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PHRM 864 > E2 Breast Cancer > Flashcards

E2 Breast Cancer Flashcards

1
Q

some risk factors for breast cancer

A

age
family hx
radiation (prior tx for lymphoma)
estrogen exposure
alcohol
high BMI
diet

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2
Q

2 tumor suppressor genes in breast cancer

A

BRCA 1
BRCA 2

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3
Q

risk assessment tool to determine relative risk in % of developing breast cancer

A

gail risk model

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4
Q

4 types of breast cancer

A

invasive carcinoma
ductal carcinoma in situ
lobular carcinoma in situ
inflammatory

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5
Q

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

A

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6
Q

More common:
A. invasive ductal carcinoma
B. invasive lobular carcinoma

A

A

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7
Q

Normal cells have undergone pre-malignant genetic transformation
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

B

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8
Q

Usually an incidental finding on biopsy
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

C

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9
Q

T or F:
Ductal and lobular in situ cancers are considered invasive

A

false, thats why they arent called invasive breast cancer sherlock

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10
Q

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

A

D

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11
Q

pt presents with edema, redness, warmth
A. invasive carcinoma
B. ductal carcinoma in situ
C. lobular carcinoma in situ
D. inflammatory

A

D no fuckin shit

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12
Q

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

A

D. (they think its cellulitis)

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13
Q

2 different ways you can test for HER2 status *

A

1) Immunohistochemistry (IHC): detects protein overexpression
2) Fluorescence In-Situ Hybridization (FISH): detects gene amplification

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14
Q

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

A

Oncotype Dx

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15
Q

what stages of breast cancer can you use oncotype dx in?

A

stage I or II

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16
Q

T or F: Oncotype Dx is used in ER negative and HER2 positive cancers

A

false, other way around. ER pos and HER2 neg

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17
Q

Oncotype Dx: TAILORx:
Low risk (<__) = ________ therapy only

A

26, hormone

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18
Q

Oncotype Dx: TAILORx:
High risk (>/=__) = ______ and hormonal therapy

A

26, chemo

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19
Q

Oncotype Dx in LN(+) Disease:
both _________ and __________ patients with LN+ disease

A

pre and post menopausal

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20
Q

T or F:
Breast cancer can metastasize anywhere

A

true

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21
Q

for what stages of breast cancer is the goal curing it?

A

I, II, and IIIA, IIIB, IIIC

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22
Q

Stage I, II, IIIA guidelines

A

lumpectomy + radiation
OR
modified radical mastectomy +/- radiation

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23
Q

T or F:
Most women will receive adjuvant therapy after surgery) in stages I, II, IIA

A

True

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24
Q

Stage IIIB and IIIC guidelines

A

same as I, II, and IIIA but with neoadjuvant chemo before MRM or lumpectomy

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25
Q

Stage IV guidelines

A

basically whichever combo makes most sense for patient (chemo, hormonal, biologics, immunotherapy)
AND
Surgery is only for symptomatic relief

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26
Q

when you see XRT what is it

A

radiation therapy

27
Q

what stage is breast cancer metastatic?

A

IV

28
Q

does radiation fall under neoadjuvant or adjuvant?

A

adjuvant

29
Q

before surgery
A. neoadjuvant
B. adjuvant

A

A

30
Q

In stages I, IIA, IIB, and III when do you choose to give neoadjuvant therapy?

A

pts with tumors >1 cm

31
Q

what are the 2 benefits of neoadjuvant therapy (she made this sound important)

A
  • allows less extensive surgery
  • allows you to see response to chemo while tumor is in tact
32
Q

HER2 negative ,tumor < or = to 0.5 cm -> consider what therapy?

A

adjuvant endocrine

33
Q

HER2 positive ,tumor < or = to 0.5 cm -> consider what therapy?

A

adjuvant endocrine +/- chemo with HER2 targeted therapy

34
Q

T or F:
SERMS and LNRH analogs are considered neoadjuvant therapies

A

false, adjuvant

35
Q

adjuvant chemo regimen HER2 negative (2 preferred options)

A

DOSE dense AC -> paclitaxel (NCCN preferred), doxo, cyclo
TC -> docetaxel, cyclo

36
Q

what does dose dense mean?

A

pts got same amount of chemo but in less time than usual

37
Q

if pt is HER2 negative and has cardiac issues what should you consider>

A

using docetaxel and cyclo instead of the doxorubicin onee

38
Q

drug to include every time if her2 positive

A

trastuzumab, (or combo with pertuzumab)

39
Q

adjuvant her2 positive regimens

A

APT -> paciltaxel, trast
TCH -> docetaxel, carboplatin, trast

40
Q

what does residual disease mean in breast cancer

A

that the cancer is still there after some level of treatment

41
Q

what is ado-trastuzumab

A

trast with emtansine (TDM-1)

42
Q

if you see keynote trial what do you think of

A

triple negative breast cancer

43
Q

triplle negative regimen

A

pembro+ chemo, paclitaxel, carboplat

44
Q

ER+/PR+ means what kind of therapy

A

hormone

45
Q

ER/PR- means what kind of therapy

A

chemo and HER2 depending on her2+ or -

46
Q

if there is something that says “bone only disease” what kind of therapy do you choose

A

hormone

47
Q

recommended 1st line option for her2 positive metastatic

A

trast
pert
docetaxel

48
Q

2nd line her2 + metastatic

A

fam-trast
deruxtecan-nxki

49
Q

when do you use the fam-trast deruxtecan thing

A

in her2 low patients

50
Q

what class has shown benefit in triple negative

A

platinum agnets

51
Q

two first line options for triple negativee

A

carboplatin
cisplatin

52
Q

pembro is also approved in triple negative, what is something you check for to determine if this is appropriate

A

combined positive score, assess number of pd-L1 staining cells, max is 100 and usually use it with score 10 or above

53
Q

1st line hormonal therapy metastatic

A

aromatase inhibitor + cdk4/6 inhibitor

54
Q

2nd line hormonal therapy metastatic

A

fulvestrant + cdk4/6 inhibitor
or
everolimus + endocrine therapy (exemestane, fulvestrant, tamoxifen)

55
Q

T or F:
CDK 4/6 inhibitors are activated in ER+ breast cancer

A

true

56
Q

3 cdk4/6 inhibitors

A

abemaciclib
palbociclib
ribociclib

57
Q

what is the main monitoring parameter for cdl4/6 inhibitors

A

complete blood count

58
Q

which cdl 4/6 inhibitor can cause qtc prolongation **

A

ribociclib

59
Q

what age are mammograms cant think of the verb

A

40-44 and above

60
Q

T or F:
pts with BRCA mutations are at risk for breast cancer

A

no fuckin shit

61
Q

what 3 agents have been studied in preventative setting

A

tamoxifen
raloxifene
exemestane

62
Q

T or F:
tamoxifen is used more often than raloxifene in prevention because it is more effective

A

false, same effectiveness

63
Q

what two ae’s did pts taking raloxifene have less of than tamoxifen

A

uterine cancer and blood clots

PHRM 864 (15 decks)

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