BREAST CANCER TREATMENT

Question 1

What are the three breast cancer treatments

Answer 1

1. Selective oestrogen receptor modulators e.g. tamoxifen
2. Aromatase inhibitors e.g. Anastrozole
3. Oestrogen receptor downregulators / antagonist e.g. Fulvestrant

Question 2

What is the moa of tamoxifen

Answer 2

Permits the AF1 transcription activation domain to bind to the basic
transcriptional machinery via adaptor (co-activator) proteins
* Prevents the AF2 transcription activation domain from binding to the basic
transcriptional machinery via adaptor (co-activator) proteins

Question 4

ADRS of tamoxifen

Answer 4

Tamoxifen also binds to the ERβ receptor and acts as an
agonist enabling both AF1 and AF2 binding to adaptor
proteins leading to increased gene expression
* Results in:
* Hot flushes, fluid retention and menstrual irregularities
* And risk of:
* Endometrial cancer (due to uterine cell proliferation)
* Deep vein thrombosis
* Stroke

Question 5

moa of anastrozole

Answer 5

Aromatase (CYP19A1) catalyses the synthesis of
estradiol from testosterone (the main source of
oestrogen in post menopausal women)
* Aromatase inhibitors block the synthesis of ALL
oestrogens from testosterone
* Anastrozole is a reversible inhibitor of CYP19A1
* Blocks oestrogen dependant cell division

Question 6

what is adrs of anastrozole

Answer 6

ADRs associated with low oestrogen i.e. menopausal
symptoms

Question 7

what does anastrozole decrease the risk of?

Answer 7

decreased risk of endometrial cancer, thrombosis
and stroke

Question 8

what is the moa of fulvestrant?

Answer 8

• This binds to the receptor resulting in
• Receptor downregulation and
• Antagonises the ability of the receptor to bind to DNA
• May also inhibit aromatase

Question 9

does fulvestrant have oestrogenic effects

Answer 9

no

Question 10

what is pertuzumab

Answer 10

Prevents HER2 heterodimer formation with HER3

Question 11

what are BRCA1 AND BRCA2

Answer 11

Mutation in both copies of the gene is required for inactivity, mutation is the second copy
is normally acquired by a somatic mutation

Question 12

What is BRCA1

Answer 12

• Involved in double strand break repair
• Increases risk of breast cancer and ovarian cancer
• Increase risk of prostate cancer

Question 13

WHAT IS BRCA2

Answer 13

Involved in homologous recombination
* Increased risk of gall bladder, bile duct, stomach cancer and melanoma

Question 14

HOW IS BRCA CANCER TREATE

Answer 14

Fluorouracil (anti-metabolite)
* Epirubicin (topoisomerase inhibitor)
* Cyclophosphamide (DNA crosslinker)
* Docetaxel (microtubule inhibitor)

Question 15

what are risk factors of breast cancer

Answer 15

increased estrogen exposure, advanced age, and genetic predisposition (e.g., BRCA1/BRCA2 mutations

Question 16

if the tumor is ER or PR RECEPTOR positive what does this mean?

Answer 16

it can be treated systemically with hormone therapy (e.g., tamoxifen).

Question 17

if the tumor is HER2 receptor positive what does this mean?

Answer 17

it should receive targeted therapy (e.g., trastuzumab

Question 18

what are the side effects of trastuzumab

Answer 18

Cardiotoxicity; dilated cardiomyopathy

Question 19

what is breast conserving surgery

Answer 19

a type of surgery that focuses on the removal of cancerous breast tissue only, in contrast to full-breast mastectomy

Question 20

what is a mastectomy

Answer 20

A mastectomy involves the removal of the entire breast and, depending on the specific procedure, possibly other structures, such as lymph nodes and muscles.

Question 21

what analysis can be used for HER2

Answer 21

FISH AND IHC

Question 22

Her two (HER2) breasts can be treated with trastwozumab

Question 23

Sid effects of tamoxifen

Answer 23

dvt
uterine sarcoma