E2 Breast Cancer Flashcards
some risk factors for breast cancer
age
family hx
radiation (prior tx for lymphoma)
estrogen exposure
alcohol
high BMI
diet
2 tumor suppressor genes in breast cancer
BRCA 1
BRCA 2
risk assessment tool to determine relative risk in % of developing breast cancer
gail risk model
4 types of breast cancer
invasive carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
inflammatory
Has invaded beyond the basement membrane of duct or lobule
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
A
More common:
A. invasive ductal carcinoma
B. invasive lobular carcinoma
A
Normal cells have undergone pre-malignant genetic transformation
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
B
Usually an incidental finding on biopsy
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
C
T or F:
Ductal and lobular in situ cancers are considered invasive
false, thats why they arent called invasive breast cancer sherlock
aggressive form of breast cancer with rapid onset and poor prognosis
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
D
pt presents with edema, redness, warmth
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
D no fuckin shit
delayed in diagnosis because docs think its probably something else
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory
D. (they think its cellulitis)
2 different ways you can test for HER2 status *
1) Immunohistochemistry (IHC): detects protein overexpression
2) Fluorescence In-Situ Hybridization (FISH): detects gene amplification
Genetic test for expression of 21 genes which gives a recurrence score
can determine likelihood that breast cancer will return and whether pt will benefit from chemo
Oncotype Dx
what stages of breast cancer can you use oncotype dx in?
stage I or II
T or F: Oncotype Dx is used in ER negative and HER2 positive cancers
false, other way around. ER pos and HER2 neg
Oncotype Dx: TAILORx:
Low risk (<__) = ________ therapy only
26, hormone
Oncotype Dx: TAILORx:
High risk (>/=__) = ______ and hormonal therapy
26, chemo
Oncotype Dx in LN(+) Disease:
both _________ and __________ patients with LN+ disease
pre and post menopausal
T or F:
Breast cancer can metastasize anywhere
true
for what stages of breast cancer is the goal curing it?
I, II, and IIIA, IIIB, IIIC
Stage I, II, IIIA guidelines
lumpectomy + radiation
OR
modified radical mastectomy +/- radiation
T or F:
Most women will receive adjuvant therapy after surgery) in stages I, II, IIA
True
Stage IIIB and IIIC guidelines
same as I, II, and IIIA but with neoadjuvant chemo before MRM or lumpectomy
Stage IV guidelines
basically whichever combo makes most sense for patient (chemo, hormonal, biologics, immunotherapy)
AND
Surgery is only for symptomatic relief
when you see XRT what is it
radiation therapy
what stage is breast cancer metastatic?
IV
does radiation fall under neoadjuvant or adjuvant?
adjuvant
before surgery
A. neoadjuvant
B. adjuvant
A
In stages I, IIA, IIB, and III when do you choose to give neoadjuvant therapy?
pts with tumors >1 cm
what are the 2 benefits of neoadjuvant therapy (she made this sound important)
- allows less extensive surgery
- allows you to see response to chemo while tumor is in tact
HER2 negative ,tumor < or = to 0.5 cm -> consider what therapy?
adjuvant endocrine
HER2 positive ,tumor < or = to 0.5 cm -> consider what therapy?
adjuvant endocrine +/- chemo with HER2 targeted therapy
T or F:
SERMS and LNRH analogs are considered neoadjuvant therapies
false, adjuvant
adjuvant chemo regimen HER2 negative (2 preferred options)
DOSE dense AC -> paclitaxel (NCCN preferred), doxo, cyclo
TC -> docetaxel, cyclo
what does dose dense mean?
pts got same amount of chemo but in less time than usual
if pt is HER2 negative and has cardiac issues what should you consider>
using docetaxel and cyclo instead of the doxorubicin onee
drug to include every time if her2 positive
trastuzumab, (or combo with pertuzumab)
adjuvant her2 positive regimens
APT -> paciltaxel, trast
TCH -> docetaxel, carboplatin, trast
what does residual disease mean in breast cancer
that the cancer is still there after some level of treatment
what is ado-trastuzumab
trast with emtansine (TDM-1)
if you see keynote trial what do you think of
triple negative breast cancer
triplle negative regimen
pembro+ chemo, paclitaxel, carboplat
ER+/PR+ means what kind of therapy
hormone
ER/PR- means what kind of therapy
chemo and HER2 depending on her2+ or -
if there is something that says “bone only disease” what kind of therapy do you choose
hormone
recommended 1st line option for her2 positive metastatic
trast
pert
docetaxel
2nd line her2 + metastatic
fam-trast
deruxtecan-nxki
when do you use the fam-trast deruxtecan thing
in her2 low patients
what class has shown benefit in triple negative
platinum agnets
two first line options for triple negativee
carboplatin
cisplatin
pembro is also approved in triple negative, what is something you check for to determine if this is appropriate
combined positive score, assess number of pd-L1 staining cells, max is 100 and usually use it with score 10 or above
1st line hormonal therapy metastatic
aromatase inhibitor + cdk4/6 inhibitor
2nd line hormonal therapy metastatic
fulvestrant + cdk4/6 inhibitor
or
everolimus + endocrine therapy (exemestane, fulvestrant, tamoxifen)
T or F:
CDK 4/6 inhibitors are activated in ER+ breast cancer
true
3 cdk4/6 inhibitors
abemaciclib
palbociclib
ribociclib
what is the main monitoring parameter for cdl4/6 inhibitors
complete blood count
which cdl 4/6 inhibitor can cause qtc prolongation **
ribociclib
what age are mammograms cant think of the verb
40-44 and above
T or F:
pts with BRCA mutations are at risk for breast cancer
no fuckin shit
what 3 agents have been studied in preventative setting
tamoxifen
raloxifene
exemestane
T or F:
tamoxifen is used more often than raloxifene in prevention because it is more effective
false, same effectiveness
what two ae’s did pts taking raloxifene have less of than tamoxifen
uterine cancer and blood clots
