Breast Cancer Flashcards
Incidence of breast cancer
Life time risk 10%, 27% of cancers
What are the cellular origins of breast cancer?
Ductal, lobular, medullary
What are the drugs active against the HER2 receptor?
Tratuzumab (herceptin), Pertuzumab
What is palbociclib and ribocilib?
Inhibits CKD signalling pathways that are essential for cancer cell proliferation. Indication ER &/or PR positive HER2 neg, lumal subtype A.
What are the options for hormone therapy?
Surgery (oopherectomy) in premenopausal women
SERMs - Tamoxifen, toremifen, reloxifen
oestrogen receptor downregulator - Fluvestrat
Aromatase inhibitor - anastrazole, lesrozole, exametstone
LHRH agonist - leuprolide, goserelin
Describe the mechanism of action of tamoxifen
A selective oestrogen receptor modulator it acts as an anti-oestrogen in mammary tissue but actives oestrogen receptors in cholesterol metabolism, bone density and endometrial tissue.
What is the difference between tamoxifen and anastrazole?
Tamoxifen is a SERM with anti-oestrogen properties in mammary tissue. Anastrazole is an aromatase inhibitor which blocks the conversion of androgens to oestrogen in the peripheral tissues with less oestrogen the cancer cell receptor cannot be activated. Unlike tamoxifen there is no protection against bone density loss and cholesterol changes. Anastozole has better efficacy than tamoxifen and is preferred in the postmeopausal group.
How does goserelin work?
It is a GnRH agonist which works to decrease oestrogen production via negative feedback. Also used in prostate cancer
What is a oestrogen receptor downregulator and how does it work?
Fluvestrant used in postmenopausal women with ER positive breast cancer who have progressed on tamoxifen. It competitively binds to the oestrogen receptor, it has no agonist ability. Given IM monthly
What is the role of radiotherapy in breast cancer?
In patients with a curative intent it can be used with a lobectomy to achieve the same outcomes as a mastectomy while preserving breast tissue.
In palliative patients it can be used for symptomatic relief eg bony metastasise
