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Cancer Medicines > Breast Cancer > Flashcards

Breast Cancer Flashcards

Know the medications used for breast cancer treatment, when they are indicated, how to manage their side effects

1
Q

Risk factors for breast cancer

A
  • female
  • exposure to estrogen (including nulliparity, > 55 yo, HRT)
  • BRCA1 or BRC2
  • family history
  • prior chest irradiation

get mammogram at 40 - 50 yo

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2
Q

Stages of breast cancer

A

Stage 0: carcinoma in situ (DCIS)

Stage 1: small tumor, no lymph nodes

Stage 2: regional lymph nodes involved

Stage 3: lots of nodes

metastativ (IV): distant organs

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3
Q

Hormone Receptor (HR) + Treatment

A

Estrogen and Progesterone Receptor

Positive response to endocrine therapy

  • reduced risk of recurrence
  • decreased mortality

Duration:
minimum 5, max 10 years

slower treatment onset than chemo

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4
Q

Human Epidermal Growth Factor (HER2) + Treatment

A

Poor prognosis
Aggressive tumors

use HER2 targeting agents to decrease risk of disease recurrence

Recommended for metastatic: pertuzumab + trastuzumab + taxane

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5
Q

Neoadjuvant Therapy

A

systemic treatment prior to locoregional therapy

indicated to reduce tumor size/burden prior to surgery

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6
Q

Adjuvant Therapy

A

post-operative

used to eradicate all traces of tumor

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7
Q

Tamoxifen

A

Hormone TX

Can be used for all menopausal stages; SERM
(antag in breast and vagina, ag in bone and uterus)

  • *AEs**
  • hot flashes and night sweats
  • thromboembolic events
  • endometrial hyperplasia
    • DDIS **
  • CYP2D6 substrate, avoid with fluoxetine and paroxetine
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8
Q

Hormonal Therapy: Pre menopause

A

Tamoxifen +/- ovarian suppression (ovarian ablation)

aromatase inhibitor + ovarian suppression

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9
Q

Hormonal Therapy: Post-menopause

A

Tamoxifen

Aromatase inhibitors

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10
Q

Hormonal Therapy: Peri-menopause

A

Aromatase inhibitors
tamoxifen

consider switching when status changes

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11
Q

Pertuzumab

A

HER2 targeting; binds extracellular domain to prevent intracellular activation

    • AEs **
  • Infusion reactions
  • cardiotoxicity

** Monitoring **
LVEF

  • *Notes **
  • if patient has had previous infusion reaction, pre-med them for next time
  • always given with trastuzumab
  • do not give concurrently with anthracyclines unless you want to kill their heart
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12
Q

Trastuzumab (Herceptin)

A

HER2 targeting; binds extracellular portion to prevent intracellular activation

    • AEs **
  • infusion rxn
  • cardiomyopathy (arrhythmias, reduced ejection fraction)
  • *Monitoring **
  • LVEF
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13
Q

Anastrazole, Letrozole, Exemestane

A

aromatase inhibitors: inhibit peripheral conversion of androgens to estrogen

    • AEs **
  • hot flashes and night sweats
  • Osteoporosis & bone fractures
  • GI upset
    • DDIs **
  • Exemestane is a CYP3A4 substrate (increase dose with inducers)
  • take exemestane after food to increase AUC
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14
Q

Fulvestrant

A

Estrogen Receptor Antagonist

    • AEs **
  • hot flashes
    • Notes**
  • used in the setting of progressive dx, post aromatase inhib
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15
Q

Leuprolide and Goserelin

A

LHRH Agonists

to cause ovarian ablation

    • AEs **
  • hot flashes
  • mood swings
  • headache
  • injection site pain
    • Notes **
  • administered monthly to suppress estrogen levels
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16
Q

Doxorubicin (Adriamycin)

A

DNA intercalator, topoisomerase inhibitor

    • AEs **
  • N/V
  • Extravasation (vesicant)
  • irreversible cardiotoxicity
  • myelosuppression
  • Red discoloration of bodily fluids
  • alopecia
    • Monitoring Parameters **
  • LVEF at baseline
  • LFTs (adjust)
  • ANC/platelets
  • EKG if suspected heart problems
  • for fluid overload (HF)
  • monitor cumulative dose
    • Notes **
  • used in dose dense (ddAC) regimen = high emetogenicity)
  • may require G-CSF prophylactically
  • central line recommended (cold compress)
17
Q

Cyclophosphamide

A

DNA alkylator, metabolized to an acrolein

    • AEs **
  • N/V
  • hemorrhagic cystitis
  • myelosuppression
    • Monitoring Parameters **
  • SCr (adjust)
  • LFTs (adjust)
  • ANC/platelets
    • Notes **
  • Requires hydration 1 -2 days after
18
Q

Paclitaxel (Taxol)

A

taxane: microtubule stabilizer (too stable!!)

    • AEs **
  • Hypersensitivity (from cremophor)
  • peripheral neuropathy
  • alopecia
  • myelosuppression
    • Monitoring Parameters **
  • LFTs (adjust)
  • ANC/platelets
    • Administration **
  • premed with diphenhydramine, famotidine and dex to prevent cremophor reaction
19
Q

Docetaxel (Taxotere)

A

taxane: microtubule stabilizer

    • AEs **
  • Hypersensitivity (not as severe as paclitaxel)
  • Fluid retention
    • Monitoring Parameters **
  • LFTs (dose adjust)
  • ANC/platelets
    • Administration **
  • premed with dex to prevent fluid retention
20
Q

Palbociclib

A

selective CDK 4/6 inhibitor

used in combo with letrozole

for HR/ER-positive but HER2 negative breast cancer

21
Q

Dexrazoxane

A

anthracycline antidote (chelates)

  • helps with extravasation
  • cardioprotective for high dose anthracyclines
22
Q

Ado-trastuzumab

A

targeted cytotoxin (maytansine) delivery. it’s a microtubule inhibitor

    • AEs**
  • infusion reaction (fever, chills, dyspnea)
  • cardiotox
  • hepatotox
  • abdominal pain
  • diarrhea
  • peripheral neurop
  • thrombocytopenia
    • Monitoring**
  • LVEF
  • LFTs
  • ANC/platelets
    • Notes **
  • do not substitute for trastuzumab
23
Q

Lapatinib

A

binds tyrosine kinase to stop HER2 signaling

    • AEs **
  • diarrhea (within 6 days)
  • palmar-plantar erythrodyesthesia
  • hepatotox
  • cardiotox
    • Monitoring **
  • LVEF
  • QTc
  • electrolytes
  • LFTs (adjust)
    • Admin **
  • take on empty stomach (because food increases AUC)
    • DDIs **
  • CYP3A4 substrate
24
Q

MILD hypercalcemia of malignancy

A

Corrected calcium < 12 mg/dL

    • Treat **
  • hydration PO
  • the cancer
25
Q

Risk for hypercalcemia

A

breast cancer
lymphoma
multiple myeloma
renal cell

26
Q

MODERATE hypercalcemia of malignancy

A

Corrected Calcium: 12 - 14 mg/dL

may be asymptomatic

  • *Treatment**
  • Hydration IV
  • bisphosphonate IV
  • calcitonin (maybe)
  • treat the cancer
27
Q

SEVERE hypercalcemia of malignancy

A

Corrected Calcium > 14 mg/dL

    • Treatment **
  • Hydration IV
  • bisphosphonate IV
  • calcitonin
  • +/- dialysis
  • treat the cancer

Sx:

  • malaise/fatigue, lethargy
  • confusion, coma
  • N/V
  • costipation
  • shortened QTc interval
  • renal impairment
28
Q

Corrected calcium

A

= measured serum calcium + 0.8 * (4 - albumin)

29
Q

Calcitonin

A

** Indication **
Hypercalcemia of malignancy,; maybe moderate, definitely severe

** MOA **
Inhibition of bone resorption
Increased renal Ca excretion

    • AEs **
  • hypersensitivity
  • nausea

** Onset **
within 4 - 6 hours

    • Notes **
  • do not use as monotherapy, as it will cause tachyphylaxis w/in 2 days
30
Q

Bisphosphonates

A

** Preferred Agents **
Zoledronic Acid
Pamidronate

** Indication **
Hypercalcemia of malignancy; moderate and severe

** MOA **
Inhibits osteoclast bone resorption

  • *AEs**
  • nephrotox
  • infusion reaction
  • osteonecrosis (jaw!!)
    • Onset **
  • 2 - 4 days
  • peak at 5 - 7 days
    • Notes **
  • can be given concurrently with fluids and calcitonin
  • C/I in severe renal dx, use denosumab instead
31
Q

Normal Saline for hypercalcemia of malignancy

A
    • MOA **
  • want to increase calcium removal
  • *AEs**
  • fluid overload
    • Onset **
  • right then
    • Notes **
  • caution in CHF
  • caution if oliguric
32
Q

Denosumab

A
  • Indication **
    Refractory Hypercalcemia of malignancy: failed bisphosphonates

** MOA **
RANK-L mAb

  • *AEs**
  • bone pain
  • arthralgia
  • osteonecrosis)
    • Onset **
  • 3 days
  • peak: 9 days
    • Notes **
  • okay in chronic kidney dx (over bisphosphonates)
33
Q

Hemodialysis for hypercalcemia

A
    • indications **
  • oliguric renal failure
  • hydration is unsafe
  • severe sx refractory to tx

Cancer Medicines (9 decks)

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