Scammell- pharmocological Rx of breast cancer Flashcards
does combination birth control pills for premenopausal patients have a link to breast cancer
no
does topical vaginal estrogen products have a link to breast cancer in peri and post-menopausal patients
no
increases risk of breast cancer BUT reduces risk of endometrial cancer
progestin
____ approved that is an estrogen antagonist at breast and endometrium while getting estrogen benefits elsewhere
SERM
hormonal therapy taken for ____ years for breast cancer treatment
5-10
selective estrogen receptor modulator (SERM) used to treat breast cancer in premenopausal women
Tamoxifen
increased risk of endometrial cancer and blood clots with this medicine
Tamoxifen
aromatase inhibitor used to treat breast cancer in postmenopausal women
Letrozole, Anastrazole
won’t see estrogenic effects with _____ inhibitors b/c estradiol levels are low
aromatase
SE of hormonal therapy
menopausal symptoms, risk of endometrial cancer and blood clots
___ promotes the growth of cancers that are estrogen receptor +
estrogen
hormone receptor + means ___ and ___ receptor +
estrogen and progesterone
___ increases progesterone receptor synthesis, so ____ receptor + tissues have both ER and PR
estrogen
stop estrogen from acting (SERM or SERD) OR
lower estradiol levels (aromatase inhibitor) OR
inhibit estradiol secretion
hormone therapies
if the cancer is ER- and PR-, ___ therapy is ineffective
hormone
Estrogens agonists at some tissues, BUT
estrogens antagonists at others
SERM (selective estrogen receptor modulators)
to treat ER + breast cancer: antagonist at the breast; agonist at the endometrium and clotting factors (endometrial cancer and blood clot risks)
Tamoxifen
SERM that is pro-fertility, antagonist at hypothalamus and increase in GnRH
Clomiphene
SERD (selective ER depleter or down-regulator); blocks the estrogen receptor and the receptor is degraded intracellularly
Second-line therapy in metastatic breast cancer after initial failure
Fulvestrant
SE of this drug is hot flashes and night sweats due to antagonism of some effects of estrogen
Fulvestrant
letrozole, anastrazole, exemestane
aromatase inhibitors
used in premenopausal women for fertility induction + postmenopausal women for breast cancer treatment
Letrozole, Anastrazole
SE of aromatase inhibitors
bone thinning, osteoporosis
acts at GnRH receptor and downregulates entire pathway; decreases FSH secretion and decreases estradiol
Leuprolide
feedback at hypothalamus and pituitary to decrease FSH secretion; decrease FSH secretion and decrease estradiol
progestin and androgen
is expressed on 20% of breast cancer cells and stimulates growth
HER2
monoclonal antibody to HER2
Main side effect is cardiovascular especially if combined with doxorubicin
Trastuzumab (Herceptin)
targets HER2 but at a different site than trastuzumab; given together for synergistic effect
Pertuzumab
the monoclonal antibodies to treat breast cancer can be used with what other 2 inhibitors
tyrosine kinase inhibitor
CDK 4/6 inhibitor
do not get chemo
topoisomerase II inhibitor used to treat triple - breast cancer
doxorubicin
main toxicity of doxorubicin
cardiac
stabilizes microtubules; used to treat triple - breast cancer
paclitaxel
main SE of paclitaxel
neuropathy
inhibits thymidylate synthase; used to treat triple - breast cancer
5–fluorouracil
main SE of 5-fluorouracil
neurotoxicity
alkylates DNA; used to treat triple - breast cancer
cyclophosphamide
main SE of cyclophosphamide
hemorrhagic cystitis
Inhibit osteoclastic activity, decrease bone turnover; used in osteoporosis, bone pain and bone metastasis of breast cancer
bisphosphonates
Monoclonal Ab that inhibits osteoclast activity by binding to RANK; used in osteoporosis and bone pain for bone metastasis of breast cancer
Denosumab
