Solid Tumors Flashcards
What are the risk factors for breast cancer?
- hormone exposure (female, early menarche, late menopause, older age at first live childbirth, prolonged hormone replacement, obesity)
- genetics (family history, mutations: BRAC1/2, p53, PTEN)
- radiation
What is BRCA1/BRCA2 mutations?
tumor supressor genes that are associated with breast and ovarian cancer risk
What is the management for BRCA1/BRCA2 mutations?
mastectomy and/or oophorectomy, chemoprevention, or intensive screening
What drugs can be used as chemoprevention in patients with breast cancer risk?
- tamoxifen
- raloxifen
- exemestane
- anastrozole
Which chemopreventive for breast cancer can only be given to patients that are post-menopausal?
raloxifene, exemestane, anastrozole
How can hormone receptor status be used in breast cancer therapy?
estrogen (ER) and progesterone (PR) which indicated superior response to hormone therapy
How does HER2 status be used for breast cancer therapy?
HER2 directed therapy may be used, indicates the disease may be more agressive and higher rates of reoccurance
Describe the breast cancer staging:
- localized (confined to the primary site)
- regional (lymph node involvement)
- distant (metastasized)
What is the treatment for operable local/regional disease?
- surgery (mastecomy)
- drug therapy (presurgery= neoadjuvant therapy, post surgery= adjuvant)
- radiation if mastecomy with lymph node involvement, tumor > 5cm, close margins, breast conserving surgey preformed (administered after chemotherapy is complete!)
What adjuvant endocrine therapies may be considered for non-metastatic breast cancer?
- selective estrogen receptor modifiers= tamoxifen
- aromatase inhibitors= anastrozole, letrozole, exemestane
- ovarian suppression w/ LHRH/GnRN agonists= goserelin, leuprolide, triptorelin
- CDK 4/6 inhibitor= abemaciclib
What adjuvant endocrine therapy for non-metastatic breast cancer is appropiate for pre-menopausal women?
tamoxifen and ovarian suppressors (LHRH/GnRH agonists) and aromatase inhibitors if ovarian suppression is present
What adjuvant endocrine therapy for non-metastatic breast cancer is appropiate for post-menopausal women?
tamoxifen and aromatase inhibitors (anastrozole, letrozole, and exemestane)
When would use of CDK 4/6 inhibitor (Abemaciclib) be appropiate for non-metastatic breast cancer?
lymph node positive (2 years of use permitted)
When would adjuvant endocrine therapy be considered for non-metastatic breast cancer?
ER+ or PR+ disease for 5-10 years
What are the adverse effects of aromatase inhibitors?
hot flashes, night sweats, vaginal dryness, musculoskeletal symptoms, osteoprosis, bone fractures
What are the adverse effects of selective estrogen receptor modifiers (SERMs)- Tamoxifen?
hot flashes, night sweats, vaginal dryness, increased uterine cancer risk and DVT, increased bone mineral density
What are the preferred adjuvant chemotherapy regimens in non-metastatic breast cancer?
- dose dense AC every 14 days for 4 cycles followed by weekly paclitaxel (A= doxorubicin & C= cyclophosphamide)
- TC every 21 days for 4 cycles (T= docetaxel & C= cyclophosmamide)
filgrastim or pegfilgrastim for support
What regimens are recommended for HER2 + non-mestatic breast cancer?
- low risk disease= paclitaxel + trastuzumab
- TCH (T= docetaxel, C= carboplatin, H= trastuzumab) +/- pertuzumab
What drugs can be used for breast cancer treatment if the patient has a BRCA mutation?
PARP inhibitor (olaparib or talazoparib)
What is the treatment scheme for local/regional (stage I/II) non-metastatic breast cancer?
surgery +/- radiation -> adjuvant treatment based on receptor status
What is the treatment scheme for locally advanced (stage III) non-metastatic breast cancer?
neoadjuvant therapy -> surgery -> complete chemotherapy -> endocrine therapy and HER2 directed therapy if indicated
