Early Hormone Receptor Positive Breast Cancer Management Flashcards
How is early ER+ Breast Cancer with negative oncotype treated?
- Surgery
- Aromatase Inhibitor
- Bisphosphonate
- If pre-menopausal - ovarian supression
What drug is used to supress the ovaries?
Leuprorelin (LHRH)
What is a positive oncotype?
For older women >26
For younger women >13
How is early ER+ Breast Cancer with positive oncotype treated?
- Surgery
- Aromatase Inhibitor
- Bisphosphonate
- Chemotherapy - EC-T
- If pre-menopausal - ovarian supression
Name the aromatase inhibitors
- Letrazole
- Anastrazole
- Exemestane
When should an AI be switched to Tamoxifen?
- Osteoporotic already
- Does not tolerate AI
- Patient preference
What is Tamoxifen?
Selective oestrogen receptor modulator - decreases growth of ER+ breast cancer cells
What is the evidence for prolonged Tamoxifen treatment?
ATTOM trial showed that 10 years of tamoxifen reduced breast cancer mortality by 1/3
What is the mechanism of action of aromatase inhibitors?
Inhibits the aromatase enzyme which converts androgens to oestrogens.
This supresses recurrence of breast ca.
What is the trial evidence for Aromatase Inhibitors + ovarian supression?
- SOFT (Supression of Ovarian Function Trial)
- TEXT
When should adjuvant chemotherapy be given?
If tumour is 5mm then send for oncotyping
If >50y/o then oncotype >26 for chemo
If younger then oncotype >13 for chemo
What chemotherapy is given adjuvantly in ER+ early breast CA with high oncotype?
EC-T
What is EC-T?
- Epirubicin
- Cyclophosphamide
- Docetaxel
How is EC-T given?
- 6 cycles
- EC Day one cycles 1-3
- Docetacel Day one cycles 4-6
(FEC-T is same with fluourouricil given with EC)
When are CDK 4 and 6 inhibitors given?
- If >4 nodes
- If grade 3 + nodes
- If >4cm + nodes
