Exam 2 - Breast Cancer Flashcards

1
Q

What is the most common type of breast cancer?

A

invasive ductal carcinoma

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2
Q

What does oncotype DX determine?

A
  1. the likelihood that the breast cancer will return
  2. whether the patient will benefit from chemotherapy
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3
Q

Oncotype DX score < 26 =

A

hormonal therapy only

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4
Q

Oncotype DX score ≥ 26 =

A

chemotherapy and hormonal therapy

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5
Q

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

A

stage IIIB and stage IIIC

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6
Q

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

A

for patients with tumors > 1 cm

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7
Q

What are the benefits of neoadjuvant chemotherapy?

A
  1. Allows less extensive surgery
  2. Allows you to see response to chemotherapy while tumor is still intact
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8
Q

Adjuvant hormonal therapy options:

A
  1. surgical ablation (oopherectomy)
  2. SERMs (tamoxifen)
  3. LHRH/GnRH analogs (leuprolide, goserelin)
  4. Aromatase inhibitors (Anastrozole, letrozole, exemestane)
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9
Q

HER2(-) adjuvant chemotherapy NCCN preferred regimen 1:

A

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

followed by:
paclitaxel every 14 days x 4

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10
Q

HER2(-) adjuvant chemotherapy NCCN preferred regimen 2:

A

TC:
Docetaxel
Cyclophosphamide
Repeat every 21 days x 4

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11
Q

What patients should not have an anthracycline-based regimen?

A

Patients with cardiac problems

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12
Q

Triple negative preferred chemotherapy regimen:

A

(Chemotherapy + immunotherapy)

Paclitaxel + Carboplatin + Pembrolizumab

repeat every 21 days x 4 then,

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

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13
Q

HER2+ metastatic 1st line option:

A

Trastuzumab
Pertuzumab
Docetaxel (or paclitaxel)

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14
Q

HER2+ metastatic 2nd line option:

A

Fam-trastuzumab deruxtecan

(only after failure of trastuzumab/pertuzumab/taxane)

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15
Q

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

A

carboplatin or cisplatin

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16
Q

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

A

HER2(-) and ER(+)

17
Q

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

A

CBC - may cause neutropenia

18
Q

What side effect can all CDK4/6 inhibitors cause?

A

diarrhea

19
Q

Which side effect is unique to ribociclib?

A

QTc prolongation

20
Q

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

A

Paclitaxel
with
Trastuzumab
Pertuzumab

21
Q

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

A

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

22
Q

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

A

hormonal therapy - aromatase inhibitor with a CDK4/6 inhibitor

23
Q

Which hormonal therapy is only used in postmenopausal women?

A

aromatase inhibitors

24
Q

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

A

ovarian suppression (with LHRH agonists)

25
Q

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

A

ado-trastuzumab emtansine (TDM-1)

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

26
Q
A