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Block 10 Week 3 > Breast Cancer Therapeutics-Buxton > Flashcards

Breast Cancer Therapeutics-Buxton Flashcards

1
Q

(blank) therapy is linked to breast cancer

A

HRT

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2
Q

T or F
Breast cancer death rates are higher than those for any other cancer, besides lung cancer.

Besides skin cancer, breast cancer is the most commonly diagnosed cancer among American women. Just under 30% of cancers in women are breast cancers.

A

T

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3
Q

In TMN staging (talks about metastasis) what are the following:
T 0 to 4 indicates?
M 0 to 1 indicates?
N 0 to 3 indicates?

A

size
spread to organs
spread to lymph nodes and how many nodes are affected

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4
Q

(blank) are slightly more likely to develop breast cancer than African-American women.

However, in women under 45, breast cancer is more common in (blank) African-American women than white women.

Overall, (blank) women are more likely to die of breast cancer.

Asian, Hispanic, and Native-American women have a lower risk of developing and dying from breast cancer.

A

White women
African-American
African-American

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5
Q

where does breast cancer most commonly spread?

A

bone liver brain and lung

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6
Q

About 5-10% of breast cancers can be linked to inherited gene mutations. Mutations of the (blank) and (Blank) are most common.
WOmen with a BRCA1 mutation have a (blank) risk of developing breast cancer before age 70. For women with a BRCA2 mutation, this risk is (blank)%. What other cancers are associated with this?

A

BRCA1 BRCA2
BRCA1
Ovarian cancer

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7
Q

What do non-mutated BRCA1 and BRCA2 do?

A

repair double-stranded DNA breaks

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8
Q

About (blank) of breast cancers occur in women who have no family history of breast cancer. These occur due to (blank) that happen as a result of the aging process and life in general, rather than inherited mutations.
The most significantrisk factorsfor breast cancer are (blank and blank)

A

85%
genetic mutations
gender (being a woman) and age (growing older).

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9
Q

The (blank) consists of 10-100 acini, that drain into the terminal duct that drains into larger ducts and finally in the main duct of the lobule (or segment), that drains into the nipple

A

Terminal ductal lobuar unit (TDLU)

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10
Q

How many lobes does the breast consist of and how many lobules does each contain?

A

15-18 lobes

then each contain 20-40 lobules

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11
Q

Most invasive cancers arise from the (blank). It is also the site of origin of (blank)

A

TDLU (terminal ductal lobular unit)

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12
Q

Most calcifications in the rbeast form either within the (blank) or within the (blank)

A 
terminal ducts (intraductal calcifications)
acini (lobular calcifications)
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13
Q

Lobular calcification:
Calcium deposits in acini result in (blank) calcifications. When a lobule has a lot of fibrosis then what are the calcifications like?
Calcifications usually have a (blank) or (blank) distribution. Are these calcifications malignant or benign?

A

punctate

  • calcifications are smaller and less uniform
  • diffuse or scattered
  • benign
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14
Q

What is the median age of High grade DCIS? When does this become invasive?
If it becomes invasive how do you treat them? What is the survival at 5 years?

A

54 years
after 3 years
-surgery, radiation, chemotherapy, prophylaxis (Tamoxifen for ER+ tumors)….
-73%

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15
Q

What do breast cancer patients die from?

A

bone, brain or liver mets

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16
Q

Why is breast cancer so hard to treat in the first world?

A

because by the time it has been detected it probaby has already entered the blood stream and traveled to distant sites i.e breast cancer patients succumb to metastatic, not local disease

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17
Q

How does breast cancer kill people in the third world?

A

Primary tumor-> exsanguination (axillary or internal mammary artery erosion) or sepsis

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18
Q

T or F

Primary human breast tumors suppress the growth of their own metastases

A

T

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19
Q

Without a blood supply, tumors cannot grow beyond (blank) in size. The process of blood vessel growth into a tumor, angiogenesis, is required for metastases to cause disease.

A

1 mm3

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20
Q

What is the angiogenic switch hypothesis?

A

that when a primary tumor is removed, distant metastases are able to attract a blood supply

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21
Q

What does sNDPK?

A

used to prevent breast cancer metastasis
- In triple negative breast cancer, it secretes sNDPK and causes endothelial cells to permit intravasation and extravasation of tumor cells. The kinase activates endothelial cells to grow as new blood vessels.

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22
Q

In mice carrying human triple negative tumors, blockade of sNDPK prevents (blank) in mice

A

lung metastases

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23
Q

Blocking the sNDPK pathway cures (blank) in mice.

A

breast cancer

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24
Q

Inhibiting (blank) or (Blank) activation reduced primary tumor growth and metastases while combinatorial treatment completely eradicated metastatic lung lesion.

A

NDPK

P2Y

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25
Q

What are the ER antagonists/modulators

A 
tamoxifen
raloxifene
toremifene
fulvestrant
toremifene
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26
Q

What are the aromatase inhibitors?

A

anastrozole
exemstane
letrozole

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27
Q

What are the HER2 blockers?

A

Trastuzumab
Pertuzumab
Lapatinab

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28
Q

What are the blockers of DNA replication?

A

Doxorubicin

Epirubicin

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29
Q

What are the immunosuppressants used in breast cancer?

A

Everolimus

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30
Q

What are the Anti-microtubule assembly drugs?

A

vinblastine
eribulin
ixabepilone

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31
Q

What are the GnRH agonists?

A

-Gaserelin

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32
Q

What are the cell cycle interrupter drugs?

A

palbociclib

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33
Q

What are the chemotherapeutic (blockers of cell division) drugs?

A 
Cyclophosphamide
Methotrexate
Paclitaxel
Docetaxel
Fluorouracil
Capecitabine
Gemcitabine
34
Q

(blank) breast cancer is cancer that has spread beyond the breast. Treatment for metastatic disease usually involves some type of (blank) to try to reduce the cancer burden.
How is it usually given?

A

Advanced (metastatic)
chemotherapy (anti-cancer drugs)

-in combo with other drugs

35
Q

How do antitumor agents (chemotherapy) work?

A

damage cancer cells by preventing those cells from dividing.

36
Q

What are the known side effects of anti-tumor agents?

A

n/v, leukopenia and in some cases cardiotoxicity (doxorubicin)

37
Q

What is the efficacy of chemotherapy?

What are the side effects of chemotherapy?

A
  • decreased cancer progression
  • shrinkage of tumor

SE: cardiotoxicity, leukopenia, n/v

38
Q

Advanced breast cancer is (blank) but not curable. Women with advanced breast cancer have an average survival of (blank). Is chemotherapy a good treatment?

A

treatable
about 2 years

chemotherapy may improve survival for women with metastatic breast cancer, but it can also cause toxic side effects. i.e. it might not help and may make you feel terrible instead

39
Q

T or F

there is insufficient evidence to determine if there is an impact on time to disease progression and overall survival

A

T

40
Q

Many women like with advance disease for many years, tx is aimed at (blank) of symptoms.
The first choice tx for advanced disease is dependent on (blank) or whether the tumor overexpresses (blank) and can be treated with (blank)

A

alleviation rather than cure
hormone status
human epidermal growth factor receptor-2 (HER-2)
Trastuzumab (herceptin)

41
Q

Is using combination chemotherapy or an intesive therapy good at treating advanced cancer?

A

It does reduce disease progression and shrink tumor size but adverse effects were really terrible

42
Q

What is neoadjuvant therapy?

A

treatment given before primary therapy

43
Q

Patients who have a higher risk of breast cancer recurrence are more likely to need (blank) therapy. Both prognostic and predictive factors are needed to decide which patients might benefit from adjuvant treatments.

A

adjuvant

44
Q

Adjuvant and neoadjuvant therapies have side effects, but careful studies have shown that the risks of adjuvant therapy for breast cancer are (blank) by the benefit of treatment—that is, increasing the chance of long-term survival.

A

outweighed

45
Q

A women may receive neoadjuvant chemotherapy for breast cancer to (blank) a tumor that is inoperable in its current state, so it can be usrgically removed

A

neoadjuvant

46
Q

T or F
A woman whose tumor can be removed by mastectomy may instead receive neoadjuvant therapy to shrink the tumor enough to allow breast-conserving surgery

A

T

47
Q

How does hormonal therapy work?

A

deprives breast cancer cells of the hormone estrogen, which many breast tumors need to grow.

48
Q

What is a commonly used hormonal treatment for breast cancer?

A

tamoxifen (blocks estrogen activity in the body)

49
Q

(blank) helps prevent the original cancer from returning and also helps to prevent the development of new cancers in the other breast; however, many women develop resistance to the drug over time.
Who do you give tamoxifen to?

A

Tamoxifen

-premenopausal and postemenopausal

50
Q

The growth of ER postitive tumors is generally (blank) dependent

A

hormone

51
Q

Tamoxifen when metabolized becomes (inactive/active). What cytochrome does this?

A

more active 4hydroxytamoxifen form

CYP2D6 and CYP3A4

52
Q

Postmenopausal women may receive hormonal therapy with a drug called an (blank), either after tamoxifen therapy or instead of tamoxifen therapy.
Rather than blocking estrogen’s activity, as tamoxifen does, (blank) prevent the body from making estrogen.

A 
aromatase inhibitor (AI)
Aromatose Inhibitors
53
Q

What does aromatase do?

A

converts testosterone to estradiol and convertes androstendione to esterone

54
Q

(blank) is a non-steroidal aromatase-inhibiting drug approved for treatment of breast cancer AFTER surgery, as well as for METASTASIS in both pre and post menopausal women.

A

Anastrozole

55
Q

Anastrozole binds (irreversibly/reversibly) to the (Blank) enzyme through competitive inhibition, inhibits the conversion of androgens to estrogens in peripheral tissues.

A

reversibly

aromatase

56
Q

(blank) is effective as first line tx in patients with ER positive tumors but carries the risk of (blank).

A

anastrozole

bone fracture

57
Q

Some premenopausal women may undergo ovarian ablation or suppression which greatly reduces the amount of (blank) produced by the body. What women would want to do this?

A

estrogen

Premenopausal women with BRCA1 and BRCA2 gene mutations who susceptibly to breast and ovarian cancer

58
Q

(blank) is a monoclonal antibody that targets cancer celles that overexpress, a protein called HER2

A

Trastuzumab

59
Q

When cancer cells overexpress HER2 protein, they are said to be HER2 positive and overexpress (blank) and grow uncontrollably as a result

A

EGF

60
Q

Appr. (blank) percent of all breast cancers are HER2 positive

A

20

61
Q

Clinical trials have shown that targeted therapy with (blank) in addition to chemotherapy decreases the risk of relapse for women with HER2 positive tumors

A

Trastuzumab

62
Q

(blank) blocks DNA synthesis. It is used in the tx of metastatic breast cancer as chemotherapy when other approaches have faild

A

Doxorubicin

63
Q

Doxorubicin is often combined with (blank) or (blank)

A

cyclophosphamide or a vinca alkaloid

64
Q

How does doxorubicin works?

A

it intercalates within DNA and prevents topoimeriase II from binding the double helix together and thus inhibits cell replication

65
Q

What is indicated in the tx of advanced ER/PR-positive, HER-2 negative breast cancer in postemenopausal women.

A

Everolimus

66
Q

Everolimus is a (blank) immunosuppressant and and a mechanistic target of (blank) inhibitor which has antiproliferative and antiangiogenic properties

A

macrolide

67
Q

Everolimus binds to (blank) binding protein-12, an intracellular protein, to form a complex that inhibits activation of (blank) activity

A

FK

mTOR serine-threonine kinase activity

68
Q

Everolimus reduces angiogenesis by inhibiting (blank) and (blank)

A

vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF-1) expression

69
Q

What are the side effects of tamoxifen?

A 
hot flashes
vaginal discharge
nausea
cataract development
blood clot (especially if taken with chemo)
uterine cancer (if still have uterus)
70
Q

Since uterine cancer is increased for those taking tamoxifen, what should you do regularly?

A

do pelvic exams and promptly exam patients if they have any pelvic pain or any abnormal vaginal bleeding

71
Q

What are the side effects of aromatase inhibitors?

A

hot flashes
vaginal dryness
other symp of menopause

72
Q

WOmen taking aromatase inhibitors may also experience (blank) or (blank) pain during treatment

A

joint pain

muscle pain

73
Q

Women taking aromatase inhibitors may have a higher risk of (blank) than those taking tamoxifen.

A

heart problems

74
Q

(blank) also reduce bone densitiy and increase the risk of bone fractures

A

Aromatase inhibitors

75
Q

When taking aromatase inhibitors should be monitored for any signs of (blank) or (Blank)

A

heart damange

changes in bone density

76
Q

(blank) can help redue bone loss caused by aromatase inhibitors for patients at high risk of fractures

A

Bisphosphonates

77
Q

THe most dangerous side effect of doxorubicin is (blank) leading to (blnk)

A

cardiomyopathy
congestive heart failure
The higher the dose, the worse the side effects

78
Q

(blank) has immunosuppressant properties which may result in infection. This drug increases the risk of developing bacterial, viral, fungal, and protozoal
infections. Everolimus can lead to what dangerous problems? (x4)

A

Everolimus

-sepsis, respiratory failure, hepatic failure, fatality

79
Q

Does everolimus cause CV problems?What are the CNS SEs of everolimus?

A
  • yes, including angina, A fib, DVTs and PEs

- agitation, changes in behavior

80
Q

What are the SEs of trastuzumab?

A

nausea, vomiting, hot flashes, and joint pain.

-heart problems (cardiomyopathy, but not as serious as in doxorubicin)

81
Q

What is the future therapy for breast cancer?

A

Using viruses to kill tumor cells

thyroidal sodium iodide symporter, HIV T cells

Block 10 Week 3 (9 decks)

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