Breast Cancer

Question 1

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?

Answer 1

adjuvant endocrine therapy

Question 2

What entails adjuvant endocrine therapy for premenopausal women?

Answer 2

Tamoxifen x 5 years; re-evaluate for total of 10 years

Question 3

What entails adjuvant endocrine therapy for post menopausal women?

Answer 3

Aromatase inhibitor x 5 years; re-evaluate for total of 10 years
(letrozole, anastrazole, exemestane)
or Tamoxifen

Question 4

For patients that are ER/PR+ and HER2 - and tumor size > 0.5 cm; what does a score of RS > 26 indicate?

Answer 4

chemotherapy regimen followed by adjuvant endocrine therapy

Question 5

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?

Answer 5

chemotherapy then followed by adjuvant endocrine therapy (tamoxifen)

Question 6

What is indicated for a patient whom is ER/PR +, lymph node - or +, HER2+ and tumor size < 0.5 cm?

Answer 6

endocrine therapy +/- chemo + HER2 therapy

Question 7

What is indicated for a patient whom is ER/PR+, lymph node - or +, HER2+ and tumor size > 0.5 cm?

Answer 7

chemo + HER2 therapy followed by endocrine therapy

Question 8

What are the two most common chemotherapy regimens for HER2 negative patients?

Answer 8

AC dose dense
TC

Question 9

What is in the dose dense AC regimen?

Answer 9

doxorubicin and cyclophosphamide
followed with paclitaxel
-need to use CSFs

Question 10

What is in the TC regimen?

Answer 10

docetaxel and cyclophosphamide

Question 11

What pre-medications are needed with paclitaxel?

Answer 11

steroid (dexamethasone)
diphenhydramine
H2 antagonist
Why? Cremaphor can cause hypersensitivity reactions & is the solubilizer for paclitaxel

Question 12

What are the 3 most common chemotherapy dosing regimens for HER2+ patients?

Answer 12

APT
TCH
TCH + pertuzumab (P)

Question 13

What is the APT dosing regimen?

Answer 13

Paclitaxel
Trastuzumab
-complete out 1 year of trastuzumab

Question 14

What is the TCH dosing regimen?

Answer 14

Docetaxel
Carboplatin
Trastuzumab
-complete out 1 year of trastuzumab

Question 15

What is the TCH + P dosing regimen?

Answer 15

Docetaxel
Carboplatin
Trastuzumab
Pertuzumab
-complete out trastuzumab and pertuzumab

Question 16

What dosing regimens are used for triple negative breast cancer?

Answer 16

Pembrolizumub + Chemotherapy
-paclitaxel, carboplatin, pembrolizumub followed by doxorubicin, cyclophosphamide, pembrolizumab
-need to be positive for PD-L1 (score of 10 out of 100)

Question 17

What is preferred in the case of residual disease after surgery and patient is HER2+?

Answer 17

-give ado-trastuzumab emtansine (TDM-1)
-if no residual disease continue T & P for 1 year

Question 18

What is the course of therapy for metastatic disease and patient is ER/PR+, only bony mets, or asymptomatic?

Answer 18

endocrine therapy
if in bones add bisphosphonate or denosumab
-clinical trials

Question 19

What is the course of therapy for metastatic disease and patient is ER/PR-, symptomatic or hormone refectory?

Answer 19

HER2 therapy if + & +/- chemotherapy
or chemotherapy if HER2 -
-consider single agent chemotherapy

Question 20

What is recommended for 1st line HER2+ metastatic disease?

Answer 20

trastuzumab
pertuzumab
docetaxel/ paclitaxel

Question 21

In metastatic disease after failing 1st line and patient is HER2 low or + what is the new 2nd line?

Answer 21

Fam-trastuzumab deruxtecan
-monitor for SOB (interstitial lung disease)

Question 22

What is the hormonal therapy option in the metastatic setting?

Answer 22

1st line: aromatase inhibitor + CDK 4/6 inhibitor

Question 23

What side effects are considered with CDK4/6 inhibitors?

Answer 23

-all need CBCs (risk for neutropenia)
-Abemaciclib - diarrhea
-Ribociclib - QTc prolongation
Palbociclib - none (diarrhea ?)

Question 24

Woman with early stage, triple negative breast cancer. What would be her chemotherapy course?

Answer 24

Pembrolizumab + chemotherapy (paclitaxel, carboplatin; followed by doxorubicin, cyclophosphamide)

Question 25

Woman with early stage, ER/PR negative, HER2 positive disease. What would be her chemotherapy course?

Answer 25

TCH/P
trastuzumab, carboplatin, docetaxel, pertuzumab
APT
Paclitaxel, trastuzumab

Question 26

Woman with early-stage disease ER/PR positive, HER2 negative disease. What would be her treatment course?

Answer 26

Tamoxifen or AI
maybe chemo
AC dose dense or TC

Question 27

What would be the treatment for 1st line, ER/PR positive, HER2 negative metastatic disease?

Answer 27

Aromatase inhibitor + CDK 4/6 inhibitor

Question 28

What would be the treatment option for a patient with HER2 positive, ER/PR negative metastatic disease?

Answer 28

trastuzumab, pertuzumab, docetaxel