Treatment and pre-meds

Question 1

HER2+

Answer 1

Trastuzumab + chemotherapy
AC–>T + H +/- P
TCH+/- P
DDAC–>T + H

Continue trastuzumab even if they progress.

Question 2

Dose limiting toxicity of doxorubicin

Answer 2

Cardiac dysfunction

Question 3

Unique toxicity of cyclophosphamide that requires hydration

Answer 3

Hemorrhagic cystitis

Question 4

AC regimen emetogenic potential

Answer 4

High. Give dexamethasone, aprepitant (NK antagonist), and 5HT3 antagonist.

Question 5

Red urine

Answer 5

Common side effect of doxorubicin. Also colors tears red.

Question 6

Menopausal symptoms, bone loss, arthralgia/myalgias

Answer 6

Aromatase inhibitors

Question 7

Visceral mets

Answer 7

Single-agent chemotherapy

Question 8

Max cumulative dose of doxorubicin

Answer 8

550 mg/m2

Question 9

ER/PR+ Pre-menopausal

Answer 9

Tamoxifen- hot flashes, night sweats, vaginal dryness, uterine cancer, DVTs and PEs
Goserelin or Leuprolide + aromatase inhibitor
Surgical oophorectomy or ovarian irradiation

Question 10

Triple negative

Answer 10

Chemotherapy

Question 11

Triple positive

Answer 11

Trastuzumab + chemo then hormonal therapy

Question 12

HER2-

Answer 12

DDAC–>T (q14 days)
AC–>T (q21 days)
TC

Question 13

ER/PR+ post-menopausal

Answer 13

Aromatase inhibitors: anastrazole, letrozole, exemestane.
Exemestane may cause less joint pain.
Start them on calcium and vitamin D supplement.
Menopausal symptoms, myalgias/arthralgias, osteoporosis, hypercholesterolemia, insomnia.

Question 14

Patient with bone mets

Answer 14

Treated with hormonal therapy and denosumab or zoledronic acid. Renal dose adjustment required with zoledronic acid.

Question 15

Patient with symptomatic visceral mets

Answer 15

Treat with single agent chemo