Breast Cancer: Approaches to Breast Cancer Treatment

Question 1

What is the GAIL score

Answer 1

Statistical model/tool using a women’s own personal information to estimate risk of developing breast cancer over a specific period of time using: age, age for first menstruation, age of first live birth, number of first degree relatives with breast cancer, number of previous breast biopsies

Question 2

What are risk factors of the the GAIL score, what does the GAIL score not accurately estimate

Answer 2

Heredity, hormonal, pathologic/women carrying a breast-cancer-producing mutation, women with a previous history of invasive or in situ breast cancer, women in certain other subgroupes

Question 3

What type of breast cancer drug is tamoxifen, what is it used for

Answer 3

Adjuvant therapy used to treat node-negative positive and early/advanced disease/prevention for women at high risk

Question 4

T/F: Tamoxifen is usually used in premenopausal patients while aromatase is usually used in postmenopausal patients BUT there can be crossover

Answer 4

True

Question 5

T/F: Raloxifene is MORE bioavailable than tamoxifen

Answer 5

False: Tamoxifen is MORE bioavailable than raloxifene (has a lower doses need to reach its effect)

Question 6

Which of the SERMs is safer, how

Answer 6

Raloxifene, less in risk of thromboembolic events and uterine cancer

Question 7

What is the aromatase inhibitors that is shown to prevent breast cancer BUT is NOT APPROVED BY the FDA

Answer 7

Exemestane, anastrozole,letrozole

Question 8

What enzyme is tamoxifen dependent on

Answer 8

2D6

Question 9

T/F: Estrogen and ethinylestradiol are effective in patients with resistant breast cancer but is not usually used due to the side effects

Answer 9

True

Question 10

For patients who are estrogen receptor positive what is the best course of action

Answer 10

Endocrine therapy plus herceptin

Question 11

For patients who are positive with HER2 overexpression what is the best course of action

Answer 11

Targeted therapy plus herceptin

Question 12

What is HER2

Answer 12

A tyrosine kinase growth factor receptor that must dimerize to signal with another HER that binds a ligand

Question 13

What monoclonal antibody binds to the ligand binding domain of HER and blocks a signal, what is it indicated for, treatment. monitoring parameters

Answer 13

Trastuzumab (Herceptin), indicated in HER2 (overexpressed or amplified) or neutral, one year, cardiotoxicity

Question 14

What class of drugs is trastuzumab never admnistered with

Answer 14

Anthracyclines

Question 15

What monoclonal antibody prevents HER2:HER3 dimerization, what drugs are given simultaneously, adverse effects

Answer 15

Pertuzamab (Perjeta), trastuzumab and docetaxel/paclitaxel, cardiotoxicity and CBC in combination with docetaxel

Question 16

What is the monoclonal antibody that is a combination of binding HER and introduces a microtubule agent, indication, adverse effects

Answer 16

Trastuzumab/Emtansine (Kadcyla), indicated following a failure of trastuzumab and taxane/ thrombocytopenia, LFTs, peripheral neuropathies, cardiac function, hypersensitivity reactions

Question 17

What is the tyrosine kinase inhibitor that works intracellularly to block HER2 and EGFR/HER1, what drugs can it be taken with, BBW, toxicities, drug-drug interactions

Answer 17

Lapatinib, capecitabine and letrozole, Hepatoxicity, diarrhea rash and cardiotoxicity, Strong 3A4 inhibitor

Question 18

Which tyrosine kinase inhibitor inhibits HER and ER crosstalk leading to more comprehensive antitumor activity, BBW, drug drug interactions

Answer 18

Neratinib (Nerylnx), Heptatoxicity, Strong CYP3A4 inhibitor and inducer

Question 19

What mTOR inhibitor is used in breast cancer, which cases

Answer 19

Everolimus- combination with aromatase inhibitor or tamoxifen in hormone receptor positive AND in HER2 positive patients

Question 20

What CDK4/6 inhibitors are used in breast cancer, which cases

Answer 20

Abemaciclib, Ribociclib, Palbociclib- used in combination with aromatase inhibitors or fulvesterant (SERD) in hormone positive/HER2 negative patients WITH metastatic breast cancer

Question 21

What is the MOA of CDK4/6, adverse effects

Answer 21

Blocks G1 to S cell cycle transition/ myelosupression, N/V, diarrhea, stomatis, fatigue

Question 22

What is the endocrine therapy considerations when ER is positive and premenopausal/postmenopausal

Answer 22

Tamoxifen and LHRH agonist/ Aromatase inhibitors (preferred): Exemestane (sterodial) OR anastrozole or letrozole (nonsterodial) plus tamoxifen

Question 23

T/F: Tamoxifen therapy should be given concurrently with chemotherapy

Answer 23

False: Tamoxifen therapy should NOT be given with chemotherapy, chemotherapy administered first THEN endocrine therapy

Question 24

What are the PARP inhibitors, when are they used

Answer 24

Olaparib, talazoparib, rucaparib/ treatment for triple negative breast cancer with BRCA mutations

Question 25

What are the side effects of the PARP inhibitors

Answer 25

Nausea, fatigue, abdominal pain, vomiting, upper respiratory tract infection, anemia

Question 26

What is the immunotherapy combination approved as first line option for patients with advanced triple-negative breast cancer (inoperable or metastatic)

Answer 26

Atezolizumab and nab-paclitaxel chemotherapy for

Question 27

What is the FDA approved drugspecifically for patients with a PIK3CA mutation in hormone positive/HER2 negative advanced breast cancer

Answer 27

Novartis piqray

Question 28

What are the approved regimens for patients who are HER2 positive AND hormone receptor negative, trastuzumab exposed

Answer 28

Pertuzumab/trastuzumab/taxane (preferred) OR trastuzumab plus or minus chemotherapy/ trastuzumab and emantansine (preferred) OR lapatinib and caecitabine

Question 29

What are the approved regimens for patients who are HER2 positvie AND hormone receptor positive

Answer 29

Endocrine therapy (1st line), trastuzumab plus anastrozole, lapatinib and letrozole

Question 30

What is oncotype DX

Answer 30

a recurrence score based on 21 genes (16 cancer and 5 reference genes from studies) and determines whether a patient requires chemotherapy or not