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Therapeutics IV > Breast Cancer - Block 4 > Flashcards

Breast Cancer - Block 4 Flashcards

1
Q

What are the RF of breast cancer?

A
  1. Female
  2. Current hormone therapy
  3. Increasing age
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2
Q

What are the screening recommendation of ACS?

A

Breast self-exam: ≥20 YO optional
Clinical breast exam: N/A
Mammogram: 40-44 (optional annually)
* ≥55 YO Q2Y

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3
Q

What are the screening for USPTF?

A

Breast self-exam: Not recommended
Clinical breast exam: N/A
Mammogram: 40-50 (optional)
* 50-74 YO: Q2Y

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4
Q

What are the screening recommnedations of NCCN?

A

Breast self-exam: ≥25 breast awareness
Clinical breast exam: 25-39 YO Q1-3Y
Mammogram: ≥40 Y annually

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5
Q

How do you diagnose of breast cancer?

A
  1. Mammogram
  2. MRI if dense tissue
  3. Biopsy
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6
Q

What are the stages of breast cancer?

A

0: carcinoma in situ
1: Small and confined to breast
2: large tumor and/or local lymph node involvement
3: Tumor any size or direct extension into chest wall with more extensive lymph node involvement
4: metastases

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7
Q

What are the prognostic factors of breast cancer?

A
  1. Number of affected lymph nodes (most important)
  2. Age <35 YO
  3. Ethnicity: AA are more at risk
  4. Estrogen receptor/Progesterone receptor (ER/PR) Status (most favorable prognosis)
  5. HER-2/neu oncogene (most aggressive)
  6. Anti-HER2 therapy
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8
Q

Tx modalities for breast cancer?

A
  1. Surgery
  2. Neoadj
  3. Systemic adj (chemo and endocrine therapy)
  4. Radiation
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9
Q

What are the surgical options for breast cancer?

A
  1. Modified radical mastectomy
  2. Breast conserving therapy
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10
Q

Outline the modifiedradical mastectomy?

A

Removal of entire breast to maintain ROM and strengh
* Recommend for those with BRCA 1 o 2 mutations

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11
Q

Outline and indications of BCT therapy?

A

Must follow with radiation (3-5 wks) due to higher risk for local recurrance
Indication: must meet lumpectomy criteria (<5cm, no h/o radiation to the chest, only in one quadrant, positive margins, not pregnant or very early)
* Neoadjuvnt therapy is required

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12
Q

When is sentinel lymph node biopsy indicated?

A

Identified with radiologic dye
Preferred for stage 1-2

  • Reduces problems from lymph node the dissection such as lymphedema, sensory loss, pain
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13
Q

What are the RF of lymphedema?

A
  1. Extent of axillary surgery
  2. Axilliary radiation
  3. Infection
  4. Obesity
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14
Q

What are adj options?

A
  1. Hormone
  2. Chemo
  3. Radiation
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15
Q

Factors you need to consider for adjuvant therapy?

A
  1. ER/PR status
  2. HER2 status
  3. Menopause status
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16
Q

What is the tx option for tumors >1 cm or + lymph nodes?

A
17
Q

What are the preferred adj regimens for HER2- Stage 1-2?

A
  1. Dose dense AC followed by weekly paclitaxel
  2. Dose dense AC followed by q2week paclitaxel
  3. Doxetaxel, cyclophosphamide (TC)

AC: doxorubicin/cyclophosphamide

18
Q

What are the preferred adj regimens for HER2+ Stage 1-2?

A
  1. AC followed by paclitaxel + trastuzumab
  2. AC followed by paclitaxel + trastuzumab ± pertuzumab
  3. Docetaxel, carboplatin, trastuzumab (TCH) ± pertuzumab

AC: doxorubicin/cyclophosphamide

19
Q

What are the HER2 + tx options?

A
  1. Trastuzumab
  2. Pertuzumab
20
Q

How do you dose trastuzumab? ADRs?

A

Don’t administer with antracyclines
* Hypersensitivity >12hrs after admin

ADR: arthralgias, cardiac tox, infusion related rx

21
Q

Monitoring and ADRs of pertuzumab?

A

Monitoring: LVEF
ADRs: diarrhea, N, alopecia, PN, LV dysfunction, infusion rx

22
Q

Indications for adj endocrine therapy?

A
  1. Estrogen receptor
  2. Pregesterone receptor
  3. Cancer cells can have 1 receptor or both
23
Q

Types of adjuvant endocrine tx?

A
  1. Ovarian ablation
  2. Use of LH-RH agonists
  3. Use of aromatase inhibitors
  4. Use of SERM

Tx is based on pre/post menopausal

24
Q

What are is the adj endocrin tx for premenopausal?

A
25
Q

What are is the adj endocrin tx for postmenopausal?

A
26
Q

Antiestrogen types?

A
  1. Tamoxifen
  2. Fulvestrant
27
Q

ADRs and CP of tamoxifen?

A

ADR: VTE and uterine cancer
CP: DDI with paroxetine or fluoxetine
* CYP2D6 interaction decreases tomoxifen efficacy

28
Q

ADR and CP of fulvestrant?

A

ADR: VTE and increased LFTs
CP: used for progression only, no initial tx

29
Q

What are types of aromatase inhibitors?

A
  1. Anastrozol
  2. Letrozole
  3. Exemestane
30
Q

ADR and CP of aromatase inhibitors?

A

ADR: Arthralgias, decreased bone density, increased risk of fracture
CP: Supplemental calcium and vit D, may increase cholesterol

31
Q

Overall tx outline for adjuvant endocrine tx?

A
32
Q

Tx options for metastatic breast cancer?

A
  1. Surgery (supportive care)
  2. Radiation
  3. Endocrine therapy
  4. HER2 targeted
  5. Chemo
33
Q

Metastatic tx for pre menopausal?

A

If no endocrine tx within 1 year:
* 1st line tx is tamoxifen OR
* Ovarian suppression

If pt received endocrine tx within last year:
* Ovarian ablation/suppression with systemic therapy

34
Q

Metastatic tx for post menopausal?

A

AI + fulvestrant OR
AI + palbociclib

35
Q

What are preferred agents for metastatic chemo?

A
  1. Capcetibine
  2. Doxorubicin
  3. Gemcitabine
  4. Vinorelbine
  5. Paclitaxel
36
Q

Preferred agents for metastatic HER2 +?

A
  1. Pertuzumab, trastuzumab, docetaxel
  2. Pertuzumab, trastuzumab, paclitaxel
37
Q

Indications for radiation?

A
  1. After chemo
  2. After surgery
  3. Neoadj
  4. Local recurrance
  5. Palliative

Therapeutics IV (39 decks)

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