Breast Cancer Drugs Flashcards
(26 cards)
1
Q
Treatment of cancer
A
Hormone therapy
- Estrogen-sensitive breast cancer
- Anti-estrogen: Tamoxifen, Raloxifen
- Aromatase inhibitors
Targeted therapy
- Trastuzumab (Herceptin)
2
Q
Hormone Therapy
- Antiestrogen
- Aromatase Inhibitor - 1st line
A
Antiestrogen
- Tamoxifen - Nolvadex
- Toremifene - Fareston
- Raloxifen - Evista
Aromatase Inhibitors
- Anastrozole - Arimidex
- Letrozole - Femara
- Exemestane - Aromasin
3
Q
Nolvadex
- MOA
- Dose
- PRE-menopausal
- POST-menopausal
- SEs
A
Tamoxifen
- MOA: STIMULATES uterine estrogen receptors
Dose
- 20 mg BID in PRE-menopausal
- 10 mg BID or 20 mg QD in POST-Menopausal
SEs
- Hot flashes, breast pain, wt gain, HA, edema, nausea
- ** Thrombo-embolism
- Endometrial cancer
- Menstrual irregularities, hyperCa, bone loss, cataracts, tumor flare
4
Q
Nolvadex
DDI
- Strong 2D6 inhibitors
- Mod 2D6 inhibitors
- Alternative
A
Tamoxifen
- Is a prodrug convert by 2D6
- Strong 2D6 inhibitors: paroxetin, fluoxetin
- Mod 2D6 inhibitors: setraline, duloxetine, amiodarone
Alternative:
- Switch tamoxifen to aromatase inhibitor (anastrozole), but it’s not for PRE-manopausal
- SSRIs or venlafaxine, desvenlafaxine, wellbutrin, bupropion
5
Q
Evista
- Indication
A
Raloxifene
- I: reduce risk of breast cancer. Only for postmenopausal women
6
Q
Evista
- MOA
- Indication
- FDA approved:
- BBW
A
Raloxifense
- MOA: BLOCKS estrogen receptor
- Indication: to reduce risk of breast cancer
- FDA approved: POSTmenopausal women with osteoporosis with high risk of breast cancer. NOT for PRE-menopausal women
- BBW: blood clot and stroke => d/c 72H b/4 prolonged immobility
- An alternative to tamoxifen to REDUCE breast cancer in post-menopausal
7
Q
Raloxifense and Tamoxifen Comparison
A
- Raloxifene is less likely to lead to uterine cancer, hysterectomy, or cataracts
- Raloxifense box warning: blood clot and stroke => d/c 72H b/4 prolonged immobility
- Tamoxifen STIMULATES uterine estrogen receptors while Raloxifense BLOCKs them
- Both increase risk of blood clot but Raloxifense is less likely
- If pt switches from tamoxifen to Evista, the clock does NOT start over. Pt should be on these drugs for 5-10 yrs
8
Q
Arimedex
- Class:
- Dose
A
Anastrozole
- Aromatase Inhibitors
- 1mg PO QD
9
Q
Femara
- Class:
- Dose
A
Letrozole
- Aromatase Inhibitors
- Dose: 2.5mg QD
10
Q
Aromasin
- Class:
- Dose
A
Exemestane
- Aromatase Inhibitors
- Dose: 25mg QD
11
Q
Aromatase Inhibitors
- SEs
- DDI
- Advantage over tamoxifen
A
- SEs: hot flashes, tumor flare, HA, wt gain, vaginal bleeding, GI upset
- DDI: Tamoxifen decreases aromatase inhibitors
Adv:
- No hyperCa++
- No thromboembolism
- No endometrial cancer
12
Q
Fareston
- Class
- Dose
A
Toremifene
- Class: Anti-estrogen
- Dose: 60mg QD
13
Q
EGFR
A
- Epidermal Growth Factor Receptor
14
Q
Herceptin
A
Trastuzumab
15
Q
Herceptin
- Class:
- Indication
- Dosage form:
- Duration of treatment
A
Trastuzumab
- Class: Monoclonal antibody
- I: Herceptin + Paclitaxel = 1st line tx of HER-2 overexpressing metastatic breast cancer & HER-2 + metastatic stomach cancer
- DF: injection
Dose
- Initial: 4mg/kg IV infusion over 90 min
- Then: 2mg/kg IV over 30 min weekly x 51 weeks
- Total is 52 weeks
16
Q
HerCePtIn = Herceptin
- SE
- BBW
A
Trastuzumab
SE:
- Flu like symptoms: 40%
- Fever, chills
- N/V
- Diarrhea, infection, rash, increase cough, HA, fatigue, SOB, low white and RBC
BBW
- Cardiotoxicity = C
- Pulmonary toxicity = P
- Infusion rxn: SOB => stop drug => when pt feels better => continue
17
Q
Perjeta
- Indication:
- Dosage Form:
A
Pertuzumab
- Indication: Combo Perjeta + Herceptin + docetaxel for tx of HER-2 + metastatic breast cancer who HAVE NOT received prior anti-HER-2 therapy or chemo
- Dosage Form: IV only
18
Q
Kadcyla
- Indication
- Dose Form
- Boxed Warning
A
Ado-Trastuzumab emtansine
- I: tx of HER-2 + metastatic breast cancer who PREVIOUSLY received HERCEPTIN + TAXANE
- DF: IV only
BW:
- Hepatotoxicity
- Cardiac (L.V dysfxn)
- Embryo-fetal toxicity
19
Q
Ixempra
A
Ixabepilone
20
Q
Ixempra
- Class:
- Indication:
- Dosage form:
- Vial contain:
- Pretreatment with:
- DDI:
A
Ixabepilone
- Class: Epothilone microtubule inhibitor
- I: Tx of metastatic or locally adv breast cancer in pts whose tumors are resistant or refractory or anthracyclines, taxanes, and capecitabine
- DF: Vial and powder for IV
- Contain EtOH and castor oil
- Pretx with H1 and H2 1H prior to infusion and w/ steroid if hypersensitivity rxn occurs
- DDI: avoid CYP 3A4 inhibitors/inducers
21
Q
Ixempra - IxabepiLoNE
- CI
A
CI
- Liver fxn
- Neutrophils: CI if neutrophil less than 1500 and platelets less than 100000
22
Q
Tykerb
- Indication:
- SEs
A
Lapatinib
- I: breast cancer
SEs
- Diarrhea, hand/food syndrome
- Decrease LVEF
- QT prolongation
23
Q
Halaven
- MOA
- Indication:
A
Eribulin
- MOA: Microtubule inhibitor
- I: Pts w/ metastatic breast cancer who have received at least 2 prior chemo regimens for late-stage disease
24
Q
Faslodex (Fulvestrant)
- Dosage form
- MOA
- Indication:
- Hepatic adjustment
A
Fulvestrant
- Give IM Once a month
- MOA: estrogen receptor antagonist
- I: hormone receptor + metastatic breast cancer in postmenopausal women with disease progression following antiestrogen therapy
- Hepatic: cut dose by 1/2
25
Faslodex
- Warning
- ADES
Fulvestrant
Warning/Precaution
- Bleeding
- Thrombocytopenia
SEs
- Inj site rxn, GI upset, bone pain, HA, back pain, fatigue, pain in extremity, hot flash, anorexia, musculoskeletal pain, cough, dyspnea, constipation, increased hepatic enzymes
26
Megace
- Indication
- SEs
Megestrol
- Progestin => Increase appetite = wt gain
Indications:
- Palliative tx of advanced breast
- Endometrial cancer
- Stimulate appetite
Dose
- Breast: 40 mg BID
- Endometrial: 40-320 mg in divided doses
SEs
- Thromboembolism
- HF
- Breakthrough bleeding
- HyperG
- HyperTN
- Wt gain
- Hot flashes
