Exam 2 - Breast Cancer

Question 1

What is the most common type of breast cancer?

Answer 1

invasive ductal carcinoma

Question 2

What does oncotype DX determine?

Answer 2

1. the likelihood that the breast cancer will return
2. whether the patient will benefit from chemotherapy

Question 3

Oncotype DX score < 26 =

Answer 3

hormonal therapy only

Question 4

Oncotype DX score ≥ 26 =

Answer 4

chemotherapy and hormonal therapy

Question 5

Most women will have neoadjuvant chemotherapy in which stages of breast cancer?

Answer 5

stage IIIB and stage IIIC

Question 6

In patients with stage I, IIA, IIB, or III disease, who would be a candidate for neoadjuvant chemotherapy?

Answer 6

for patients with tumors > 1 cm

Question 7

What are the benefits of neoadjuvant chemotherapy?

Answer 7

1. Allows less extensive surgery
2. Allows you to see response to chemotherapy while tumor is still intact

Question 8

Adjuvant hormonal therapy options:

Answer 8

1. surgical ablation (oopherectomy)
2. SERMs (tamoxifen)
3. LHRH/GnRH analogs (leuprolide, goserelin)
4. Aromatase inhibitors (Anastrozole, letrozole, exemestane)

Question 9

HER2(-) adjuvant chemotherapy NCCN preferred regimen 1:

Answer 9

Dose Dense AC -> Paclitaxel:
Doxorubicin
Cyclophosphamide
repeat every 14 days x 4 with growth factors

followed by:
paclitaxel every 14 days x 4

Question 10

HER2(-) adjuvant chemotherapy NCCN preferred regimen 2:

Answer 10

TC:
Docetaxel
Cyclophosphamide
Repeat every 21 days x 4

Question 11

What patients should not have an anthracycline-based regimen?

Answer 11

Patients with cardiac problems

Question 12

Triple negative preferred chemotherapy regimen:

Answer 12

(Chemotherapy + immunotherapy)

Paclitaxel + Carboplatin + Pembrolizumab

repeat every 21 days x 4 then,

Doxorubicin
Cyclophosphamide
Pembrolizumab
repeat every 21 days and pembro x 1 year

Question 13

HER2+ metastatic 1st line option:

Answer 13

Trastuzumab
Pertuzumab
Docetaxel (or paclitaxel)

Question 14

HER2+ metastatic 2nd line option:

Answer 14

Fam-trastuzumab deruxtecan

(only after failure of trastuzumab/pertuzumab/taxane)

Question 15

In patients with triple negative breast cancer and BRCA+, what agent has shown benefit?

Answer 15

carboplatin or cisplatin

Question 16

In what type of breast cancer might CDK4/6 inhibitors be indicated?

Answer 16

HER2(-) and ER(+)

Question 17

What should be monitored routinely when taking a CDK4/6 inhibitor? Why?

Answer 17

CBC - may cause neutropenia

Question 18

What side effect can all CDK4/6 inhibitors cause?

Answer 18

diarrhea

Question 19

Which side effect is unique to ribociclib?

Answer 19

QTc prolongation

Question 20

Patient case: women with early stage ER-/PR-, HER2+ - what would her chemotherapy course be?

Answer 20

Paclitaxel
with
Trastuzumab
Pertuzumab

Question 21

Patient case: women with early stage ER+/PR+, HER2(-) - what would be her treatment course?

Answer 21

Tamoxifen + Oncotype DX to determine if she’s a candidate for chemotherapy

Question 22

ER+/PR+, HER2(-) metastatic disease 1st line treatment:

Answer 22

hormonal therapy - aromatase inhibitor with a CDK4/6 inhibitor

Question 23

Which hormonal therapy is only used in postmenopausal women?

Answer 23

aromatase inhibitors

Question 24

Aromatase inhibitors may be used in premenopausal women only if what occurs first?

Answer 24

ovarian suppression (with LHRH agonists)

Question 25

In HER2+ disease, what agent is used if residual disease is found after surgery?

Answer 25

ado-trastuzumab emtansine (TDM-1)

(if no residual disease, continue trastuzumab and pertuzumab for a total of one year)