Oncology Flashcards
Name three ER positive cancers
Luminal A
Luminal B
Luminal C
Name two ER negative cancers
HER Overexpression
Basal like - triple negative
How is luminal A type of cancer treated?
Endocrine therapy
How is luminal B type of cancer treated?
Chemo followed by endocrine
How is HER2 positive cancer treated?
Chemo
Anti-HER2
Endocrine if ER positive
How is triple negative cancer treated?
Chemo
Immunotherapy
State the indications for neoadjuvant chemotherapy
- downsizing tumour
- enroll patients in clinical trials
- locally advanced breast cancer (inflammatory, ulcerative)
- large primary tumour compared to breast
State the indications for adjuvant chemotherapy
- risk of relapse
- tumour extent
- grade
- proliferation
- vascular invasion
- patient preference
What is the key online prognostic tools?
NHS PREDICT
What tool can be used to predict recurrence?
Oncotype Dx type genomic testing
Name the acute side effects of chemotherapy
Fatigue Myelosuppression Nausea/vomiting Alopecia Mucositis Diarrhoea Constipation Renal Neurotoxicity Infertility
Name the late side effects of chemotherapy
Cardiac Infertility - premature menopause Neuropathy Renal impairment Osteoporosis Carcinogenesis
Name three anti-HER2 treatments
- Monoclonal antibodies
- Antibody drug conjugate
- Kinase inhibitor
Name two monoclonal antibodies
Transtuzumab
Pertuzumab
Describe antibody drug conjugates
Monoclonal antibody linked to chemo - antiHER2 attaches to HER2 protein signalling for the chemo drug to directly come to it
Name an antibody drug conjugate
TDM1
Describe kinase inhibitor
HER2 is a kinase protein that tells the cell to grow
Name the side effects of HER2 targeted drugs
Heart disease Diarrhoea Hand-foot syndrome Transaminitis Pneumonitis/IDL
What neoadjuvant endocrine therapy can be given?
Pre-menopausal - unlikely
Post-menopausal - letrozole
What kind of drug is tamoxifen?
Partial ER antagonist
What kind of drug is letrozole?
Aromastase inhibitor (enzyme converts hormones to oestrogen)
Name the side effects of endocrine therapy
Bone/joint pain Hot flushes Fatigue Weight gain Mood swings Hair thinning Loss of libido
In post menopausal women with an ER positive tumour what endocrine treatment is given?
Low risk - tamoxifen for 5 years or AI
High risk - aromatase inhibitor for 10 years
In pre menopausal women with an ER positive tumour what endocrine treatment is given?
Low risk - tamoxifen for 5 years
High risk - ovarian suppression, tamoxifen, exmestane
How is triple negative cancer treated?
Neoadjuvant chemotherapy
High risk of brain/CNS mets or visceral mets
Clinical trials
When is bisphosphonate recommended?
Post-menopausal high risk for hormone therapy
Pre-menopausal treated with ovarian suppression
What is needed in addition to bisphosphonate?
Vitamin D daily
What is the assessment guideline for metastatic disease?
Minimal staging No routine brain imaging Evaluate treatment response every 2-4 months biopsy metastatic lesion reassess biological markers
What new drug can be used in metastatic disease?
CDK4/6 Inhibitors
Describe CDK4/6 Inhibitors
Block phosphorylation of retinoblastoma - 3 different types
What the side effects of CDK4/6 Inhibitors?
Neutropenia, diarrhoea, increased LFT, QTc prolongation, thromboembolic events
What type of drugs can be used in triple negative disease?
Immunotherapy
What is the aim of radiotherapy?
Reduce recurrence rate - 12 weeks post surgery
State the early toxicity of radiotherapy
Fatigue, skin reaction, hair loss
State the late toxicity of radiotherapy
Breast changes, discomfort, telangiectasia, lymphedema, heart/lung disease
