Breast Cancer Flashcards
For patients that are ER/PR+ and HER2 - and tumor size < or > 0.5 cm what does a score of < 26 and over 50 years old indicate on the RT-PCR Assay?
adjuvant endocrine therapy
What entails adjuvant endocrine therapy for premenopausal women?
Tamoxifen x 5 years; re-evaluate for total of 10 years
What entails adjuvant endocrine therapy for post menopausal women?
Aromatase inhibitor x 5 years; re-evaluate for total of 10 years
(letrozole, anastrazole, exemestane)
or Tamoxifen
For patients that are ER/PR+ and HER2 - and tumor size > 0.5 cm; what does a score of RS > 26 indicate?
chemotherapy regimen followed by adjuvant endocrine therapy
For patients that are ER/PR+ and HER2 - and tumor size < or > 0.5 cm what does a score of 15-26 and under 50 years old indicate on the RT-PCR Assay?
chemotherapy then followed by adjuvant endocrine therapy (tamoxifen)
What is indicated for a patient whom is ER/PR +, lymph node - or +, HER2+ and tumor size < 0.5 cm?
endocrine therapy +/- chemo + HER2 therapy
What is indicated for a patient whom is ER/PR+, lymph node - or +, HER2+ and tumor size > 0.5 cm?
chemo + HER2 therapy followed by endocrine therapy
What are the two most common chemotherapy regimens for HER2 negative patients?
AC dose dense
TC
What is in the dose dense AC regimen?
doxorubicin and cyclophosphamide
followed with paclitaxel
-need to use CSFs
What is in the TC regimen?
docetaxel and cyclophosphamide
What pre-medications are needed with paclitaxel?
steroid (dexamethasone)
diphenhydramine
H2 antagonist
Why? Cremaphor can cause hypersensitivity reactions & is the solubilizer for paclitaxel
What are the 3 most common chemotherapy dosing regimens for HER2+ patients?
APT
TCH
TCH + pertuzumab (P)
What is the APT dosing regimen?
Paclitaxel
Trastuzumab
-complete out 1 year of trastuzumab
What is the TCH dosing regimen?
Docetaxel
Carboplatin
Trastuzumab
-complete out 1 year of trastuzumab
What is the TCH + P dosing regimen?
Docetaxel
Carboplatin
Trastuzumab
Pertuzumab
-complete out trastuzumab and pertuzumab
What dosing regimens are used for triple negative breast cancer?
Pembrolizumub + Chemotherapy
-paclitaxel, carboplatin, pembrolizumub followed by doxorubicin, cyclophosphamide, pembrolizumab
-need to be positive for PD-L1 (score of 10 out of 100)
What is preferred in the case of residual disease after surgery and patient is HER2+?
-give ado-trastuzumab emtansine (TDM-1)
-if no residual disease continue T & P for 1 year
What is the course of therapy for metastatic disease and patient is ER/PR+, only bony mets, or asymptomatic?
endocrine therapy
if in bones add bisphosphonate or denosumab
-clinical trials
What is the course of therapy for metastatic disease and patient is ER/PR-, symptomatic or hormone refectory?
HER2 therapy if + & +/- chemotherapy
or chemotherapy if HER2 -
-consider single agent chemotherapy
What is recommended for 1st line HER2+ metastatic disease?
trastuzumab
pertuzumab
docetaxel/ paclitaxel
In metastatic disease after failing 1st line and patient is HER2 low or + what is the new 2nd line?
Fam-trastuzumab deruxtecan
-monitor for SOB (interstitial lung disease)
What is the hormonal therapy option in the metastatic setting?
1st line: aromatase inhibitor + CDK 4/6 inhibitor
What side effects are considered with CDK4/6 inhibitors?
-all need CBCs (risk for neutropenia)
-Abemaciclib - diarrhea
-Ribociclib - QTc prolongation
Palbociclib - none (diarrhea ?)
Woman with early stage, triple negative breast cancer. What would be her chemotherapy course?
Pembrolizumab + chemotherapy (paclitaxel, carboplatin; followed by doxorubicin, cyclophosphamide)
Woman with early stage, ER/PR negative, HER2 positive disease. What would be her chemotherapy course?
TCH/P
trastuzumab, carboplatin, docetaxel, pertuzumab
APT
Paclitaxel, trastuzumab
Woman with early-stage disease ER/PR positive, HER2 negative disease. What would be her treatment course?
Tamoxifen or AI
maybe chemo
AC dose dense or TC
What would be the treatment for 1st line, ER/PR positive, HER2 negative metastatic disease?
Aromatase inhibitor + CDK 4/6 inhibitor
What would be the treatment option for a patient with HER2 positive, ER/PR negative metastatic disease?
trastuzumab, pertuzumab, docetaxel
