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PHRM 864 therapeutics > Breast Cancer Therapeutics > Flashcards

Breast Cancer Therapeutics Flashcards

1
Q

what are risk factors for breast cancer

A

Age
Family history
Radiation
Estrogen Exposure (endogenous)
Alcohol
Nulliparity
Elevated BMI

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2
Q

what are the tumor suppressor genes associated with breast cancer?

A

BRCA-1 and BRCA-2

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3
Q

what are the two most common invasive cancer spots in breast cancer?

A

lobes
ducts

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4
Q

what is an invasive carcinoma

A

invaded beyond the basement membrane of the duct or lobule

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5
Q

what are the non invasive breast cancers

A

ductal carcinoma in situ
lobular carcinoma in situ
inflammatory

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6
Q

what is the most aggressive form of breast cancer

A

inflammatory

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7
Q

describe inflammatory breast cancer

A

aggressive, rapid onset
poor prognosis
onset is days and weeks
orange peel look

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8
Q

how to test for HER2 status

A

IHC or FISH testing

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9
Q

what is oncotype DX

A

-genetic test for expression of 21 genes which fives recurrence score
-can determine if cancer will return and if patient will benefit from chemo

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10
Q

what is treatment for a low risk (< 26) for oncotype DX

A

hormonal therapy only

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11
Q

what is treatment for a high risk (>=26) for oncotype DX

A

chemo and HRT

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12
Q

will women < 50 w/ score of 16 to 25 benefit from chemo?

A

yes they will benefit

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13
Q

general treatment strategies for breast cancer stages I, II, IIIA

A

breast conserving surgery
mastectomy
neoadjuvant chemo
adjuvant chemo

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13
Q

what is the goal of BC stages I, II, IIIA

A

goal is to cure

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13
Q

what is the goal for breast cancer stages IIIB and IIIC?

A

goal is to cure

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14
Q

what is the general treatment strategy for breast cancer stages IIIB and IIIC?

A

neoadjuvant chemo
adjuvant therapy as needed

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15
Q

what is the treatment goal for stage IV breast cancer

A

palliative

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16
Q

what is the general treatment strategy for breast cancer

A

chemo
HRT
biologics
immunotherapy

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17
Q

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor less than/equal to 0.5mg

A

consider adjuvant endocrine therapy

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18
Q

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor greater than 0.5mg with an oncogene score of less than 26

A

adjuvant endocrine therapy

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19
Q

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor greater than 0.5mg and an oncogene score of greater than or equal to 26

A

adjuvant chemo followed by endocrine therapy

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20
Q

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor less than 0.5mg

A

consider adjuvant endocrine therapy +/- chemotherapy with HER2 targeted therapy

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21
Q

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor greater than 0.5mg

A

adjuvant chemo with HER 2 targeted therapy followed by endocrine therapy

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22
Q

what is an adjuvant hormonal therapy option in breast cancer

A

SERMs
LHRH analogs (ovarian suppression)
Aromatase Inhibitors

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23
Q

what is the SERM for breast cancer

A

Tamoxifen (pre and post meno)
anti-estrogen effect
major toxicity - Hotflashes

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24
Q

what is the LHRH analogs in breast cancer

A

Leuprolide or Goserelin
will initially cause a “flare” due to increase in FSH and LH

25
Q

what is the Aromatase Inhibitor (AI) in breast cancer

A

Nonsteroidal: anastrozole, letrozole
Steroidal: exemestane

26
Q

who can and can’t use AIs

A

used only in post menopause,
if pre must give ovarian suppression first

27
Q

If premenopausal at diagnosis, what is the first step in the hormone treatment therapy pathway

A

Tamoxifen x 5 years +/- OS
AI x 5 years + OS

28
Q

If premenopausal at diagnosis, and still premenopausal after 1st round of adjuvant HRT treatment, what is the next step?

A
  1. Tamoxifen for 5 more years (total 10 years)
    or
  2. No further HRT
29
Q

If premenopausal at diagnosis, and now postmenopausal after 1st round of adjuvant HRT treatment, what is the next step?

A
  1. could consider an additional 5 years of AI (total 10) or tamoxifen for 5 years
30
Q

If postmenopausal at diagnosis, what are the 3 adjuvant HRT options?

A

AI x 5 years then maybe another 5
T x 2-3 years then AI for 5 or vice versa
T x 4-5 years then AI x 5 years or T x 5 years

31
Q

what should you consider when doing an additional 5 years of HRT adjuvant treatment?

A

toxicities and tolerance for patient

32
Q

what is the ideal length of adjuvant chemotherapy

A

3 to 6 months

33
Q

what are the common chemos in adjuvant therapy

A

Doxorubicin
Cyclophosphamide
Methotrexate
5-FU
Carboplatin
Paclitaxel
Docetaxel

34
Q

what are the standard chemo lengths and cycles?

A

4-6 cycles every 3-4 weeks

35
Q

what are the 2 adjuvant chemo regimens for HER2 negative disease

A

Dose Dense AC to Paclitaxel or TC

36
Q

what is dose dense AC

A

Doxorubicin and cyclophosphamide followed by paclitaxel

37
Q

what is TC

A

docetaxel and cyclophosphamide

38
Q

what is the risk of dose dense AC

A

cardiac risks

39
Q

what are the 3 adjuvant therapies for HER2 positive

A

APT
TCH
TCH to pertuzumab

40
Q

what is APT

A

Doxarubicin
paclitaxel
trastuzumab

41
Q

what is TCH

A

docetaxel
carboplatin
trastuzumab

42
Q

what is TCH to pertuzumab

A

docetaxel
carboplatin
trastuzumab
pertuzumab

43
Q

what is the standard of care for triple negative breast cancer

A

immunotherapy

44
Q

what is the preferred adjuvant chemo regimen for triple negative breast cancer

A

Paclitaxel
Carboplatin
Pembrolizumab
followed by
AC + pembrolizumab

45
Q

in ER/PR+ metastatic breast cancer, where should therapy start?

A

hormonal therapy

46
Q

in ER/PR- HER2+ metastatic breast cancer where should therapy start

A

anti-HER2 therapy +/- chemo

47
Q

in ER/PR- HER2- metastatic breast cancer where should therapy start

A

chemotherapy

48
Q

in metastatic breast cancer, what should you do if the disease-free period becomes shorter?

A

switch from HRT to chemo

49
Q

what is first line regimen for HER2+ metastatic breast cancer?

A

Trastuzumab + Pertuzumab + Docetaxel

50
Q

what is second line regimen for HER2+ metastatic breast cancer?

A

fam-trastuzumab deruxtecan-nxki

51
Q

what drug can be used in HER2 low patients

A

fam-trastuzumab deruxtecan

52
Q

what is the first line regimen for triple negative metastatic breast cancer

A

carboplatin or cisplatin single agent
or
pembrolizumab + chemo

53
Q

what is the first line hormonal therapy in metastatic breast cancer

A

AI + CKD4/6 inhibitor

54
Q

what are the CDK4/6 inhibitors

A

abemaciclib
palbociclib
ribociclib

55
Q

what is 2nd line HRT in metastatic breast cancer

A

fulvestrant + CDK4/6 inhibitor if not used before
Everolimus + endocrine therapy

56
Q

what is a monitoring parameter for abemaciclib?

A

CBC
diarrhea

57
Q

what is a monitoring parameter for palbociclib?

A

CBC (if low decrease dose)

58
Q

what is a monitoring parameter for ribociclib?

A

CBC and QTc prolongation (get ekg baseline)

59
Q

at what age does annual mammograms become available

A

40-44

60
Q

at what age do annual mammograms become mandatory

A

45-54

61
Q

at what age do mammograms become every other year if healthy

A

55

PHRM 864 therapeutics (10 decks)

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