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Medical Oncology SCE > Breast Cancer > Flashcards

Breast Cancer Flashcards

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USMLE® Step 1 flashcards
1
Q

Name size of tumour in T stages T1-3

A

T1 <2cm, T2 2-5cm and T3 >5cm

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2
Q

Describe N1 stage

A

1-3 positive axillary LNs

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3
Q

Describe N1b stage

A

Internal mammary sentinel lymph node

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4
Q

Describe N1c stage

A

Up to 3 positive axillary lymph nodes + positive intramammary sentinel lymph nodes (ie. 1a+1b)

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5
Q

When might you offer neoadjuvant endocrine therapy and for how long?

A

Women for whom there is no definitive indication for chemotherapy where shrinkage is needed for BCS.

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6
Q

Who is likely to see shrinkage with neoadjuvant endocrine therapy, pre- or post- menopausal women.

A

Post menopausal women, shrinkage with neoadj ET as effective as NACT whereas NACT more effective in pre-menopausal women.

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7
Q

If LVEF drops below LLN (55%) on anti-HER2 therapy but remains >40%, what is the best next step?

A

Start ACEi, continue trastuzumab and arrange interval MUGA in 6-8 weeks.I

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8
Q

If LVEF drops below 40% on anti-HER2 therapy, what is the best next step?

A

Stop trastuzumab, start ACEi, refer to cardiology and MUGA in 6 weeks.

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9
Q

Describe the increase in chance of pCR with the addition of neoadjuvant immunotherapy in TNBC

A

51.2% with NACT alone, 64.8% with addition of immunotherapy.

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10
Q

What additional imaging should be considered in lobular carcinomas?

A

MRI breast as size often underestimated on other modalities, particularly if aiming for BCS.

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11
Q

How do you calculate NPI?

A

Maximum invasive cancer size (cm) x 0.2 + Lymph node stage (1= no LN involvement, 2= low axillary nodal involvement, 3= high axillary or IMN involvement) + grade

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12
Q

What NPI is considered low risk

A

<3.4

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13
Q

What NPI is considered high risk

A

> 5.4

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14
Q

When should Oncotype Dx be considered?

A

In patients with intermediate NPI with ER positive, HER2 negative disease.

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15
Q

What is the relative risk reduction with adjuvant tamoxifen in ER+ve disease?

A

41%

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16
Q

When would you consider a woman post menopausal?

A

FSH consistently >30 and no menstrual period for 1 year.

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17
Q

Which drugs would you consider if patients were struggling with hot flushes on endocrine therapy?

A

Venlafaxine, clonidine, gabapentin. Consider switch to tamoxifen if on AI.

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18
Q

When is abemaciclib licensed in the adjuvant setting?

A

> 4 axillary lymph nodes, 1-3 axillary lymph nodes AND/OR G3/T3

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19
Q

When would you consider 12 weeks of paclitaxel/trastuzumab in the adjuvant setting?

A

Lower risk T2N0 HER2 positive patients.

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20
Q

When would you give adjuvant radiotherapy despite mastectomy?

A

Mass >5cm (T3)

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21
Q

When would you consider omitting post operative radiotherapy in patients with BCS.

A

Age >65yrs, T1N0, ER+ve/HER2 -ve, G1-2, negative margins and willing to have adjuvant endocrine therapy.

22
Q

What is radiation recall dermatitis?

A

Inflammatory skin reaction at the site of previous RT, typically caused by chemotherapy (docetaxel is common).

23
Q

When should re-excision be considered in DCIS?

A

If margin is <1mm, 10mm margin preferred.

24
Q

When should radiotherapy be offered in DCIS?

A

In all patients undergoing BCS, if RT declined then endocrine therapy should be offered.

25
Q

What is the PFS of palbo vs letrozole alone?

A

27.8m vs 14.5m

26
Q

When is everolimus and examestane used in ER+ve metastatic disease?

A

On progression of CDK46i and non-steroidal AI in patients without symptomatic visceral disease.

27
Q

PFS for Docetaxel plus Phesgo vs Docetaxel alone

A

46.5m vs 40.8m

28
Q

When can Trastuzumab deruxtican be used in metastatic HER2 positive disease?

A

After 2 lines of anti-HER2 directed therapy, can’t be used in untreated or symptomatic brain metastases.

29
Q

When can trast/cape/tucatinib be used in metastatic HER2 positive disease?

A

After 2 lines of anti-HER2 directed therapy, as long as cape not used in first line.

30
Q

When can TNBC patients access Atezolizumab and Nab-Paclitaxel?

A

First line setting if PDL1 SP142 >1%

31
Q

What would you use in the first line for triple positive metastatic disease?

A

Docetaxel + Phesgo + AI

32
Q

When can TNBC patients access Pembrolizumab plus chemotherapy?

A

First line setting if PDL1 CPS >10

33
Q

When can sacituzumab govitecan be given in metastatic TNBC?

A

In 3rd line, must have had either NACT or adjuvant SACT and 1 line of treatment in metastatic setting or 2 lines in metastatic setting.

34
Q

What can be used in the metastatic setting when there is a concern for cardiotoxicity with antracycline but ongoing good clinical response?

A

Can used dextrazoxane before infusion to prevent chronic cumulative cardiotoxicity.

35
Q

What percentage of breast cancer cases are associated with BRCA?

A

4-6%

36
Q

Which BRCA mutation is more commonly associated with TNBC?

A

BRCA1

37
Q

When is Olaparib licensed in the adjuvant setting?

A

TNBC with residual disease post NACT. Or node positive/T2 disease having adjuvant chemotherapy.
HR positive disease (HER2 -ve) with >4 positive axillary LNs pre- chemotherapy or residual disease post NACT with CPS and EG (recurrence) score at least 3.

38
Q

Common side effects of olaparib?

A

Myelosuppression, nausea and fatigue.

39
Q

How do PARPi work?

A

Inhibit the repair of single strand DNA breaks. If unrepaired leads to dsDNA breast (which can’t be repaired in BRCA1/2 mutations due to deficiency in homologous recombination).

40
Q

When can Talozoparib be used in the metastatic setting?

A

In BRCAm cancer where they have had either anthracycline or taxane in the adjuvant, neoadjuvant or metastatic setting. If ER positive must have had appropriate endocrine therapy.

41
Q

If you have used olaparib in the adjuvant setting when can you use Talazoparib?

A

If progression is more than 12m since stopping olaparib.

42
Q

What reduces rate of premature ovarian failure following chemotherapy?

A

Administration of GNRH analogues (around 60% reduction).

43
Q

What is your lifetime risk of breast cancer if you carry a BRCA1 mutation?

A

Around 70%

44
Q

Is your lifetime risk of breast cancer higher with a BRCA1 or BRCA2 mutation

A

BRCA1

45
Q

What is the average 5yo OS for patient with low NPI?

A

93%

46
Q

What is the average 5yo OS for patient with intermediate NPI?

A

70-85%

47
Q

What is the average 5yo OS for patient with poor risk (high) NPI?

A

50%

48
Q

How would everolumus/examestane combination be changed in presence of ESR1 mutation?

A

Switch examestane backbone with fulvestrant

49
Q

What is denosumab?

A

RANK ligand cytokine inhibitor (monoclonal antibody) that reduces osteoclast recruitment, activation and function.

50
Q

What technique does the Oncotype assay use?

A

Reverse transcriptase polymerase chain reaction

51
Q

What is the most common resistance pathway for CDK4/6 inhibitors?

A

Loss of retinoblastoma (RB1)

52
Q

What percentage of breast tumours are related to tumour susceptibility genes?

A

20-25%

Medical Oncology SCE (27 decks)

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