Exam 2

Question 1

For any pt that is HER2/neu+ What should be given with chemo?

Answer 1

Herceptin (trastuzumab)

Question 2

If HER2/neu+ and metastatic what should be added? What if they are HR+?

Answer 2

pertuzumab

Add Hormonal Tx if HR+ but this isnt common (letrozole has been approved for use with trastuzumab`

Question 3

What cant be used with anthracyclines? What is the change that needs to be made?

Answer 3

Herceptin (trastuzumab) should be used AFTER the anthracycline is finished (added CV tox with anthracyclines)

Question 4

For premenopausal HR+ stage I/II pts what can be used and in combo with what other drugs?
What should this drug cause?

Answer 4

Goserelin alone or Goseralin + Tamoxifen are effective. Goserelin + Aromatase inhibitor is even better.
Goserelin should cause medical menopause

Question 5

BRCA +?

Answer 5

Platinums or olaparib may yield good results

Question 6

oral contraceptives?

Answer 6

non-hormonal birth control

Question 7

If a pt responses to hormonal treatment and then has a relapse what should be tried?

Answer 7

Another hormonal Tx with a different mechanism

Question 8

What should be used when hormonal options fail?

Answer 8

Chemo

Question 9

In postmenopausal pts what drugs are good to use as first line? These can also be substituted for?

Answer 9

Aromatase inhibitors
- Letrozole/Femara
- Anastrazole/arimidex
- Exemestane /aromasin
Sub for tamoxifen in the last 2-3 yrs of 5 yr tamoxifen therapy or added to the 5 year

Question 10

Options for premenopausal patients?

Answer 10

Tamoxifen (SERMS)
LHRH agonists (also call GnRH agonists, like goserelin) +/- aromatase inhibitors
Progestins
Oophorectomy

Question 11

Post menopausal pt treatment?

Answer 11

Aromatase inhibitors
Tamoxifen (SERMs)
Pure estrogen antagnists
Progestins

Question 12

WHat are the 3 SERMs?

Answer 12

Tamoxifen
Teremifene
Raloxifene (breast cancer prophylaxis)

Question 13

Tamoxifen is metabolized into?
And by what?
What is the interactio

Answer 13

endoxifen which is the active drug by CYP2D6

Fluoxetine and Paroxetine may reduce activity significantly of Tamoxifen

Question 14

What Side effects do SERMs cause?

Answer 14

pre or post-menopausal; hot flashes, vaginal discharge/bleeding, thromboemboli,
endometrial ca, with bony disease involvement- bone pain flare and possibly hypercalcemia,
possible need for non-hormonal contraception, less heart disease than aromatase inhibitors,
premenopausal increased osteoporosis, postmenopausal decreased osteoporosis

Question 15

Aromatase Inhibitors SEs

Answer 15

n/v, hot

flashes, arthralgias, myalgias, increased osteoporosis (use bisphosphonate).

Question 16

Aromatase Inhibitors Pre or post? Unless?

Answer 16

Post unless given with LHRH agonist

Question 17

What can be used for muscle pain associated with Aromatase inhibitors?

Answer 17

Duloxetine, acupuncture anf high dose vit D

Question 18

What are the 3 Aromatase Inhibitors?

Answer 18

Anastrazole
Letrozole
Exemestane

Question 19

Pure Estrogen Antagonists treatment of what patients? Drug?

Answer 19

Postmenopausal
Fulvestrant IM monthly
Less arthralgia or hormonal defects

Question 20

Progestins for who?

Answer 20

Medroxyprogesterone Acetate

Megestrel Acetate

Question 21

What is the hormonal therapy for Premenopausal women only?

Answer 21

Oophorectomy

LHRH agonists

Question 22

What are the LHRH Angonists? SEs?

Answer 22

Leuprolide
Goserelin
Triptorelin