Systemic Rx Breast Cancer Flashcards
Neoadjuvant
Before
Adjuvant
After
What is goal of neodjuvant Rx
Reduce tumour size before surgery Inoperable disease operable Mastectomy - WLE Easier WLE Clear nodal disease
What is goal of adjuvant
Clear micro disease not detected
Adjuvant chemo increases survival
Neoadjuvant chemo shows no increase in survival but may allow breast conserving surgery
What are options for neoadjuvant
Hormone
Chemo
What is hormone therapy given or
ER / PR +ve
Neoadjuvant
Adjuvant
Unfit elderly
What do you give if pre-menopausal
Tamoxifen
What is tamoxifen
SERM
If don’t respond to tamoxifen what can you do
Ovarian ablation (surgery / RT) or GnRH analogue (gorselin)
Make menopause
Can give AI
What do you do if post menopausal
Aromatase inhibitor (Lebrazole) Tamoxifen if excellent prognosis / or AI CI
What does AI do
Inhibit oestrogen synthesis from androgens in fat
How long on hormonal and when do you give
5-10 years
Usually adjuvant
If having chemo usually start after
If having RT / Tratuzumab can be started during
When is chemotherapy beneficial
ER -ve HER2 +ve Young <50 Increasing with advancing risk LN involvement Grade 3 Lymphovascular invasion
When is chemo not beneficial
ER+Ve HER2-ve post menopause
The most common type
What can you do to determine benefit
Gene assay
When do you do chemo
Before surgery to shrink
Reduce recurrence
Adjuvant if axillary node or high stage
For Rx of metastatic
What targeted therapy is there
Tratuzumab (Hercepdin)
Anti-HER2
What does tratuzumab do
Monoclonal Ab blocking growth factor from going to HER2 and proliferating
Given every 3 weeks for 1 year
What do you always use with Tratuzuman
Combination with chemo
When is it CI
Heart disorder
What adjuvant Rx is there
Hormone Chemo Tratuzumab RT Biphosphonates Add aspirin
What do biphosphonates do
Prevent bony met
Increase survival
When do you use
Post menopause
Post chemo
What are SE of tamoxifen
Similar to menopause
- Hot flush / night sweats
- Loss of libido
- Amenorrhoea / eratic bleeding/. discharge
- Vaginal dry
- Weight gain
Less common Vaginal bleeding Endometrial cancer VTE Osteoporosis if post-menopausal
