are some of the Hormonal Therapies that are used in Metastatic Disease?

A
  • 1st Line: AI + CDK4/6 Inhibitor
  • 2nd Line: Fulvestrant + CDk4/6 Inhibitor OR Everolimus + Endocrine Therpay
52
Q

What is the role of Cyclin Dependent Kinases?

A
  • Promote G1 to S phase transition by phosphorylating the retinoblastoma
  • CDK4/6 are activated in ER+
53
Q

What are the CDK4/6 inhibitors that are used in Metastatic Breast Cancer?

A
  • AbemaCICLIB, PalboCICLIB, RiboCICLIB
54
Q

What are the important monitoring Parameters for the CDK4/6 Inhibitors in Metastatic Breast Cancer?

A
  • Complete Blood Counts
  • Diarrhea [Abemaciclib]
  • QTc Prolongation [Ribociclib]
55
Q

EXAMPLE: if a patient has eatly stage TNBC, what would be the chemotherapy course?

A
  • AC –> Paclitaxel + Pembro
  • Doxorubicin, Cyclophosphamide, Pembrolizumab repeatin 21d x4 THEN Paclitaxel + Pembrolizumab every 3w
56
Q

EXAMPLE: Women with early stage, ER/PR-, HER2+ disease, what is the chemotherapy course?

A
  • THC+P
  • Docetaxel, Carboplatin, Trastuzumab, Pertuzumab repeating 21d x4 THEN Trastuzumab + Pertuzumab
57
Q

EXAMPLE: Women has early stage, ER/PR+, HER- disease, what is the chemotherapy course?

A

?

58
Q

EXAMPLE: What is the 1st line treatment for ER/PR+, HER2- metastatic disease?

A
  • AI + CDK4/6 inhibitor [monitor for ~2 months]
59
Q

EXAMPLE: what is the treatment for HER2+, ER/PR- metastatic disease?

A
  • Docetaxel, Pertuzumab, Trastuzuamb [every 3w]

PHRM 864: Therapeutics IV (28 decks)

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