Lecture 8 - Breast cancer Flashcards by Patryk Lasiuk

Breast cancer prevention

chopping them off
Tamoxifen
Raloxifene (Evista) option too

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Mammography screening

women 50-74 every 2 years
women 40-49 not recommended to screen but discuss pro/con

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If results show biomarker HR, options are

Aromatase inhibitors
SERM
SERD
CDK4/6 inhib
Steroid aromatase inactivator

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If results show biomarker for HER-2, options are…

Anti HER-2 monoclonal antibodies
Monoclonal antibody - cytotoxic antineoplastic conjugates

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If results show biomarker for BRCA 1/2, options are….

PARP

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If results show biomarker for PIK3CA activating mutation, options are

PI3K inhibitor

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If results show biomarker for NTRK fusion mutation, options are…

Neurotrophic tyrosine kinase inhibitors

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invasive cancer is when it has spread beyond the area of…

carcinoma in situ

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Goal for Stage 1-3 =

cure and prevention of recurrence

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Goal of Stage 4 =

palliation and control
not candidate for surgery

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Hormone therapy for DCIS

consider for 5-10yrs in pts with HR+ tumors

Pre-meno = Tamoxifen 20 QD

Post-meno = Tamoxifen 20 QD, Anastrazole 1 QD, Letrozole 2.5 QD

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Factors favoring Lumpectomy

want to preserve breast
small tumor
single tumor
Negative Post-op margin
pts accepts long-term txm

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Factors favoring Mastectomy

Doesn’t want to preserve breast
large tumor
multi-centric tumors
postive post-op margin
one time procedure

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Factors favoring Mastectomy

Doesn’t want to preserve breast
large tumor
multi-centric tumors
positive post-op margin
one time procedure

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Pre-operative chemotherapy

3-4 cycles

If HER2+ = add trastuzumab +/- pertuzumab depending on tumor

Hormone therapy if ER+

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adjuvant therapy after surgery

can give radiation therapy after either proceudere

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adjuvant therapy after surgery

can give radiation therapy after either procedure

rare in mastectomy

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HR+ and HER2- pts therapy is…

Anthracyclines + taxanes
4-6 cycles every 14-21 days based on regimen

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Dose-dense AC + weekly paclitaxel for…

HR+ or HER2-

Doxorubicin+ cyclophosphamide and Paclitaxel 80mg/m2 every week X 12 cycles

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Dose dense AC + biweekly paclitaxel for…

HR+ or HER2-

Doxorubicin + cyclophosphamide and Paclitael 175mg/m2 every 2 wks X 4 cycles

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TC therapy for….

HR+ or HER2-

Doxorubicin + cyclophosphamide Q 3wks for 4-6 cycles

HR+ or HER2+ therapy is…

docetaxel (+/- carboplatin) or paclitaxel

Trastuzumab or pertuzumab given neoadjuvant or adjuvant setting

HR+ or HER2+, post op w/ no residual disease therapy….

docetaxel (+/- carboplatin) or paclitaxel + Trastuzumab or pertuzumab for 1yr

HR+ or HER2+, post op w/ residual disease therapy….

docetaxel (+/- carboplatin) or paclitaxel + ado-trastuzumab emtansine or combo Trastuzumab/pertuzumab

HER2 therapies

Trastuzumab = needs loading dose Pertuzumab = needs loading dose Ado-trastuzumab emtansine (Kadcyla) Fam-trastuzumab deruxtecan-nxki (Enhertu) need BL echo, drugs are cardiotoxic

Neratinib (Nerlynx) info

MOA: irreversible Tyrosine kinase inhibitor of EGFR, HER2,HER4 Dose: 240mg QD oral ADE: Severe diarrhea, Hepatotoxicity, rash no commonly used

HR- and HER2+ therapy

Surgery, Chemo, Anti-HER2 therapy Endocrine therapy not indicated

HR- and HER2+ therapy meds

Docitaxel or paclitaxel w/ Trastuzumab or pertuzumab

HR- and HER2- also known as....

TNBC Triple negative breast cancer

TNBC therapy....

HER2 and endocrine therapy not recommended Left with surgery and chemo

Recommended regimen for TNBC

Dose dense AC + wkly paclitaxel Dose dense AC + biweekly paclitaxel TC (Docetaxel + cyclophosphamide) if residual disease present, adjuvant capecitabine for 6-8 cycles

Capecitabine (Xeloda) info

MOA: prodrug of Fluorouracil Dose: 1000-1250 mg/m2 BID, 14 day on/7 days off ADE: Handfoot syndrome, diarrhea, hyperbilirubinemia

Olaparib (Lynparza) info

BRCA1/BRCA2, HER2- cancers ADE: inc N/Fatigue/anemia/vomiting/HA/D/Dec neuropathic count

HR+ HER- therapy

Hormonal therapy +/- targeted agents mTOR inhibitors CDK4/6 inhibitors Chemo

HR+ HER2+ therapy

Hormonal therapy and HER2 directed therapy

HR- HER2 therapy

chemo and HER2 directed therapy

HR- HER2 therapy

chemo

Hormone therapy info

slower onset than chemo may benefit pts without visceral disease better tolerated than chemo

SERM drugs

Tamoxifen Toremifine Raloxifene = only prevention

SERD drugs

Fuvestrant Elacestrant

Drug for pre-menopausal.....

Leuprolide (ovarian ablation or suppression)

Drug for post-menopausal.....

letrozole

CDK4/6 inhibitors.....

Palbocciclib (Ibrance) Ribociclib (Kisqali) abemaciclib (Verzenio)

1st line HR+ disease

1.Aromatase inhib + CDK4/6 inhibitors 2. Fulvestrant + exemestane 3. Fulvestrant + CDK4/6 inhibitor ** if premenopausal, req ovarian ablation or suppression **

Tamoxifen indications

adjutant therapy after surgery metastatic breast cancer DCIS- adjuvant to dec risk of invasive disease Breast cancer prophylaxis in high-risk women

Fulvestrant (Faslodex) dosing info

Loading dose and then once monthly after

Elacestrant (Orserdu) dosing info

QD with food

Drugs for Ovarian ablation/supression

Goserelin (Zoladex) = LHRH agonist Luprolide = LHRH agonist or option is surgery

Aromatase inhibitor drugs

Anastrozole Letrozole Exemestane choose based on safety profile

HR+ and HER2+ therapy category 1

1. Pertuzumab + trastuzumab + docetaxel 2. Trastuzumab + tucatinib + capecitabine 3. Ado-trastuzumab emtansine

Sacituzumab goviteca-hziy (Trodelvy) indication

unresectable locally advanced or metastatic TNBC who received 2+ therapies and atleast 1 in metastatic setting

Fam-trastuzumab (Enhertu) info

txm of unresectable or metastatic HER2+ BC who received 2 or more prior anti HER2 based regimens in metastatic settings high emetic potential req ECHO monitoring CI w/ pneumonitis or ISLD