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BPT Oncology > Breast cancer > Flashcards

Breast cancer Flashcards

1
Q

What is the mean age at first diagnosis?

A

60 years

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2
Q

What are the screening programs in Aus?

A

Women aged 50-74 are invited for breast mammogram 2 years in Aus
- women aged 40-49 and >74 are not invited back have access to free screening

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3
Q

What clinical factors are associated with BRCA1/BRCA2 mutations?

A 
Invasive breast Ca <30 years
Triple negative breast ca <60 years
Male invasive breast ca at any age
Ovarian or primary peritoneal cancer
Ashkenazi Jewish heritage
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4
Q

What is the function of BRCA1 and BRCA 2?

A

Tumour suppressor gene - Doubled-stranded DNA repair

Presence of mutation predisposition to homologous recombination deficiency

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5
Q

What is the difference in phenotype of the cancers predisposed by BRCA 1 vs BRCA 2

A

BRCA1 typically associated with triple negative breast cancers

BRCA 2 typically associated with increased risk of hormone-receptor positive breast cancers

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6
Q

What are some management options for BRCA positivity?

A

Risk reducing bilateral mastectomy or salpingo-oophorectomy once childbearing is complete

Increase surveillance - from aged 30 including breast MRI

Chemoprevention with tamoxifen/ anastrozole or exemestane

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7
Q

Which class of drugs can be used in BRCA positive patients? Why does it work?

A

PARP inhibitors

Knocking off another DNA repair mechanism (via PARP) causes flooding of mutations and cell death

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8
Q

What are the general principles of management?

A

Stage I-III that is resectable - curative intent

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9
Q

What are the stages in breast Ca?

A

Stage I-II - no lymph node involvement

Stage III - LN mets

Stage IV - distant mets

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10
Q

What is the implication of oligometastatic disease?

A

Treat all the mets with local therapy eg stereotactic radiotherapy

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11
Q

How is oestrogen/progesterone receptor vs HER2-amplification expression identified?

A

IHC

FISH - HER2

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12
Q

Which hormone/HER2 subtype has the best prognosis?

A

Hormone receptor +

HER2 negative

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13
Q

What are the treatments per cancer type?

A

Hormone receptor pos, HER2 neg: Endocrine therapy (+/- chemotherapy)

HER2-positive: HER2-targeted therapies. Chemo +/- endocrine

Triple negative breast cancer: Chemotherapy

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14
Q

Which subtype has low vs high late recurrence?

A

Triple negative low,

Hormone receptor positive high

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15
Q

What is the most important factor in determining whether adjuvant chemo should be given in early stage?

A

Lymph node status

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16
Q

What is dose dense chemo?

A

Increasing dose intensity facilitated by GCSF

17
Q

Which targeted therapies targets HER2?

A

Trastuzumab

In selected high risk patients consider adding;
Lapatinib
Pertuzumab
Neratinib

18
Q

What adjuvant can you use in lower risk patients?

A

In patients with tumour size <3cm, node neg, and HER2 pos

- Paclitaxel for 12 weeks with trastuzumab

19
Q

What is the evidence for neoadjuvant?

A

No evidence currently

20
Q

What the benefits of neoadjuvants?

A

Identify high risk disease that may benefit from more intense treatment in adjuvant setting
Convert tumour from unresectable to resectable

21
Q

What are the adjuvant endocrine therapies?

A

Tamoxifen - selective oestrogen receptor modulator

Aromatase inhibitor - reduces oestrogen biosynthesis

22
Q

When can’t aromatase inhibitors be used?

A

Pre-menopausal women (unless ovarian function suppression is given) as there can be rebound increased oestrogen production

23
Q

What other adjuvant therapies are given?

A

Bisphosphonates

Denosumab

24
Q

Why might you rebiopsy a patient with new met. disease?

A

Genetic change with time

25
Q

What is the mechanism of CDK 4/6 inhibitor?

A

Cell cycle inhibition

26
Q

What are the CDK 4/6 inhibitors?

A

Palbociclib
Ribociclib
Abemaciclib

27
Q

What are the PI3-kinase inhibitors?

A

Alpelisib

28
Q

What are the SE’s of alpelisib

A

Rash
Hyperglycaemia
N/V and diarrhoea

29
Q

What is T-DM1? What are SE’s?

A

Trastuzumab conjugated to cytotoxic agent emtansine

Thrombocytopenia, liver toxicity

30
Q

When is T-DM1 used?

A

2nd line for HER2 positive metastatic breast Ca

31
Q

When is immune checkpoint blockage used in met. breast Ca?

A

Advanced triple negative breast cancer in combination with chemo

BPT Oncology (17 decks)

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