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PHARM 444 : Neurology/Oncology > Lecture 3-4 > Flashcards

Lecture 3-4 Flashcards

Breast Cancer

1
Q

Breast Cancer can happen in :

A

Ducts ***
Lobules
Other areas

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2
Q

What action has proven to be reducing the risk of cancer ?

A

Breastfeeding

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3
Q

What are the risks factors for breast cancer ?

A

Age
Sex
History
Estrogen exposure
Radiation at a young age
Alcohol
Obesity
Dense breast tissue

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4
Q

Can contraceptives have a high risk of cancer ?

A

No currently low

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5
Q

What age has a high risk of breast cancer ?

A

45 - 65 yo

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6
Q

What type of estrogen exposure can increase the risk ok breast cancer ?

A

Endogenous : early puberty, late menopause, first pregnancy > 30 yo

Exogenous: HRT after menopause , HRT > 5 yo

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7
Q

What is BRCA gene and relation to breast cancer ?

A

Breast cancer susceptibility genes
Tumour suppressor gene that increases the risk of breast cancer
Most common in Ashkenazi Jewish

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8
Q

What is Li Fraumeni Syndrome ?

A

Rare germ line mutation to TP53 gene , tumor suppressor gene that increases the risk of breast cancer .

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9
Q

How does radiation works as oncology Tx ?

A

Rays cause DNA damage … which accumulates and causes the cells to no longer divide —> DEATH

Only cancer cells cannot repair DNA but normal cells can effectively repair it

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10
Q

What is the main difference between **external beam RT ** and Brachytherapy ?

A

External is the most common , the higher the energy beam and the deeper the radiation

Brachytherapy requires an implant directly to the tumor and body cavity . This limits the absorption of other healthy cells

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11
Q

How often is RT usually given ?

A

Daily

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12
Q

Which of the cancer is palliative when RT is involved ?

A

Lung
Head/ Neck Cancer

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13
Q

What are radiosensitizers ?

A

Chemicals that increase the biological effects of RT
Some chemo agents are radiosensitizers

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14
Q

Which of the chemotherapy agents or radio sensitizers?

A

5FU and cisplatin

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15
Q

What percentage of RT is given with palliative intent?

A

About 50%

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16
Q

What are indications for palliative RT?

A

Bone metastases, spinal cord compression brain metastases, advance lung cancer, superior vena cava syndrome

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17
Q

Give an example of RT emergencies

A

Spinal cord compression

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18
Q

What are one of the generalized side effects of radiation therapy?

A

fatigue

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19
Q

What is Gene TP 53? What happens when it’s mutated?

A

TP 53 is it true or surface one mutated it increases the risk of breast cancer

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20
Q

At what age would you recommend screening for breast cancer through mammograms?

A

Asymptomatic women, transgender, gender, diverse, and non-binary people excluded risk 45 to 74 years old is recommended for screening mammograms

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21
Q

From the LGBTQ community , who can we screen ?

A

breast tissue
>5 years of feminizing hormone
maybe top surgery ( decided by the doctor)

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22
Q

What are the predictive markers of breast cancer ?

A

Hormone receptors, HER2

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23
Q

What are the prognostic markers for bresat cancer ?

A

Ki67

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24
Q

BAsed on the breast type, which has the worsr prognosis ?

A

Invasive Ductal carcinoma

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25
Q

what is stage IV breast cancer ?

A

metastatic

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26
Q

What is stage 1 breast cnacer ?

A

early stage disease ( resectable)
<2 and no nodes

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27
Q

What is stage 0 breast cancer ?

A

insitu only

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28
Q

What is stage 2 breast cancer ?

A

Stage 3 : > 5 and lots of nodes
early stage - resectable

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29
Q

What is HIGH grade ?

A

less differiential cells
poor prognosis and better response to therapy

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30
Q

What is Ki67 ?

A

marker of proliferation

31
Q

What is an oncogene in breast cnacer ?

A

hER2/neu

32
Q

What are the genomic test for cancer ?

A

OncotypeDx
Prosigna

33
Q

Which genomic test will provide onformation about which tx would work for breast cancer ( chemo, endocrine, HER ) ?

A

OncotypeDx

34
Q

What is the goal of tx at stage 0 ?

A

prevention of the invasice cancer

35
Q

When would you consider adding endocrine tx in cancer breast ?

A

Stage 0 and down

36
Q

When would you consider adding chemo adjuvant in breast cancer ?

A

Stage 1 and down

37
Q

When would you consider adding HER2 target for breast cancer ?

A

stage 2 and down

38
Q

What is the main diff in modified and radical masectomy ?

A

modified : entire breast and some auxillary nodes
radical : entire breast and more axillary nodes

39
Q

What is the use of sentinnel nodes in breast cancer ?

A

hypothetical first affected nodes
free of cancer, don’t spread the infected radioactive agent

40
Q

what is a possible consequence of blocked or removed axillary nodes ?

A

lymphedema

41
Q

What does it mean grade 1 breast cancer ?

A

Low grae, well differentiate and growing slow and well organized

42
Q

What is the suffix of anthracycline ?

A

“rubicin”

43
Q

What are the drug combination for stage 1-3 breast cancer ?

A

“3 aunties can talk feeding”
3 : carboplatin, cyclophosphamide , ALONE - capecitabine

AC, TC , FECD, CT

44
Q

What is the difference in chemo tx for stage 1-3 to 4 ?

A

4 : now includes vinca alkoid or NAB-Pacitaxel

45
Q

What are the MOA of doxorubicin ?

A

Intercalated base pairs
inhibits topoisomerase 2
Chelates with iron → radicals

46
Q

Which of the anthracyclines stays longer in the body ?

A

Doxorubicin is longer because fastter metabolism of epirubicin

47
Q

What are your f/u measures for anthracyclines ?

A

Rubicin
red urine
cardio ( ECG , LVEF)
blister
N/V

48
Q

What is the MOA of cyclophosphamide ?

A

alkylatin agent –> nitrohen mustard
breaks DNA

49
Q

What is the ADR or cyclophosphamide ?

A

Hemorrhagic cystitis ( acrolein)
nausea ( ** if with the anthracyclines)
fertility suppression

50
Q

a patient is taking cyclophosphamide , what can you counsel them ?

A

Drink lots of water and pee often * help with cystitis
Fertility is suppressed

51
Q

What is the MOA or taxanes ?

A

“tangles vines “
disrupts the microtbules

52
Q

What are the main ADR of taxanes?

A

hypersensitivity rxn
Acute intoxications
fluid retention
fatigue
neuropathy and nail changes

53
Q

What is the role of dexamethasone with taxanes and with which agent ?

A

Dexa + doctaxel ( double D’s)
helps with fluid retention, hypersensitivity and ??? antiemetic

54
Q

How is carboplatin vs cisplatin ?

A

Less oto/nephrotoxic
N/V ( <cisplatin)
More myelosuppression

55
Q

What is HER receptors ?

A

Transmembrane protein that stimulates intracellular signaling to proliferate .

HER2 is activated by COUPLING

56
Q

Name the breast cancer HER2 tx ?

A

Trastuzumab :
Trastuzumab + DM1: emtansine
Trastuzumab + Dxd : Deruxetecan
Pertuzumab

Tucutinib
Lapatinib

57
Q

What is the MOA of trastuzumab ?

A

mABs of HER2 –> ligand dependent
leading to NK cells to kill it

58
Q
A
59
Q

What is MOA of pertuzumab ?

A

inhibits the dimerization of HER2 - HER1/3/4

60
Q

Which hormonal Tx for breast cancer is best after menopause ?

A

Tamoxifen

aromatase inhibitors ( anastrozole/letrozole/exemestane)

Fulvestrant

CDK4/6 ( palbociclib,ribociclib,abemaciclib)

61
Q

Where does tamoxifen bind ?

A

agonist on the endometrium/bone/lipids
antagonist on the breast / breast cancer cells

62
Q

What is the DDI between tamoxifen and Fluoxetine vs venlafaxine ?

A

Fluoxtine –> CYP2D6 inhibitors ( not activation of tamoxifen)

venlafaxine –> not a CYP2D6 inhibitors

63
Q

What is exemestane ?

A

Aromatase inhibitors used in the breast cancer ER+/PR+

64
Q

What are tamoxifen side effects ?

A

Side effects :
Menopause like
Flare-ups
Myalgias
?! DVT/PE

65
Q

What are the MOA of anstrozole ?

A

Aromatase inhibitors for breast cancer

Stops the production of estrogen from the adipose tissue

66
Q

What are the Side effects of letrozole ?

A

Aromatase inhibitors :

Myalgia
Edema
Vaginal dry
Bone loss
Hypercholesterol

67
Q

What is the fulvestrant ?

A

FULL estrogen antagonist

68
Q

Which of the CDK4 /6 inhibitors is used in early disease ?

A

abemaciclib

69
Q

What is palociclib ?

A

CDK 4/6 inhibitors - breast cancer : metastatic

70
Q

What should we monitor for pt on ribociclib ?

A

CDK4/6 inhibitors –> metastatic

CYP3A4 –> not grapefruit
fatigue
bone marrow suppression
Watch for Qtc

71
Q

what are the side effects for fulvestrant ?

A

Injection site rxn
Hypersensitivity
Hepatoxic
Hot flashes

72
Q

What is Olaparib ?

A

PARP inhibitors in BRCA mutations

73
Q

What are the immune checkpoint therapies for breast cancer ?

A

Pembrolizumab
Olaparib
Natural health ( vitamib D)

PHARM 444 : Neurology/Oncology (10 decks)

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