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Oncology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are the pathologic types of breast cancer?

A
  • Ductal carcinoma in situe (DCIS)
  • Lobular carcinoma in situ (LCIS)
  • Invasive ductal carcinoma
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2
Q

Endocrine Therapy

A
  • Deplete estrogen or block its effects
  • Cytostatic: Block progression through cell cycle
  • Started AFTER chemotherapy is complete
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3
Q

Selective Estrogen Receptor Modulator (SERM)

A
  • MOA: Competes w/ estradiol binding to estrogen receptors
  • Tamoxifen and Toremifene
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4
Q

What are some adverse effects of SERMs?

A
  • Hot flashes
  • Vaginal discharge/dryness
  • Irregular menses
  • Endometrial thickness
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5
Q

What are some serious adverse effects of SERMs?

A
  • Thromboembolism
  • Endometrial/uterine cancer
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6
Q

Tamoxifen

A

Significant drug interactions with CYP2D6 inhibitors
* ex: fluoxetine, paroxetine, and bupropion
* May prevent bone loss
* May lower total cholesterol

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7
Q

Aromatase inhibitors

A
  • Inhibit armotase
  • Should NOT be used as single agent therapy for premenopausal women
  • Exemestine, Anastrozole, Letrozole
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8
Q

Exemestine

A
  • Steroid (Type I)
  • Irreversibly and covalently inactivates the enzyme
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9
Q

Anastrozole, Letrozole

A
  • Non-steroidal (Type II)
  • Reversibly binds to the enzyme
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10
Q

What are the adverse effects of aromatase inhibitors?

A
  • Hot flashes
  • Arthralgias/myalgias
  • Bone loss with long-term use
  • Vaginal dryness
  • Headaches
  • Diarrhea
  • Mild nausea
  • Alopecia and hair thinning
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11
Q

What is the choice of endocrine therapy for premenopausal?

A
  • Tamoxifen for 5-10 years
    OR
  • Ovarian suppression or ablation PLUS either: Tamoxifen or AI
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12
Q

What is the choice of endocrine therapy for postmenopausal?

A
  • AI for 5-10 years
  • Other options:
    • Various schedules of AI to tamoxifen or tamoxifen to AI (continued for a total of 5-10 years)
    • Tamoxifen for 10 years (if contraindication to AI)
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13
Q

What are the common adjuvant chemotherapy regimens for HER- negative breast cancer?

A
  • AC followed by paclitaxel
    • AC = doxorubicin + cyclophosphamide
  • TC (docetaxel + cyclophosphamide)
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14
Q

What are the targeted therapy options for early stage HR + HER2- treatment?

A
  • Olaparib (PARP inhibitor)
  • Abemaciclib (CDK4/6 inhibitor)
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15
Q

Trastuzumab (Herceptin)

A
  • Use in all settings
  • Major adverse effects: Cardiac
  • Do NOT administer with an anthracycline
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16
Q

Pertuzumab (Perjeta)

A
  • Use in all settings
  • Use in combination with trastuzumab
  • Major adverse effect: cardiac
  • Do NOT give with an anthracycline
17
Q

Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo)

A
  • Use in all settings
  • Administer SQ
18
Q

Neratinib (Nerlynx)

A
  • Use as extended adjuvant therapy and metastatic disease
  • Administer orally
19
Q

What is the MOA of Neratinib?

A

Blocks ATP binding site on intracellular domain of HER2 molecule

20
Q

What are the toxicities of Neratinib and how do you prevent it?

A
  • Diarrhea, N/V, abdominal pain, rash, stomatitis, AST/ALT increase
  • Recommend prophylactic scheduled loperamide for 1st 8 weeks of treatment
21
Q

Ado-trastuzumab emtansine

A
  • Use in as adjuvant therapy (for residual disease) and for metastatic cancer
22
Q

Fam-trastuzumab deruxtecan-nxki (Enhertu)

A
  • Use in metastatic cancer
23
Q

Lapatinib (Tykerb)

A
  • Use in metastatic cancer
  • Administer orally
24
Q

Tucatinib

A
  • Use in metastatic cancer
  • Administer orally
25
Q

Margetuximab

A
  • Use in metastatic cancer
26
Q

What are some common adjuvant chemotherapy regimen for HER2 targeted therapy?

A
  • AC to taxane + concurrent trastuzumab +/- pertuzumab
  • TCH (docetaxel, carboplatin, and trastuzumab) +/- pertuzumab
  • Paclitaxel + trastuzumab (consider patient w/ low risk)
27
Q

What is the targeted therapy for HR- HER- treatment?

A
  • Olaparib (PARP inhibitor)
28
Q

What is the immunotherapy for HR- HER- treatment?

A

Pembrolizumab
* Continued with chemotherapy before surgery and continued as single agent after surgery
* Pembrolizumab + carboplatin + paclitaxel for 12 weeks to pembrolizumab + AC every 3 weeks for 4 cycles

29
Q

What is the 1st line treatment for HR+ HER2- Metastatic Breast Cancer of Endocrine targeted therapy?

A
  • CDK4/6 inhibitor + AI
  • CDK4/6 inhibitor + fulvestrant
30
Q

Palbociclib

A
  • CDK4/6 inhibitors for HR+ HER- metastatic cancer
  • Causes neutropenia
31
Q

Riboclicib

A
  • CDK4/6 inhibitors for HR+ HER- metastatic cancer
  • Causes neutropenia, hepatotoxicity, and QTc prolongation
32
Q

Abemaciblib

A
  • CDK4/6 inhibitors for HR+ HER- metastatic cancer
  • Causes neutropenia, diarrhea, VTE, hepatotoxicity
33
Q

Alpelisib

A
  • PI3K pathway inhibitor
  • Indicated in combination w/ fulvestrant for patients with:
    • HR+, HER-
    • PI3CA-mutated metastatic breast cancer
    • Following progression on or after an endocrine-based regimen
  • Causes hyperglycemia
34
Q

Capivasertib

A
  • PI3K/AKT/PTEN pathway inhibitor
  • Indicated in combination with fulvestrant for patients with:
    • HR+, HER2-
    • PIK3CA-, AKT1, and/or PTEN-mutated metastatic breast cancer
    • Following progression on or after an endocrine-based regimen
  • Following progression on or after an endocrine-based regimen
  • Causes hyperglycemia, rash
35
Q

Everolimus

A
  • mTOR pathway inhibitor
  • Inhibited in combination with endocrine therapy for patients with:
    • HR+, HER2-
    • Following progression on or after an endocrine-based regimen
  • Causes stomatitis

Oncology (14 decks)

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