Early Hormone Receptor Positive Breast Cancer Management Flashcards

1
Q

How is early ER+ Breast Cancer with negative oncotype treated?

A
  • Surgery
  • Aromatase Inhibitor
  • Bisphosphonate
  • If pre-menopausal - ovarian supression
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2
Q

What drug is used to supress the ovaries?

A

Leuprorelin (LHRH)

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3
Q

What is a positive oncotype?

A

For older women >26
For younger women >13

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4
Q

How is early ER+ Breast Cancer with positive oncotype treated?

A
  • Surgery
  • Aromatase Inhibitor
  • Bisphosphonate
  • Chemotherapy - EC-T
  • If pre-menopausal - ovarian supression
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5
Q

Name the aromatase inhibitors

A
  • Letrazole
  • Anastrazole
  • Exemestane
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6
Q

When should an AI be switched to Tamoxifen?

A
  • Osteoporotic already
  • Does not tolerate AI
  • Patient preference
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7
Q

What is Tamoxifen?

A

Selective oestrogen receptor modulator - decreases growth of ER+ breast cancer cells

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8
Q

What is the evidence for prolonged Tamoxifen treatment?

A

ATTOM trial showed that 10 years of tamoxifen reduced breast cancer mortality by 1/3

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9
Q

What is the mechanism of action of aromatase inhibitors?

A

Inhibits the aromatase enzyme which converts androgens to oestrogens.
This supresses recurrence of breast ca.

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10
Q

What is the trial evidence for Aromatase Inhibitors + ovarian supression?

A
  • SOFT (Supression of Ovarian Function Trial)
  • TEXT
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11
Q

When should adjuvant chemotherapy be given?

A

If tumour is 5mm then send for oncotyping

If >50y/o then oncotype >26 for chemo
If younger then oncotype >13 for chemo

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12
Q

What chemotherapy is given adjuvantly in ER+ early breast CA with high oncotype?

A

EC-T

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13
Q

What is EC-T?

A
  • Epirubicin
  • Cyclophosphamide
  • Docetaxel
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14
Q

How is EC-T given?

A
  • 6 cycles
  • EC Day one cycles 1-3
  • Docetacel Day one cycles 4-6

(FEC-T is same with fluourouricil given with EC)

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15
Q

When are CDK 4 and 6 inhibitors given?

A
  • If >4 nodes
  • If grade 3 + nodes
  • If >4cm + nodes
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16
Q

What is the CDK 4 and 6 inhibitor used?

A

Abemaciclib

17
Q

What are examples of other CDK 4 and 6 inhibitors?

A
  • Palbociclib
  • Ribociclib
18
Q

What is the trial evidence for CDK4/6 inhibitors (Abemaciclib)?

A

MONARCH 3 trial

PFS: 28.8 vs 14.3 months
ORR: 61% vs 45%

19
Q

Why are bisphosphonates given?

A
  1. Reduce bone thinning on endocrine therapy
  2. Reduce the risk of breast cancer recurrence
20
Q

What should be done before and during treatment with bisphosphonates?

A
  • Dental review prior to starting
  • Monitor for dental changes
  • Calcium tablet alongside
  • If no bisphosphonates prescribed will need DEXA scan pre treatment
21
Q

What is the evidence for bisphosphonate use in ER+ breast cancer?

A

EBCTCG Meta-analysis showed bisphosphonates prevent recurrence of breast cancer locally, distantly and within the bone as well as breast cancer survival

Only a benefit if post-menopausal/ ovarian supressed when treatment began