Exam 2 - Breast Cancer Weddle Flashcards
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
b. most common cause of cancer related death in women (2nd most common)
T or F: more than 60% of pts will NOT have any risk factors for BC
T
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
f. decreased BMI (elevated BMI is a risk)
what percent of BCs are familial?
a. 1-2%
b. 5-10%
c. 20-25%
d. 90-95%
b. 5-10%
2 tumor suppressor genes important in breast cancer
BRCA-1 and BRCA-2
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
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)
what risk assessment tool is used to determine relative risk (RR) in % of developing BC?
GAIL Model
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. invasive ductal carcinoma (IDC)
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)
b. invasive lobular carcinoma (ILC)
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)
c. ductal carcinoma in situ (DCIS)
d. lobular carcinoma in situ (LCIS)
-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)
c. ductal carcinoma in situ (DCIS)
onset for inflammatory BC
days and weeks
which type of BC has an “orange peel look?”
inflammatory
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
> 90%; < 10%
2 ways to test for HER2 status (slide 23 of 100)
- immunohistochemistry (IHC): detects protein overexpression
- fluorescence in-situ hybridization (FISH): detects gene amplification
what is Oncotype Dx?
genetic test that determines how likely breast cancer will return and whether the pt is likely to benefit from chemo
Oncotype DX is validated for use in which 5 cases?
-newly diagnosed BC
-stage I or II
-lymph node negative and positive (1-3 nodes)
-ER positive
-HER2 negative
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
c. low risk; hormonal therapy only
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. high risk; chemo and hormonal therapy
difference between adjuvant and neoadjuvant
adjuvant = after surgery
neoadjuvant = before surgery
for which stage of BC is the treatment palliative and rather than curative?
a. I and II
b. IIIA, IIIB, IIIC
c. IV
c. IV
breast-conserving surgery for stage I, II, and IIIA pts includes what two components?
lumpectomy + XRT (radiation therapy)
2 benefits of neoadjuvant chemo
- allows less extensive surgery
- allows you to see response to chemo while tumor is still intact
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. consider adjuvant endocrine therapy +/- chemo with HER2 targeted therapy
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
b. adjuvant chemo with HER2 targeted therapy followed by endocrine therapy
what is an oopherectomy?
removing ovaries, which removes the largest source of estrogen in the body
T or F: an oopherectomy should be performed only in postmenopausal women
F (pre only)
major toxicity of tamoxifen
hot flashes
which drug class initially causes inc release of FSH and LH, which eventually inhibits estrogen production by the ovaries?
LHRH analogs (ex. leuprolide, goserelin)
when can we give aromatase inhibitors to a premenopausal woman?
if they have received ovarian suppression first (use LHRH analog first to “shut down” the ovaries, then we could use an aromatase inhibitor)
how long is the standard of therapy for tamoxifen?
5 years
2 NCCN preferred chemo regimens for HER2 negative disease
-dose dense AC -> paclitaxel
-TC = docetaxel + cyclophosphamide
what drugs are included in dose dense AC?
doxorubicin
cyclophosphamide
dose dense AC -> paclitaxel should be repeated every ____ days for ____ cycles
14; 4 (must give growth factors)
what does “dose dense” mean in regards to chemo?
pts got the same amount of chemo, but in less time (for ex. in 2 weeks instead of 3 weeks)
which is a non-anthracycline based regimen?
a. dose dense AC -> paclitaxel
b. TC
b. TC (no doxorubicin)
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
c. TC = docetaxel + cyclophosphamide
(b and d are HER2+ regimens)
which of the following is NOT an adjuvant HER2 (+) regimen for BC?
a. TC
b. APT
c. TCH
d. TCH + pertuzumab
a. TC (HER2 negative)
what drugs are included in APT for HER2 (+) BC?
APT = adjuvant paclitaxel + trastuzumab
what drugs are included in TCH for HER2 (+) BC?
docetaxel, carboplatin, trastuzumab
(TCH = taxotere, carboplatin, herceptin)
how long should adjuvant trastuzumab therapy be used after completion of adjuvant chemo?
one year
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
c. pembrolizumab
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. endocrine therapy +/- bisphosphonate or denosumab
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
b. anti-HER2 therapy +/- chemo
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
c. chemo
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
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)
T or F: ER/PR+ tumors tend to be quicker growing in metastatic BC
F (more indolent i.e. slow growing)
recommended first line option for HER2+ metastatic disease (name the 3 drugs; slide 75)
trastuzumab, pertuzumab, docetaxel (could also use paclitaxel)
“second line” chemo + HER2 therapy for metastatic BC
a. T-DM1
b. tucatinib + trastuzumab + capecitabine
c. fam-trastuzumab deruxtecan-nxki
d. pertuzumab + trastuzumab + docetaxel
c. fam-trastuzumab deruxtecan-nxki
which drug is now considered 2nd line after failure of trastuzumab/pertuzumab and a taxane for metastatic BC?
fam-trastuzumab deruxtecan
two first line platinum agents for triple neg BC
carboplatin, cisplatin
tx for 1st line, ER/PR+, HER2 neg metastatic disease?
a. APT
b. dose dense AC -> paclitaxel
c. AI with CDK4/6
c. AI with CDK4/6
two underlined 2nd line hormonal therapies for metastatic BC
-fulvestrant + CDK4/6
-everolimus + endocrine therapy (exemestane, fulvestrant, or tamoxifen)
one monitoring parameter for CDK4/6 inhibitors
CBC
major SE of abemaciclib
diarrhea
major SE of ribociclib
QTc prolongation
starting at what age do women have the opportunity for annual mammograms?
a. 40
b. 45
c. 55
d. 65
a. 40
at what age should women be getting yearly mammograms?
a. 40
b. 45
c. 55
d. 65
b. 45
at what age should women be getting mammograms every OTHER year
a. 40
b. 45
c. 55
d. 65
c. 55
which of these BC prevention surgeries decreases risk by ~90%?
a. prophylactic mastectomy
b. bilateral oophorectomy
a. prophylactic mastectomy (b. dec risk by 50%)
three drugs studied in the BC preventative setting
-tamoxifen
-raloxifene
-exemestane
which drug is FDA approved for the reduction of risk of invasive BC in high risk postmenopausal women?
raloxifene (prevention)
what would be the chemotherapy course for a woman with early stage, triple negative BC?
pembrolizumab
what would be the chemotherapy course for a woman with early stage, ER/PR-, HER2+ positive disease? (3 options in red; slide 58)
-APT = adjuvant paclitaxel and trastuzumab
-TCH = docetaxel, carboplatin, trastuzumab
-TCH + pertuzumab
what would be the treatment course of a woman with early-stage ER/PR positive, HER2- disease?
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
what would be the tx option for a pt with HER2+, ER/PR- metastatic BC?
-no hormone therapy bc ER/PR-
-HER2 targeted therapy -> trastuzumab + pertuzumab + docetaxel
