Breast Cancer Flashcards
First line management for metastatic ER+ breast cancer
CDK 4/6 inhibitor + AI
Only CDK 4/6 inhibitor that is approved for monotherapy in the metastatic setting?
Abemaciclib
Which CDK4/6 inhibitor has the least incidence of neutropenia?
Abemaciclib
Fulvestrant is approved in first line metastatic breast cancer. It is most efficacious in what population?
Those without visceral metastases
What CDK4/6 inhibitor(s) have OS benefit in metastatic setting?
Ribociclib
and abemaciclib
You have a patient with ER+ metastatic breast cancer, previously treated with with anastrozole and develops progression. No comorbidities. What is best treatment option?
CKD4/6 inhibitor + Fulvestrant
Which CDK4/6 inhibitor has good CNS penetration?
Abemaciclib
Which CDK4/6 inhibitor has QTc prolongation?
Ribociclib
Which CDK4/6 inhibitor causes the most N/V/D?
Abemaciclib
What is the difference in treatment schedule between the CDK4/6 inhibitors?
Ribo and Palbo are 3 weeks on, 1 week off.
Abemaciclib is continuous
2nd line treatment for metastatic ER+ breast cancer without any targeted mutations?
Everolimus + Exemestane
2nd line treatment for metastatic ER+ breast cancer for those with PIK3CA mutations?
Alpelasib + fulvestrant
Second line treatment for ER+ metastatic breast cancer who develop ESR1 mutation?
Elacestant
SEcond line treatment for metastatic ER+ breast cancer who has a PTEN, PIK3CA, or AKT mutation?
Capivasertib + Fulvestrant
First line treatment for HER2+ metastatic breast cancer
THP
Docetaxel
Herceptin
Pertuzumab
SEcond line therapy for metastatic HER2+ breast cancer
Trastuzumab dereuxtecan
Third line therapy for HER2+ metastatic breast cancer
Trastuzumab emtansine TDM-1
Most significant toxicity seen with trastuzumab deruxtecan
Pneumonitis
Third line treatment(+) for HER2+ metastatic breast cancer, for those with CNS mets
Capecitabine, Tucatinib, Trastuzumab
Patient with metastatic HER2+ breast cancer previously treated with THP, Enhertu, TDM1, and Cape+Tucatinib+Trastuzumab. What are options for next line? (3)
Neratinib + Capecitabine
Margetuximab + Chemotherapy
Lapatinib + Chemo
You have a patient with triple positive metastatic breast cancer. You start them on THP. What else can you add for treatment?
AI. Don’t add CDK4/6 inhibitor
You have a patient with HER2+ metastatic breast cancer and are treating with THP. They have a BRCA1 mutation and ask about olaparib. can you use it?
Not with THP, hasn’t been studied
First line for metastatic TNBC with PD-L1 CPS >=10
Pembrolizumab + Chemo (Gem+Carbo or taxane)
First line for metastatic TNBC and PD-L1 CPS <10
Single agent chemotherapy
Taxanes, anthracyclines, gem+carbo
Third line treatment for metastatic TNBC who progressed on Chemo+Pembro and another chemo line.
Sacituzumab govitecan
Treatment options for patients with HER2- metastatic breast cancer with BRCA1/2 mutation?
Olaparib
Talazoparib
What is the indication for Enhertu in the HER2 low setting?
1-2 prior lines of chemo in the metastatic setting
Ways to stage a pregnant patient with breast cancer?
CXR with fetal shielding
RUQ US
Suspicious nodal disease: Axillary US and FNA
Avoid bone scans, breast MRI
What 4 breast cancer treatments is contraindicated during the entirety of a pregnancy?
Radiation
Methotrexate
Trastuzumab (oligohydramnios)
Endocrine therapy
You have a pregnant patient with new diagnosis of breast cancer and needs chemotherapy. When do you need to avoid chemo?
In first trimester and
Avoid after week 35 to avoid neutropenia during delivery
For ER+ male breast cancer, what consideration needs to be made for endocrine therapy?
If using an AI, need to use GnRH agonist.
Most use tamoxifen
You see a patient with 2 cm ER- PR- pure tubular carcinoma, Grade 3. What is the next step?
Repeat markers. Because tubular is a favorable histology and is almost never ER/PR negative