Onco 2: cancer of breasticles Flashcards
non-modifiable risk factors for breast cancer
- Female
- Older age
- Family hx
- Personal hx
- Genetics: BRCA 1 and 2 (tumor suppresor gene that repairs DNA)
- Breast changes found on biopsy
- Ionizing radiation hx, esp before age of 30 (?)
- Breast density (=/= size): makes it hard to discern tumors
- Early menarche (< 12 yrs)/late menopause (> 55yrs)
what are breast changes foud on biopsy
- atypical hyperplasia: non-cancerous condition where breast cncer cells have abnormal features and are increased in number
- lobular carcinoma in situ
- in situ: abnormla cells found in lobules and ducts
- ductal caarcinoma in situ
modifiable risk factors for bresat cancer
- Nulliparity - no full term nirhts
- Older age (35+) at first child birth
- Postmenopausal HRT
- Postmenopaussal obestiy
- Physial inactivit
- EtOH abuse
breast cancer prognosis factors
- Tumor size
- Lymph node status: lymph node involvemnt also bad pronosis, esp if 4+
- Tmor grade (differentiation): how different it looks form a normal cell
- Grade 1: kinda look normal, kinda still have some normal activity
- Grade 3: alien goop
- Ki67 index: information on cell proliferation, higher grade = more active replicaation
- Lymphovascular invasion: tumor emboli is found in lymphatic and vascular spaces
- Helpful in identifying node (-) pts who are at risk for recurrence
non invasive breast cancer treatment
- DCIS
- lumpectomy + radiation
- mastectomy
- if hormone (+), may cosider +/- endocrine therapy
- LCIS
- regular monitoring
- no treatment
invasive treatment for breast cancer
- Lumpectomy + radiation
- Goal: breast consveration
- Mastectomy +/- radiation
- Based on nodal involvement, size and tumor margin at time of surgery
- removal of breast AND associated lymph
- Post-surgery systemic therapy
- Cytotoxi chemotherapy
- Targeted therapy
- Endocrine therapy
adjuvvnt chemo treatment for breast cancer pt: HER (-)
pt may or may not be hormone (+)
- Dose-dense doxorubicin/cyclophosphamide 4x → paclitaxel Q2W 4x OR paclitaxel QW 12x → endocrine therapy (if pt qualifies) 5-10yrs
- Docetaxel and cyclophosphamide Q3W 4-6x
adjuvant chemo treatment for breast cancer pt: HER (-), hormone (+), and high risk
- high risk: 4+ lymph nodes OR 1-3 lymph nodes with grade 3 tumor OR tumor size > 5 cm
- can consider adding abemaciclib PO BID for 2 years; given in combo with endocrie thearpy
adjuvant chemo treatment for breast cancer: pt HER (-), BRCA mutation, and high risk
- can add olaparib PO BID for 1 year
- can be lethal in pts with BRCA 1/2 deficient tumors
neoadjuvant chemo treatment for breast cancer pt: triple neg
Pembrolizumab Q3W 4x + weekly paclitaxel/carboplatin 12x → pembrolizumab + doxorubicin/cyclophosphamde Q3W 4x
adjuvant chemo treatment for breast cancer pt: triple neg and did NOT achieve pathologic complete response with chemo
try capecitabine: BID 14D, off 7D for 6-8 cycles
adjuvant chemo treatment for breast cancer pt: HER (+)
- TCH+/-P (trastuzumab/carboplatin/Docetaxel+/- pertuzumab Q3W 6x → continue the mAbs to complete a year → endocrine therapy (if pt qualifies) 5-10yrs
- ALT: Paclitaxel + trastuzumab QW 12x
All: → trastuzmab continued to complete a year → endocrine therapy (if pt qualifies) 5-10yrs
pertuzumab criteria for use
- HER (+) and either T > 2 OR > N1 (these pts are at high risk for recurrence
adjuvant chemo treatment for breast cancer pt: HER (+) and did NOT acheive pathologic complete response with chemo
try ado-trastuzumab emtansine IV Q21D 14x
adjuvant chemo treatment for breast cancer pt: HER (+) and very high risk for recurrence
- can consider adding neratinib after pt has completed the year of trastuzumab
- 6T PO QD for 1 year
- ppx loperamide
difference between neoadjuvant and adjuvant chemo for breast cancer treatment
no diffference - EXCEPT: ER/PR (-) and HER (-): same as adjuvant → surgery → pembrolizumab Q3W 9x