Lec3

Question 1

what is the primary treatment for DCIS breast cancer (stage0)

Answer 1

1-breast-conserving surgery without lymph node surgery+(WBRT) preferred or (APBI)
2-total mastectomy with or without sentinel lymph node biopsy

WBRT= whole breast radiation the APBI=accelerated partial breast irradiation

Question 2

post surgical treatment for ipsilateral BCS and RT with ER postive

BCS= breast conserving surgery RT=radiation treatment ER=estrogen rec

Answer 2

Tamoxifen for premenopausal
tamoxifen or aromatase inhibitor for post menopausal
both for 5 years

if <60 or risk of thromoembolism the =aromatase inhibitor is preferred

Question 3

follow up of post surgical DCIS

Answer 3

1-physical exam every 6-12 months for 5years then annually
2-mammogram every 12 months

Question 4

surgival treatment of stage 1-2 ct1-3 breast cancer with negative axillary nodes(cN0)

pT= tumor size

Answer 4

BCS with surgical axillary staging
adjuvant: WIth 1-WBRT+RNI (if pT2 after or-pT3 and er negative or LVI)
or APBI if low risk

or total mastectomy (preferred) with no RT if tumor <or= to 5cm and margins >or=1
if >5cm tumor or 1-3 postive nodes then RT with RNI

BCS= breast conserving surgery WBRT=whole breast radiotherapy

RNI=regional nodal irradiation LVI=extensive Lymphovascular invasion APBI=accelerated partial breast irradiation

Question 5

surgical treatment of stage 1-2 ct1-3 breast cancer with negative axillary nodes(cN0) on 70 yo patient with ER-Positive and pT1

pT= tumor size

Answer 5

BCS with Endocrine therapy

BCS= breast conserving surgery

Question 6

Stage 1-2 breast cancer wit cT1-cT2 cN0 and pN1 no preoperative chemotherapy and 1-2 postive sentinel lymph node and WBRT planned what is the treatment

Answer 6

WBRT+-boost
consider RNI

if pN=2 then theres no need for her to meet the criteria to get therapy.

Question 7

what is the purpose of radiation therapy in stage 1-2

Answer 7

to eradicate residual disease

Question 8

breast cancer radiation toxicitys ?

Answer 8

1-breast shrinkage
2-Telangiectasias
3-breast edema(less common in short therapys)

Question 9

lenth of External beam radiation treatment after BCT

Answer 9

3-5 weeks

Question 10

recommended radiation therapy dose

Answer 10

15-16 fractions

another riegemn is 25-28 fractions

Question 11

goal of adjuvent therapy in breast cancer stage 1-2

Answer 11

because local therapy such as surgery and irriadiation do not eradicate distant micrometastases.

Question 12

preferred chemotheraputic reigmen for stage 1-2 breast cancer

there 2 preferred reigemn

Answer 12

1-dose dense AC-Paclitaxel
repeat cycles every 14 days for 4 cycles
must be given growth support
paclitacel 60mg

2-Dose Dense AC-DOSE Dense paclitaxel
repeat cycles every 14 days for 4 cycles
must be given growth support
paclitacel 175mg
repeat every 14 days for 4cycles
must be given growth support

Question 13

other chemotheraputic reigmen for stage 1-2 breast cancer

Answer 13

1-AC-Paclitaxel (80mg)
2-CMF
3-TC
4-TAC

Question 14

Drug used in stage 1-2 breast cancer chemotherapy with HER2-postive

Answer 14

trastuzumab

Question 15

Drug used in chemotherapy stage 1-2 breast cancer with high-risk HER2-postive

Answer 15

trastuzumab+pertuzumab

Question 16

used as extended adjuvant for breast cancer stage 1-2 chemotherapy

Answer 16

Neratinib(oral)

Question 17

what is the Gold standard adjuvant endocrine therapy in stage 1-2 breast cancer

Answer 17

Tamoxifen

Question 18

ex of aromatase inhibitors

Answer 18

1-anastrozole
2-letrozole
3-exemestane

Question 19

premenopausal women endocrine adjuvant therapy

Answer 19

1-Tamoxifen 5y w/wo ovarian suppresion or ablation
2-Aromatase inhibitor 5y +ovarian suppresion or ablation

ablation: remove the ovaries

Question 20

postmenopausal women endocrine adjuvant therapy

Answer 20

1-AI for atleast 5 years or
2-tamoxifen 2-3 years followed by AI for a total of 5 years or
3-tamoxifen 5years followed by AI for another 5 years (total 10years)

AI= aromatase inhibitor

Question 21

what is the treatment of inflammatory breast cancer

Answer 21

Chemotherapy with the goal of achieving resectability(استاصال للورم)

Question 22

Locally advanced breast cancer (stage 3) primary chemotherapy

Answer 22

1-anthracyclin+taxane alone or with HER2 targeting agents

Question 23

goal of neoadjuvant chemotherapy in breast cancer stage 3

Answer 23

Partial response(30%or more reduction in tumor size)

Question 24

neoadjuvant only viable in patient with stage 3 breast cancer+ pneomonia

Answer 24

Endocrine therpay

Question 25

Goal of radiation therapy in stage 3 breast cancer

Answer 25

to minimize local recurrences

Question 26

primary goal of therapy in stage 3 breast cancer

Answer 26

Cure

Question 27

inoperable tumors that are unresponsive to systemic chemotherapy treatment

Answer 27

neo adjuvant radiation+increase the dose

Question 28

what is the purpose of radiation therapy in stage 4 breast cancer that metastized to bone

Answer 28

to reduce pain

Question 29

do use radiation therapy in stage 4 breast cancer if yes then where

Answer 29

yes, in the area that teh cancer metastized to.

Question 30

Stage 4 breast cancer Goal of therapy

Answer 30

improve the overall survival and quality of life

Question 31

treatment of metastatic brease cancer

Answer 31

start with endorcrine if endocrine positive w/wo targeted therapy then add chemotheapy only if theres no response to endocrine
start with chemotherapy if endocrine negative

done use chemotherapy with endocrine

Question 32

rapidly progressive metastatic breast cancer treatment

Answer 32

start with chemotherapy

Question 33

ex of endocrine therapy/biologic therapy regimens

Answer 33

1-Trastuzumab+Lapatinib w/wo AI
2-Trastuzumab w/wo AI or tamoxifen
3-Lapatinib +Capecitabine
4-Lapatinib + AI

Question 34

ex of chemotherapy/ biologic therapy regimen

Answer 34

1-Docetaxel + Trastuzumab + pertuzumab
2-paclitaxel + Trastuzumab + pertuzumab
3-Chemotherapy +Trastuzumab
4-ADO-TrastuzumabEmtansine (T-DM-1)

Question 35

breast cancer patient with bone metastases should take the following drugs and why

Answer 35

1-Pamidronate
2-Zoledronic acid
3-denosumab
because they decrease the risk of bone related events (fractures etc)

Question 36

endocrine drugs for stage 4 premenopausal breast cancer

Answer 36

AI, tamoxifen , toremifen, fulvestrant

Question 37

endocrine drugs for stage 4 postmenopausal breast cancer

Answer 37

AI is preferred

Question 38

CDK-inhibitors FDA approved for MBC

MBC= metastatic breast cancer

Answer 38

1-Abemaciclib
2-palbociclib
3-ribociclib

ONLY USED IF HER2 NEGATIVE+NEWLY DIAGNOSED+ER POSITIVE

Question 39

S/E of CDK inhibitors

Answer 39

Neutropenia
Ribociclib=QT Prolongation for first two cycles

Question 40

HER2 negative with endocrine therapy that progressed within a year

Answer 40

Everolimus

Question 41

drug used as single agents in BRCA1 BRCA2 mutations

Answer 41

Olaparib
talazoparib