Breast Cancer Therapeutics Flashcards
what are risk factors for breast cancer
Age
Family history
Radiation
Estrogen Exposure (endogenous)
Alcohol
Nulliparity
Elevated BMI
what are the tumor suppressor genes associated with breast cancer?
BRCA-1 and BRCA-2
what are the two most common invasive cancer spots in breast cancer?
lobes
ducts
what is an invasive carcinoma
invaded beyond the basement membrane of the duct or lobule
what are the non invasive breast cancers
ductal carcinoma in situ
lobular carcinoma in situ
inflammatory
what is the most aggressive form of breast cancer
inflammatory
describe inflammatory breast cancer
aggressive, rapid onset
poor prognosis
onset is days and weeks
orange peel look
how to test for HER2 status
IHC or FISH testing
what is oncotype DX
-genetic test for expression of 21 genes which fives recurrence score
-can determine if cancer will return and if patient will benefit from chemo
what is treatment for a low risk (< 26) for oncotype DX
hormonal therapy only
what is treatment for a high risk (>=26) for oncotype DX
chemo and HRT
will women < 50 w/ score of 16 to 25 benefit from chemo?
yes they will benefit
general treatment strategies for breast cancer stages I, II, IIIA
breast conserving surgery
mastectomy
neoadjuvant chemo
adjuvant chemo
what is the goal of BC stages I, II, IIIA
goal is to cure
what is the goal for breast cancer stages IIIB and IIIC?
goal is to cure
what is the general treatment strategy for breast cancer stages IIIB and IIIC?
neoadjuvant chemo
adjuvant therapy as needed
what is the treatment goal for stage IV breast cancer
palliative
what is the general treatment strategy for breast cancer
chemo
HRT
biologics
immunotherapy
what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor less than/equal to 0.5mg
consider adjuvant endocrine therapy
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
adjuvant endocrine therapy
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
adjuvant chemo followed by endocrine therapy
what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor less than 0.5mg
consider adjuvant endocrine therapy +/- chemotherapy with HER2 targeted therapy
what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor greater than 0.5mg
adjuvant chemo with HER 2 targeted therapy followed by endocrine therapy
what is an adjuvant hormonal therapy option in breast cancer
SERMs
LHRH analogs (ovarian suppression)
Aromatase Inhibitors
what is the SERM for breast cancer
Tamoxifen (pre and post meno)
anti-estrogen effect
major toxicity - Hotflashes
what is the LHRH analogs in breast cancer
Leuprolide or Goserelin
will initially cause a “flare” due to increase in FSH and LH
what is the Aromatase Inhibitor (AI) in breast cancer
Nonsteroidal: anastrozole, letrozole
Steroidal: exemestane
who can and can’t use AIs
used only in post menopause,
if pre must give ovarian suppression first
If premenopausal at diagnosis, what is the first step in the hormone treatment therapy pathway
Tamoxifen x 5 years +/- OS
AI x 5 years + OS
If premenopausal at diagnosis, and still premenopausal after 1st round of adjuvant HRT treatment, what is the next step?
- Tamoxifen for 5 more years (total 10 years)
or - No further HRT
If premenopausal at diagnosis, and now postmenopausal after 1st round of adjuvant HRT treatment, what is the next step?
- could consider an additional 5 years of AI (total 10) or tamoxifen for 5 years
If postmenopausal at diagnosis, what are the 3 adjuvant HRT options?
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
what should you consider when doing an additional 5 years of HRT adjuvant treatment?
toxicities and tolerance for patient
what is the ideal length of adjuvant chemotherapy
3 to 6 months
what are the common chemos in adjuvant therapy
Doxorubicin
Cyclophosphamide
Methotrexate
5-FU
Carboplatin
Paclitaxel
Docetaxel
what are the standard chemo lengths and cycles?
4-6 cycles every 3-4 weeks
what are the 2 adjuvant chemo regimens for HER2 negative disease
Dose Dense AC to Paclitaxel or TC
what is dose dense AC
Doxorubicin and cyclophosphamide followed by paclitaxel
what is TC
docetaxel and cyclophosphamide
what is the risk of dose dense AC
cardiac risks
what are the 3 adjuvant therapies for HER2 positive
APT
TCH
TCH to pertuzumab
what is APT
Doxarubicin
paclitaxel
trastuzumab
what is TCH
docetaxel
carboplatin
trastuzumab
what is TCH to pertuzumab
docetaxel
carboplatin
trastuzumab
pertuzumab
what is the standard of care for triple negative breast cancer
immunotherapy
what is the preferred adjuvant chemo regimen for triple negative breast cancer
Paclitaxel
Carboplatin
Pembrolizumab
followed by
AC + pembrolizumab
in ER/PR+ metastatic breast cancer, where should therapy start?
hormonal therapy
in ER/PR- HER2+ metastatic breast cancer where should therapy start
anti-HER2 therapy +/- chemo
in ER/PR- HER2- metastatic breast cancer where should therapy start
chemotherapy
in metastatic breast cancer, what should you do if the disease-free period becomes shorter?
switch from HRT to chemo
what is first line regimen for HER2+ metastatic breast cancer?
Trastuzumab + Pertuzumab + Docetaxel
what is second line regimen for HER2+ metastatic breast cancer?
fam-trastuzumab deruxtecan-nxki
what drug can be used in HER2 low patients
fam-trastuzumab deruxtecan
what is the first line regimen for triple negative metastatic breast cancer
carboplatin or cisplatin single agent
or
pembrolizumab + chemo
what is the first line hormonal therapy in metastatic breast cancer
AI + CKD4/6 inhibitor
what are the CDK4/6 inhibitors
abemaciclib
palbociclib
ribociclib
what is 2nd line HRT in metastatic breast cancer
fulvestrant + CDK4/6 inhibitor if not used before
Everolimus + endocrine therapy
what is a monitoring parameter for abemaciclib?
CBC
diarrhea
what is a monitoring parameter for palbociclib?
CBC (if low decrease dose)
what is a monitoring parameter for ribociclib?
CBC and QTc prolongation (get ekg baseline)
at what age does annual mammograms become available
40-44
at what age do annual mammograms become mandatory
45-54
at what age do mammograms become every other year if healthy
55