breast cancer + drugs Flashcards
most common form of malignancy in women, esp in this age
> 50s
RF
age
early menstruation
late menopause
older age at first completed pregnancy
FHx breast cancer
oral contraceptives
HRT
obesity
alcohol
what is non invasive breast cancer
aka ductal carcinoma in situ
cancer remains localised in the ducts
in most cases is the cancer invasive or non-invasive at time of diagnosis?
invasive - malignant cells able to spread beyond immediate area of tumour
Invasive breast cancer, where malignant cells spread beyond the ducts, can be defined as
- early breast cancer (stage 1-2)
- locally advanced disease (stage 3)
- advanced disease (stage 4)
is advanced disease curable
no
treatment aims to prolong survival, relieve symptoms, improve QOL
this should be used as initial adjuvant endocrine therapy in men and premenopausal women with oestrogen-receptor-positive invasive breast cancer.
tamoxifen
this biologic is recommended for the treatment of HER2-positive advanced breast cancer.
tratuzumab
how long should chemoprevention be continues for
5 years
options for chemoprevention (3)
tamoxifen
anastozole
rolixfene
when is tamoxifen recommended as chemoprevention
recommended for premenopausal women who do not have a history of, or increased risk of thromboembolic disease or endometrial cancer.
when is anastrozole recommended as chemoprevention
postmenopausal women who do not have severe osteoporosis
patient does not have severe osteoporosis so you would give anastrazole 5 yrs chemoprevention. but they do not want this. what can you give instead
tamoxifen as long as no history of or increased risk of thromboembolic disease or endometrial cancer
what is an option for chemo prevention [unlicensed indication] in postmenopausal women with a uterus who do not wish to take tamoxifen, unless there is a history or increased risk of thromboembolic disease.
raloxifene
Some treatments used in the management of breast cancer, such as….. or …. may lead to menopausal symptoms or early menopause, and women should be counselled about these side-effects prior to starting any of these treatments.
tamoxifen or ovarian function suppression
…. may be offered to relieve menopausal symptoms such as hot flushes in women with breast cancer who are not taking tamoxifen.
SRRIs
Selective serotonin re-uptake inhibitor (SSRIs) antidepressants may be offered to relieve menopausal symptoms such as hot flushes in women with breast cancer who are not taking tamoxifen.
However. these 3 are sometimes used for the treatment of hot flushes in women with breast cancer after discussion with the patient and information given about side effects.
Clonidine hydrochloride, venlafaxine [unlicensed indication] and gabapentin [unlicensed indication]
CI for anastrozole
do not give to premenopausal women
monitoring pt parameters anastrozole
asess BMD before treatment and at regular intervals for osteoporosos
MOA tamoxifen
An anti-oestrogen which induces gonadotrophin release by occupying oestrogen receptors in the hypothalamus, thereby interfering with feedback mechanisms; chorionic gonadotrophin is sometimes used as an adjunct in the treatment of female infertility.
what does tamoxifen increase risk of
Tamoxifen can increase the risk of thromboembolism particularly during and immediately after major surgery or periods of immobility (consider interrupting treatment and initiating anticoagulant measures).
risk of which cancer with tamoxifen?
Patients should be informed of the risk of endometrial cancer and told to report relevant symptoms promptly.
Increased endometrial changes, including hyperplasia, polyps, cancer, and uterine sarcoma reported; prompt investigation required if abnormal vaginal bleeding including menstrual irregularities, vaginal discharge, and pelvic pain or pressure in those receiving (or who have received) tamoxifen.
tamoxifen interactions
coumarins - increases AC effect, monitor INR
bupropion, fluoxetine, cinacalcet, paroxetine, terbinafine decreases efficacy of tamoxifen - avoid
these two antidepressants should not be used with tamoxifen as they decrease its efficacy
fluoextine
paroxetine
tamoxifen interaction with phenytoin and fosphwynhytoin
Tamoxifen (high-dose) might increase the concentration of Phenytoin and Phenytoin might decrease the concentration of Tamoxifen (high-dose). Manufacturer makes no recommendation.
