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PHRM 864 Therapeutics > Exam 2 - Breast Cancer Weddle > Flashcards

Exam 2 - Breast Cancer Weddle Flashcards

1
Q

which of the following is FALSE about breast cancer?

a. most common malignancy in women in the US
b. most common cause of cancer related death in women
c. 1 in 8 women have a lifetime risk of developing
d. risk of developing BC increases with age

A

b. most common cause of cancer related death in women (2nd most common)

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2
Q

T or F: more than 60% of pts will NOT have any risk factors for BC

A

T

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3
Q

which of the following is NOT a risk factor for developing BC?

a. increased age
b. family history of BC
c. early menarche (12 or younger)
d. late menopause (55 or greater)
e. nulliparity or age > 30 before first birth
f. decreased BMI

A

f. decreased BMI (elevated BMI is a risk)

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4
Q

what percent of BCs are familial?

a. 1-2%
b. 5-10%
c. 20-25%
d. 90-95%

A

b. 5-10%

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5
Q

2 tumor suppressor genes important in breast cancer

A

BRCA-1 and BRCA-2

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6
Q

which of the following is TRUE about genetics for breast cancer?

a. BRCA-1 mutation has a greater incidence in male BC
b. BRCA-2 mutation has ~20% risk for BC, ~50% risk for ovarian cancer
c. BRCA-1 has a high prevalence of variants in Ashkenazi Jews (1 in 40)
d. BRCA-1 mutation has ~60% risk for BC, ~40% lifetime risk of ovarian cancer

A

c. BRCA-1 has a high prevalence of variants in Ashkenazi Jews (1 in 40)

(a. is BRCA-2; b. switch the percentages; d. switch the percentages)

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7
Q

what risk assessment tool is used to determine relative risk (RR) in % of developing BC?

A

GAIL Model

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8
Q

which of the following accounts for 70% of all BCs?

a. invasive ductal carcinoma (IDC)
b. invasive lobular carcinoma (ILC)
c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)

A

a. invasive ductal carcinoma (IDC)

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9
Q

second most common type of BCs (~15%)

a. invasive ductal carcinoma (IDC)
b. invasive lobular carcinoma (ILC)
c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)

A

b. invasive lobular carcinoma (ILC)

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10
Q

which of the following are non-invasive? SELECT ALL THAT APPLY

a. invasive ductal carcinoma (IDC)
b. invasive lobular carcinoma (ILC)
c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)

A

c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)

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11
Q

-normal cells have undergone pre-malignant genetic transformation
-typically seen as microcalcifications on a mammogram

a. invasive ductal carcinoma (IDC)
b. invasive lobular carcinoma (ILC)
c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)

A

c. ductal carcinoma in situ (DCIS)

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12
Q

onset for inflammatory BC

A

days and weeks

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13
Q

which type of BC has an “orange peel look?”

A

inflammatory

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14
Q

presenation of BC: > ____ % of pts present with a painless lump in the breast, while < ____ % of pts have stabbing or aching pain as the first sx

A

> 90%; < 10%

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15
Q

2 ways to test for HER2 status (slide 23 of 100)

A
  1. immunohistochemistry (IHC): detects protein overexpression
  2. fluorescence in-situ hybridization (FISH): detects gene amplification
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16
Q

what is Oncotype Dx?

A

genetic test that determines how likely breast cancer will return and whether the pt is likely to benefit from chemo

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17
Q

Oncotype DX is validated for use in which 5 cases?

A

-newly diagnosed BC
-stage I or II
-lymph node negative and positive (1-3 nodes)
-ER positive
-HER2 negative

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18
Q

what does an Oncotype Dx < 26 mean?

a. high risk; chemo and hormonal therapy
b. high risk; hormonal therapy only
c. low risk; hormonal therapy only
d. low risk; chemo and hormonal therapy

A

c. low risk; hormonal therapy only

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19
Q

what does an Oncotype Dx of 26 or higher mean?

a. high risk; chemo and hormonal therapy
b. high risk; hormonal therapy only
c. low risk; hormonal therapy only
d. low risk; chemo and hormonal therapy

A

a. high risk; chemo and hormonal therapy

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20
Q

difference between adjuvant and neoadjuvant

A

adjuvant = after surgery
neoadjuvant = before surgery

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21
Q

for which stage of BC is the treatment palliative and rather than curative?

a. I and II
b. IIIA, IIIB, IIIC
c. IV

A

c. IV

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22
Q

breast-conserving surgery for stage I, II, and IIIA pts includes what two components?

A

lumpectomy + XRT (radiation therapy)

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23
Q

2 benefits of neoadjuvant chemo

A
  1. allows less extensive surgery
  2. allows you to see response to chemo while tumor is still intact
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24
Q

systemic adjuvant therapy for hormone positive, lymph node - and +, HER2 positive pt with tumor 0.5 cm or less (slide 39)

a. consider adjuvant endocrine therapy +/- chemo with HER2 targeted therapy
b. adjuvant chemo with HER2 targeted therapy followed by endocrine therapy

A

a. consider adjuvant endocrine therapy +/- chemo with HER2 targeted therapy

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25
Q

systemic adjuvant therapy for hormone positive, lymph node - and +, HER2 positive pt with tumor > 0.6 cm (slide 39)

a. consider adjuvant endocrine therapy +/- chemo with HER2 targeted therapy
b. adjuvant chemo with HER2 targeted therapy followed by endocrine therapy

A

b. adjuvant chemo with HER2 targeted therapy followed by endocrine therapy

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26
Q

what is an oopherectomy?

A

removing ovaries, which removes the largest source of estrogen in the body

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27
Q

T or F: an oopherectomy should be performed only in postmenopausal women

A

F (pre only)

28
Q

major toxicity of tamoxifen

A

hot flashes

29
Q

which drug class initially causes inc release of FSH and LH, which eventually inhibits estrogen production by the ovaries?

A

LHRH analogs (ex. leuprolide, goserelin)

30
Q

when can we give aromatase inhibitors to a premenopausal woman?

A

if they have received ovarian suppression first (use LHRH analog first to “shut down” the ovaries, then we could use an aromatase inhibitor)

31
Q

how long is the standard of therapy for tamoxifen?

A

5 years

32
Q

2 NCCN preferred chemo regimens for HER2 negative disease

A

-dose dense AC -> paclitaxel
-TC = docetaxel + cyclophosphamide

33
Q

what drugs are included in dose dense AC?

A

doxorubicin
cyclophosphamide

34
Q

dose dense AC -> paclitaxel should be repeated every ____ days for ____ cycles

A

14; 4 (must give growth factors)

35
Q

what does “dose dense” mean in regards to chemo?

A

pts got the same amount of chemo, but in less time (for ex. in 2 weeks instead of 3 weeks)

36
Q

which is a non-anthracycline based regimen?

a. dose dense AC -> paclitaxel
b. TC

A

b. TC (no doxorubicin)

37
Q

which chemo regimen is preferred for pts with HER2 negative disease and cardiac problems?

a. dose dense AC -> paclitaxel
b. APT
c. TC
d. TCH

A

c. TC = docetaxel + cyclophosphamide

(b and d are HER2+ regimens)

38
Q

which of the following is NOT an adjuvant HER2 (+) regimen for BC?

a. TC
b. APT
c. TCH
d. TCH + pertuzumab

A

a. TC (HER2 negative)

39
Q

what drugs are included in APT for HER2 (+) BC?

A

APT = adjuvant paclitaxel + trastuzumab

40
Q

what drugs are included in TCH for HER2 (+) BC?

A

docetaxel, carboplatin, trastuzumab

(TCH = taxotere, carboplatin, herceptin)

41
Q

how long should adjuvant trastuzumab therapy be used after completion of adjuvant chemo?

A

one year

42
Q

for triple negative BC, which drug should be added into the chemo regimen and continued for 1 year of therapy?

a. pertuzumab
b. trastuzumab
c. pembrolizumab

A

c. pembrolizumab

43
Q

Metastatic disease: Pt is ER/PR+, has bone mets, asymptomatic visceral disease. Which is the most appropriate therapy? (slide 67)

a. endocrine therapy +/- bisphosphonate or denosumab
b. anti-HER2 therapy +/- chemo
c. chemo

A

a. endocrine therapy +/- bisphosphonate or denosumab

44
Q

Metastatic disease: Pt is ER/PR-, HER2+, symptomatic visceral disease, or hormone refractory. Which is the most appropriate therapy? (slide 67)

a. endocrine therapy +/- bisphosphonate or denosumab
b. anti-HER2 therapy +/- chemo
c. chemo

A

b. anti-HER2 therapy +/- chemo

45
Q

Metastatic disease: Pt is ER/PR-, HER2-, symptomatic visceral disease, or hormone refractory. Which is the most appropriate therapy? (slide 67)

a. endocrine therapy +/- bisphosphonate or denosumab
b. anti-HER2 therapy +/- chemo
c. chemo

A

c. chemo

46
Q

which is TRUE about hormonal therapy and chemotherapy in metastatic BC pts?

a. hormonal therapy is mainly for ER/PR- disease
b. if the pt has a shorter disease-free interval, hormonal therapy is likely not working and should change to chemo
c. bone metastases have a worse prognosis to hormonal therapy compared to chemo
d. pts with prolonged disease-free interval will respond worse with chemo

A

b. if the pt has a shorter disease-free interval, hormonal therapy is likely not working and should change to chemo

(a. ER/PR+; c. is better prognosis; d. will respond better)

47
Q

T or F: ER/PR+ tumors tend to be quicker growing in metastatic BC

A

F (more indolent i.e. slow growing)

48
Q

recommended first line option for HER2+ metastatic disease (name the 3 drugs; slide 75)

A

trastuzumab, pertuzumab, docetaxel (could also use paclitaxel)

49
Q

“second line” chemo + HER2 therapy for metastatic BC

a. T-DM1
b. tucatinib + trastuzumab + capecitabine
c. fam-trastuzumab deruxtecan-nxki
d. pertuzumab + trastuzumab + docetaxel

A

c. fam-trastuzumab deruxtecan-nxki

50
Q

which drug is now considered 2nd line after failure of trastuzumab/pertuzumab and a taxane for metastatic BC?

A

fam-trastuzumab deruxtecan

51
Q

two first line platinum agents for triple neg BC

A

carboplatin, cisplatin

52
Q

tx for 1st line, ER/PR+, HER2 neg metastatic disease?

a. APT
b. dose dense AC -> paclitaxel
c. AI with CDK4/6

A

c. AI with CDK4/6

53
Q

two underlined 2nd line hormonal therapies for metastatic BC

A

-fulvestrant + CDK4/6
-everolimus + endocrine therapy (exemestane, fulvestrant, or tamoxifen)

54
Q

one monitoring parameter for CDK4/6 inhibitors

A

CBC

55
Q

major SE of abemaciclib

A

diarrhea

56
Q

major SE of ribociclib

A

QTc prolongation

57
Q

starting at what age do women have the opportunity for annual mammograms?

a. 40
b. 45
c. 55
d. 65

A

a. 40

58
Q

at what age should women be getting yearly mammograms?

a. 40
b. 45
c. 55
d. 65

A

b. 45

59
Q

at what age should women be getting mammograms every OTHER year

a. 40
b. 45
c. 55
d. 65

A

c. 55

60
Q

which of these BC prevention surgeries decreases risk by ~90%?

a. prophylactic mastectomy
b. bilateral oophorectomy

A

a. prophylactic mastectomy (b. dec risk by 50%)

61
Q

three drugs studied in the BC preventative setting

A

-tamoxifen
-raloxifene
-exemestane

62
Q

which drug is FDA approved for the reduction of risk of invasive BC in high risk postmenopausal women?

A

raloxifene (prevention)

63
Q

what would be the chemotherapy course for a woman with early stage, triple negative BC?

A

pembrolizumab

64
Q

what would be the chemotherapy course for a woman with early stage, ER/PR-, HER2+ positive disease? (3 options in red; slide 58)

A

-APT = adjuvant paclitaxel and trastuzumab
-TCH = docetaxel, carboplatin, trastuzumab
-TCH + pertuzumab

65
Q

what would be the treatment course of a woman with early-stage ER/PR positive, HER2- disease?

A

She is ER+, HER2-, so we should get her Oncotype Dx first. If it is > 26, use chemotherapy. If it is 26 or less, use endocrine therapy

66
Q

what would be the tx option for a pt with HER2+, ER/PR- metastatic BC?

A

-no hormone therapy bc ER/PR-
-HER2 targeted therapy -> trastuzumab + pertuzumab + docetaxel

PHRM 864 Therapeutics (28 decks)

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