Exam 3 - Breast Cancer Flashcards
List non-modifiable risk factors for breast cancer?
female, older age, family history, genetics (BRCA1/2), breast changes on biopsy, radiation, early menarche/late menopause
List modifiable risk factors for breast cancer?
nulliparity or older age at first childbirth, postmenopausal HRT or obesity, physical inactivity, alcohol consumption
Explain screening recommendations for breast cancer?
all women should have breast awareness, women aged 25-39 exam every 1-3 years, aged 40+ annually
List signs/symptoms of breast cancer?
palpable mass, pain, discharge, retraction, dimpling, skin changes (redness, warmth, edema)
What are chemo treatments for hormone +/-, HER2- breast cancer? (3)
dose-dense doxorubicin/cyclophosphamide (AC) q2w x4 then paclitaxel q2w x4, dose-dense AC x4 then paclitaxel qw x12, docetaxel and cyclophosphamide q3w x4-6
What is treatment for hormone -, HER2- (triple negative) breast cancer?
pembrolizumab q3w x4 plus paclitaxel/carboplatin qw x12 then pembrolizumab plus AC q3w x4 then surgery then pembrolizumab q3w x9
What are treatments for HER2+ breast cancer? (2)
docetaxel/carboplatin/trastuzumab plus pertuzumab q3w x6, paclitaxel plus trastuzumab qw x12
What is the MoA of trastuzumab and pertuzumab?
inhibits HER2 homodimerization and HER2-mediated signaling
What are AEs of HER2 targeted therapies (trastuzumab/pertuzumab)?
cardiotoxicity, diarrhea, infusion-related reactions
What is the MoA of SERMs (tamoxifen/raloxifene)?
blocks estrogen binding site in some tissues depending on location in body
What is the MoA of aromatase inhibitors (anastrazole/letrozole/esemexane)?
suppress plasma estrogen levels by inactivating aromatase
What hepatic enzyme is important for tamoxifen metabolism to active form, endoxifen?
CYP2D6
What is treatment for premenopausal women receiving endocrine therapy for breast cancer?
tamoxifen, aromatase inhibitor plus ovarian suppression
What is endocrine therapy for postmenopausal women with breast cancer?
aromatase inhibitor, tamoxifen
What are treatments for ovarian suppression? (2)
oophorectomy, LHRH agonists (goserelin, leuprolide)
What are the AEs of SERMs (tamoxifen/raloxifene)? (3)
menopausal symptoms (hot flashes, vaginal dryness), uterine/endometrial cancers, thromboembolic events, AVOID pregnancy
What are the AEs of aromatase inhibitors? (5)
menopausal symptoms (hot flashes, vaginal dryness), musculoskeletal symptoms, bone loss, hypercholesterolemia, CV risks
What is additional adjuvant therapy for triple negative breast cancer?
capecitabine
What is additional adjuvant therapy for HER2+ breast cancer?
ado-trastuzumab emtansine
What is additional adjuvant therapy for hormone +/- HER2- breast cancer?
neratinib
What is additional adjuvant therapy for BRCA mutated breast cancer?
olaparib
What is additional adjuvant therapy for homone + HER2- high-risk breast cancer?
abemaciclib
What is additional adjuvant therapy for postmenopausal patients at osteoporotic risk?
zoledronic acid for 2 years
List the cyclin-dependent kinase 4/6 inhibitors? (3)
palbociclib (Ibrance), ribociclib (Kisqali), abemaciclib (Verzenio)
What are endocrine therapies for metastatic breast cancer? (3)
CDK 4/6 inhibitors (palbo/ribo/abemaciclib), everolimus, alpelisib
What is combined with CDK 4/6 inhibitors, mTORis, and alpelisib after disease progression?
fulvestrant (Faslodex)
What is the MoA of everolimus (Afinitor)?
inhibits mammalian target of rapamycin (mTOR)
What are AEs of everolimus (Afinitor)? (4)
rash, stomatitis, pneumonitis, metabolic disturbances
What is the MoA of alpelisib (Piqray)?
small-molecule phosphatidylinositol-3-kinase (PI3K) inhibitor
What is the indication for alpelisib (Piqray)?
hormone +, HER2-, PIK3CA-mutated metastatic breast cancer
What are treatments for breast cancer metastases to bone? (2)
bisphosphonates (zoledronic acid, pamidronate), denosumab
List the survivorship issues for breast cancer patients? (8)
hot flashes, sexual problems, infertility, lymphedema, osteoporosis, neuropathy, cardiac toxicity, secondary malignancies
