Exam 2 - Breast Cancer Flashcards
What is the most common type of breast cancer?
invasive ductal carcinoma
What does oncotype DX determine?
- the likelihood that the breast cancer will return
- whether the patient will benefit from chemotherapy
Oncotype DX score < 26 =
hormonal therapy only
Oncotype DX score ≥ 26 =
chemotherapy and hormonal therapy
Most women will have neoadjuvant chemotherapy in which stages of breast cancer?
stage IIIB and stage IIIC
In patients with stage I, IIA, IIB, or III disease, who would be a candidate for neoadjuvant chemotherapy?
for patients with tumors > 1 cm
What are the benefits of neoadjuvant chemotherapy?
- Allows less extensive surgery
- Allows you to see response to chemotherapy while tumor is still intact
Adjuvant hormonal therapy options:
- surgical ablation (oopherectomy)
- SERMs (tamoxifen)
- LHRH/GnRH analogs (leuprolide, goserelin)
- Aromatase inhibitors (Anastrozole, letrozole, exemestane)
HER2(-) adjuvant chemotherapy NCCN preferred regimen 1:
Dose Dense AC -> Paclitaxel:
Doxorubicin
Cyclophosphamide
repeat every 14 days x 4 with growth factors
followed by:
paclitaxel every 14 days x 4
HER2(-) adjuvant chemotherapy NCCN preferred regimen 2:
TC:
Docetaxel
Cyclophosphamide
Repeat every 21 days x 4
What patients should not have an anthracycline-based regimen?
Patients with cardiac problems
Triple negative preferred chemotherapy regimen:
(Chemotherapy + immunotherapy)
Paclitaxel + Carboplatin + Pembrolizumab
repeat every 21 days x 4 then,
Doxorubicin
Cyclophosphamide
Pembrolizumab
repeat every 21 days and pembro x 1 year
HER2+ metastatic 1st line option:
Trastuzumab
Pertuzumab
Docetaxel (or paclitaxel)
HER2+ metastatic 2nd line option:
Fam-trastuzumab deruxtecan
(only after failure of trastuzumab/pertuzumab/taxane)
In patients with triple negative breast cancer and BRCA+, what agent has shown benefit?
carboplatin or cisplatin