breast cancer + drugs

Question 1

most common form of malignancy in women, esp in this age

Answer 1

> 50s

Question 2

RF

Answer 2

age
early menstruation
late menopause
older age at first completed pregnancy
FHx breast cancer
oral contraceptives
HRT
obesity
alcohol

Question 3

what is non invasive breast cancer

Answer 3

aka ductal carcinoma in situ
cancer remains localised in the ducts

Question 4

in most cases is the cancer invasive or non-invasive at time of diagnosis?

Answer 4

invasive - malignant cells able to spread beyond immediate area of tumour

Question 5

Invasive breast cancer, where malignant cells spread beyond the ducts, can be defined as

Answer 5

• early breast cancer (stage 1-2)
• locally advanced disease (stage 3)
• advanced disease (stage 4)

Question 6

is advanced disease curable

Answer 6

no
treatment aims to prolong survival, relieve symptoms, improve QOL

Question 7

this should be used as initial adjuvant endocrine therapy in men and premenopausal women with oestrogen-receptor-positive invasive breast cancer.

Answer 7

tamoxifen

Question 8

this biologic is recommended for the treatment of HER2-positive advanced breast cancer.

Answer 8

tratuzumab

Question 9

how long should chemoprevention be continues for

Answer 9

5 years

Question 10

options for chemoprevention (3)

Answer 10

tamoxifen
anastozole
rolixfene

Question 11

when is tamoxifen recommended as chemoprevention

Answer 11

recommended for premenopausal women who do not have a history of, or increased risk of thromboembolic disease or endometrial cancer.

Question 12

when is anastrozole recommended as chemoprevention

Answer 12

postmenopausal women who do not have severe osteoporosis

Question 13

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

Answer 13

tamoxifen as long as no history of or increased risk of thromboembolic disease or endometrial cancer

Question 14

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.

Answer 14

raloxifene

Question 15

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.

Answer 15

tamoxifen or ovarian function suppression

Question 16

…. may be offered to relieve menopausal symptoms such as hot flushes in women with breast cancer who are not taking tamoxifen.

Answer 16

SRRIs

Question 17

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.

Answer 17

Clonidine hydrochloride, venlafaxine [unlicensed indication] and gabapentin [unlicensed indication]

Question 18

CI for anastrozole

Answer 18

do not give to premenopausal women

Question 19

monitoring pt parameters anastrozole

Answer 19

asess BMD before treatment and at regular intervals for osteoporosos

Question 20

MOA tamoxifen

Answer 20

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.

Question 21

what does tamoxifen increase risk of

Answer 21

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).

Question 22

risk of which cancer with tamoxifen?

Answer 22

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.

Question 23

tamoxifen interactions

Answer 23

coumarins - increases AC effect, monitor INR
bupropion, fluoxetine, cinacalcet, paroxetine, terbinafine decreases efficacy of tamoxifen - avoid

Question 24

these two antidepressants should not be used with tamoxifen as they decrease its efficacy

Answer 24

fluoextine
paroxetine

Question 25

tamoxifen interaction with phenytoin and fosphwynhytoin

Answer 25

Tamoxifen (high-dose) might increase the concentration of Phenytoin and Phenytoin might decrease the concentration of Tamoxifen (high-dose). Manufacturer makes no recommendation.