Breast Cancer Flashcards
(104 cards)
1
Q
each breast has _____ lobes
A
15-20
2
Q
breast cancer is most common in the ___ > ____ > _____
A
ducts > lobes > other
3
Q
list 3 RF for breast cancer
A
increasing age, female, personal and family hx, estrogen exposure (endogenous and exogenous), radiation exposure to chest at a young age, alcohol, obesity, dense breast tissue
4
Q
genetic RF for breast cancer
A
BRCA1 and 2
5
Q
BRCA genes are
A
tumor suppressor genes
6
Q
what ancestry is more prone to breast cancer
A
ashkenazi jew
7
Q
what is the recommended age range for breast cancer screening
1. 40-49
2. 50-74
3. 40-74
4. >75
A
2
8
Q
should those who have had top surgery still get a mammogram?
A
yes
9
Q
should trans women with feminizing surgery get a mammogram?
A
yes if >5yrs of hormone therapy
10
Q
stage 0 breast cancer is
A
in situ
11
Q
stage 1 breast cancer is
A
<2cm and no spread to lymph nodes
12
Q
stage 2 breast cancer is
A
2-5cm or <2cm and spread to lymph nodes
13
Q
stage 3 breast cancer is
A
> 5cm or lots of lymph node involvement
14
Q
stage 4 breast cancer is
A
metastasis present in other areas
15
Q
which has a worse prognosis?
1. ductal carcinoma
2. lobular carcinoma
A
ductal
16
Q
pathology of BC conosiders
A
subtypes (lobular or ductal)
lymphovascular invasion
grade
Ki67
HR
HER2
17
Q
hormone receptors are
A
transcriptional factors that activate signal transduction upon hormone binding
18
Q
HER2 is an ____
A
oncogene encoding protein
19
Q
what is oncotype Dx
A
assigns recurrence score to predict which pts are most likely to benefit from chemo
20
Q
oncotype Dx is only for
A
stage 0 or 1, HR+, HER2-
21
Q
prosigna classifies
A
tumors into 4 intrinsic subtypes based on expression measures of 50 genes
22
Q
removes breast tumor without removal of remaining surrounding tissue
A
lumpectomy
23
Q
removes entire breast
A
simple/ total mastectomy
24
Q
removes entire breast + axillary lymph nodes
A
modified radical mastectomy
25
removes entire breast tissue along with some muscles of chest + more extensive axillary node dissection
radical mastectomy
26
Sentinel nodes are
first lymph nodes reached by metastasizing cancer cells from tumor
27
what is a sentinel lymph node biopsy
Inject radioactive material into breast - trace lymph drainage to first lymph node- if sentinel node free of cancer = unlikely to have spread = don’t need to remove additional lymph nodes
28
when should radiation therapy be done in stage 1-3
pts with breast conserving surgery, close or + margins, high risk features (large tumor, high grade, LVI, younger, metastasis)
29
how to sequence radiation therapy in a pt who will have adjuvant chemo
chemo, then radiation
30
when should radiation be done in a post op pt who will not undergo adjuvant chemo
after post op healing done
31
T or F: radiation can not be concurrent with trastuzumab and endocrine therapies
F- can be concurrent, just not with chemo
32
most breast cancer chemos combos
anthracycline + taxanes
33
-rubicin are
anthracyclines
34
-taxel are
taxanes
35
anthracyclines MOA
binds to DNA via intercalation and inhibits DNA repair by inhibiting TP2
also chelates with iron and binds to DNA and cell membrane, producing free radicals that cleave the DNA and cell mem
36
list 3 AEs for anthracyclines
myelosuppression
N/V
mucositis
alopecia
secondary malignancies
cardiotoxicity- cumulative
vesicant- causes necrosis of surrounding tissues
37
what are the 2 major issues with anthracyclines
cumulative cardiotoxicity = reduced LVEF or CHF
is a vesicant
38
cyclophosphamide MOA
alkylating agent that binds to DNA = breakage and repair inhibition
39
T or F: cyclophosphamide is a prodrug
T- requires activation by liver
40
cyclophosphamide AEs
hemorrhagic cystitis
N/V
myelosuppression
alopecia
fertility suppression
41
taxanes MOAs
disrupts MT network essential for mitotic and interphase cellular functions
42
hypersensitivity reactions to taxanes are due to _____ and most commonly seen in _______
diluent
first 2 cycles within first minutes of infusion
43
when can a taxane induced hypersensitivity not be rechallenged
if it is severe- bronchospasm, HPTN, rash/erythema, anaphylaxis
44
what are some issues with taxane diluents
cause hypersensitivity reactions
has enough ethanol to cause intoxication
45
AEs from taxanes
fluid retention (more with docetaxel) = pleural and pericardial effusion, ascites, dyspnea
myelosuppression
hypersensitivity
alopecia
nail changes
lacrimation
severe fatigue
peripheral neuropathy
acute intoxication
46
why might dex be given before docetaxel
to reduce freq of hypersensitivity rxn and fluid retention
+ antiemetic
47
dexamethasone dosing pre docetaxel
8mg PO BID starting day before docetaxel
must have at least 3 doses before infusion, or can give by IV right before
48
carboplatin MOA
covalently binds to DNA and disrupts DNA dunction
49
carboplatin dosing is based on the
calvert formula
50
what is the calvert formula and what is it used for?
dose (mg) = AUC x (CrCL +25)
for carboplatin
51
___% of breast cancer has HER2 overexpression
20%
52
HER2 is a
oncogene- transmembrane protein that stimulates growth
53
trastuzumab is a __MAb that blocks ___ by targeting _____
humanized MAb
blocks HER2
targets extracellular domain
54
trastuzumab is used in ____ and ____ breast cancer
early (adjuvant)-stage+
metastatic
55
pertuzumab is given with ___ and ____ in metastatic breast cancer
trastuzumab and taxane chemo
56
lapatinib is a
oral small molecule dual kinase inhibitor
57
lapatinib is given with ______ in ___ breast cancer
capecitabine
in metastatic breast cancer
58
trastuzumab emtansine MOA
attached to cytotoxic drug DM1 that inhibits tubulin polymerization and MT dynamics
59
trastuzumab deruxtecan MOA
HER2 MAb and TP1 inhibitor
60
which 2 HER2i are commonly given together
pertuzumab and trastuzumab (synergistic)
61
why are pertuzumab and trastuzumab given together
tras = inhibits ligand independent HER2 signaling and activates ADCC
pertuz = inhibits ligand dependent HER2 dimerization and signalling + activates ADCC
62
trastuzumab AEs
cardiotoxicity - decreased LVEF and CHF, arrhthmias
not dose related and mostly reversible
63
are trastuzumab cardiotoxicities reversible
yes
64
T or F: trastuzumab cardiotoxicities are dose dependent
F
65
lapatinib AE
diarrhea
66
what is the rationale behind hormone/ endocrine therapies
to deprive estrogen for cancer cells that rely on it for growth/ prolfieration
67
tamoxifen is most commonly seen as ___ therapy of ____ disease
adjuvant
early
68
what are the 4 endocrine therapies for BC
tamoxifen
aromatase inhibitors
fulvestrant
CDK 4/6 inhibitors
69
MOA of tamoxifen
SERM mixed agonist (E) and antagonist (antiE) activity depending on tissue. Competitively binds to E receptors for (ER+/PR+) = produces nuclear complex that reduces DNA synthesis = antiE effect
70
tamoxifen is an estrogen antagonist on
breast and breast cancer cells
71
tamoxifen is an estrogen receptor agonist on
endometrium, bone, lipids
72
why is tamoxifen kind of a prodrug
it is metabolized to NDM-TAM and 4-OH-TAM, then NDM-TAM is metabolzied to CYP2D6 to endoxifen which is 30-100x more potent
73
which CYP enzyme is important for endoxifen's antiE potency
CYP2D6
74
how much tamoxifen is given daily
20mg po daily
75
tamoxifen AEs
hot flashes, menopausal sx (80%), depression, amenorrhea if premenopausal, decreased libido, vaginal dryness, arthralgia/ myalgia, tumor pain/ flare (if metastatic setting)
76
serious risks of tamoxifen
DVT/PE
uterine cancers
77
tamoxifen interacts with
strong 2D6 inhibitors (fluoxetine, paroxetine, bupropion), warfarin
78
aromatase inhibitors are for _____ pts
post menopausal pts or those with induced menopause
79
what medications can induce ovarian suppression
goserelin or leuprolide
80
aromatase inhibitors used in the adjuvant setting are adminstered ________ yrs or up to ___ yrs after ____
5 yrs, 5 yrs
after tamoxifen therapy
81
aromatase inhibitors AEs
arthralgias/ myalgia, hot flashes, peripheral edema, vaginal dryness
82
what to monior for with aromatase inhibiors
bone loss, hypercholestrolemia
83
aromatase inhibitors used in metastatic/ palliative settings have durations based on
pt tolerance or disease
84
how can aromatase inhibitors be used if the cancer is HER2-
give with CDK4/6 inhibitors
85
what is an estrogen receptor antagonist with no partial agonist effects?
fulvestrant
86
fulvestrant MOA
competitive binding with estrogen receptors with affinity comparable to estradiol
87
fulvestrant place in therapy
HR+, HER2-
post menopausal or induced
metastatic disease
88
fulvestrant AEs
injection site reaction, hypersensitivity reaction, headache, hepatotoxicity, bleeding/ hematoma at injection site if on anticoagulants or severe thrombocytopenia
89
CDK is ___ from estrogen receptor signaling
downstreak
90
CDK4/6 facilitates __________ allowing progression from G1 to S
phosphorylation of retinoblastomas
91
what is overactive in cancer cells so there is uncontrolled cell cycle progression + is targeted by an endocrine therapy
CDK4/6 - use inhibitors
92
palbociclib is a
CDK4/6 inhibitor
93
what blocks signal process that is downstream from estrogen receptor?
CDK4/6 inhibitors
94
CDK4/6 inhibitors has synergism with
antiestrogen therapies
95
what are CDK 4/6i first line for?
metastatic breast cancer that is ER/PR+ and hER2- in combination with an aromatse inhibitor
96
what is a ribociclib combo that is second line for HR+, HER2- BC
ribociclob with fulvestrant
97
CDK4/6i AEs
bone marrow suppression, fatigue, infections ,pulmonary embolism, QTc prolongation
98
T or F: NHPs for menopausal sx from chemo is recommended
why or why not?
F- generally not recommended as products containing phytoestrogens can encourage growth of HR+ breast cancers
99
CDK4/6i is a CYP ___ substrate
3A4
100
what NHPs may be recommended for breast cancer and chemo
multivitamin
vit D 1000U for bone health (if serum calcium lvl not elevated)
101
T or F: antioxidants are generally recommended during chemo
F
102
exemestane is a
aromatase inhibitor
103
anastrozole is an
aromatase inhibitor
104
letrozole is an
aromatase inhibitor
