Breast Cancer: Approaches to Breast Cancer Treatment Flashcards
What is the GAIL score
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
What are risk factors of the the GAIL score, what does the GAIL score not accurately estimate
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
What type of breast cancer drug is tamoxifen, what is it used for
Adjuvant therapy used to treat node-negative positive and early/advanced disease/prevention for women at high risk
T/F: Tamoxifen is usually used in premenopausal patients while aromatase is usually used in postmenopausal patients BUT there can be crossover
True
T/F: Raloxifene is MORE bioavailable than tamoxifen
False: Tamoxifen is MORE bioavailable than raloxifene (has a lower doses need to reach its effect)
Which of the SERMs is safer, how
Raloxifene, less in risk of thromboembolic events and uterine cancer
What is the aromatase inhibitors that is shown to prevent breast cancer BUT is NOT APPROVED BY the FDA
Exemestane, anastrozole,letrozole
What enzyme is tamoxifen dependent on
2D6
T/F: Estrogen and ethinylestradiol are effective in patients with resistant breast cancer but is not usually used due to the side effects
True
For patients who are estrogen receptor positive what is the best course of action
Endocrine therapy plus herceptin
For patients who are positive with HER2 overexpression what is the best course of action
Targeted therapy plus herceptin
What is HER2
A tyrosine kinase growth factor receptor that must dimerize to signal with another HER that binds a ligand
What monoclonal antibody binds to the ligand binding domain of HER and blocks a signal, what is it indicated for, treatment. monitoring parameters
Trastuzumab (Herceptin), indicated in HER2 (overexpressed or amplified) or neutral, one year, cardiotoxicity
What class of drugs is trastuzumab never admnistered with
Anthracyclines
What monoclonal antibody prevents HER2:HER3 dimerization, what drugs are given simultaneously, adverse effects
Pertuzamab (Perjeta), trastuzumab and docetaxel/paclitaxel, cardiotoxicity and CBC in combination with docetaxel
What is the monoclonal antibody that is a combination of binding HER and introduces a microtubule agent, indication, adverse effects
Trastuzumab/Emtansine (Kadcyla), indicated following a failure of trastuzumab and taxane/ thrombocytopenia, LFTs, peripheral neuropathies, cardiac function, hypersensitivity reactions
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
Lapatinib, capecitabine and letrozole, Hepatoxicity, diarrhea rash and cardiotoxicity, Strong 3A4 inhibitor
Which tyrosine kinase inhibitor inhibits HER and ER crosstalk leading to more comprehensive antitumor activity, BBW, drug drug interactions
Neratinib (Nerylnx), Heptatoxicity, Strong CYP3A4 inhibitor and inducer
What mTOR inhibitor is used in breast cancer, which cases
Everolimus- combination with aromatase inhibitor or tamoxifen in hormone receptor positive AND in HER2 positive patients
What CDK4/6 inhibitors are used in breast cancer, which cases
Abemaciclib, Ribociclib, Palbociclib- used in combination with aromatase inhibitors or fulvesterant (SERD) in hormone positive/HER2 negative patients WITH metastatic breast cancer
What is the MOA of CDK4/6, adverse effects
Blocks G1 to S cell cycle transition/ myelosupression, N/V, diarrhea, stomatis, fatigue
What is the endocrine therapy considerations when ER is positive and premenopausal/postmenopausal
Tamoxifen and LHRH agonist/ Aromatase inhibitors (preferred): Exemestane (sterodial) OR anastrozole or letrozole (nonsterodial) plus tamoxifen
T/F: Tamoxifen therapy should be given concurrently with chemotherapy
False: Tamoxifen therapy should NOT be given with chemotherapy, chemotherapy administered first THEN endocrine therapy
What are the PARP inhibitors, when are they used
Olaparib, talazoparib, rucaparib/ treatment for triple negative breast cancer with BRCA mutations
What are the side effects of the PARP inhibitors
Nausea, fatigue, abdominal pain, vomiting, upper respiratory tract infection, anemia
What is the immunotherapy combination approved as first line option for patients with advanced triple-negative breast cancer (inoperable or metastatic)
Atezolizumab and nab-paclitaxel chemotherapy for
What is the FDA approved drugspecifically for patients with a PIK3CA mutation in hormone positive/HER2 negative advanced breast cancer
Novartis piqray
What are the approved regimens for patients who are HER2 positive AND hormone receptor negative, trastuzumab exposed
Pertuzumab/trastuzumab/taxane (preferred) OR trastuzumab plus or minus chemotherapy/ trastuzumab and emantansine (preferred) OR lapatinib and caecitabine
What are the approved regimens for patients who are HER2 positvie AND hormone receptor positive
Endocrine therapy (1st line), trastuzumab plus anastrozole, lapatinib and letrozole
What is oncotype DX
a recurrence score based on 21 genes (16 cancer and 5 reference genes from studies) and determines whether a patient requires chemotherapy or not
