Breast cancer

Question 1

What are the two main cncers that have the expression of HER-2?

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Answer 1

breast cancer and Gastric cancer

Question 2

Receptors we can see in breast cancer?

Answer 2

HER-2
ER
PR

Question 3

What is the MOA of Trastuzumab?

Answer 3

Binds EC portion of HER-2 receptor, blocking typically and almost exclusively the homodimerization

Question 4

Trastuzumab works better in association with another drug, which one?

Answer 4

Pertuzumab

Question 5

MOA of Pertuzumab?

Answer 5

blocks heterodimerization of HER2-HER3

Question 6

What drugs represent the first line of treatment for metastatic HER-2 positive tumors?

Answer 6

Trastuzumab and Pertuzumb

Question 7

What treatment can we give for post-menopausal patient, metastatic HER-2 positive?

Answer 7

Trastuzumab + Aromatase inhibitors

Question 8

An important side effect of Trastuzumab ?

Answer 8

Cardiotoxicity, in the form of heart failure.

Question 9

what is the mechanism that can cause heart failure with trastuzumab?

Answer 9

Down regulates Neuregolin-1

Question 10

what type of drug is Ado-Trastuzumab ?

Answer 10

Chemically bound Trastuzumab to DM1 (Emtansine)

Cytoskeleton drug

Question 11

Does pertuzumab binds to the same receoptor site as trastuzumab ?

Answer 11

No

Question 12

cyclins 2/4/6 regulate which phase of the cell cycle?

Answer 12

Transition phase from G1 to S

Question 13

MOA of cyclin 4/6 inhibitors ?

Answer 13

Inhibiting the cyclin D, it blocks the activity of E2F (transcription factor)

Question 14

Indication of Lapatinib?

Answer 14

1. HER-2 positive breast K, that became resistent to Trastuzumab (associated to Capecitabin)
2. Pr+ breast K, associated to Aromatase inhibitors

Question 15

What kind of agent is DM1 ?

Answer 15

Chemotherapeutic

Question 16

can we use DM-1 alone?

Answer 16

No, it is too toxic

Question 17

In what process does BRCA 1/2 proteins are involved?

Answer 17

DNA repair

Question 18

What is one of the principal risk factors for Mammarian carcinoma?

Answer 18

Estrogenic stiumuli

Question 19

which drug is able to reduce by 38% the incidence of mammary carcinoma?

Answer 19

Tamoxifen 20 mg/d

Question 20

secondary prevention in breast K?

Answer 20

Mammography screening
In asymptomatic women between the ages of 50-69, every two years

Question 21

How screening for breast K is performed in younger women ?

Answer 21

Ultrasound, in familial cases and px with risk factors

younger patients have a denser tissue (glandular)

Question 22

What is the principal prognostic factor in breast K?

Answer 22

Metastasis to axilary lymph nodes

Question 23

When do we have an elevated risk of relapse in axilary lymph node metastasis from breast K?

Answer 23

4 or more lymph nodes

Question 24

Which protein are we looking for in immunohistochemistry of breast K, that the higher it’s concentration, the higher the chance for relapse?

Answer 24

Ki67

Question 25

Does high percentage of hormonal receptors in breast (ER, PR) improve or worsens prognosis?

Answer 25

**Improves**, it lowers the risk of relapse.

Question 26

Which breast tumors are more **chemo-sensitive** but less endo-sensitive ?

Answer 26

**Tumors with high proliferation index (Ki67)**

Question 27

What is luminal A breast K?

Answer 27

Positive for ER and/or PgR Negative for HER2

Question 28

What is luminal B breast K?

Answer 28

Positive for ER and/or PgR Positive for HER2

Question 29

What is Basal like breast K?

Answer 29

Triple negative

Question 30

What is HER2-like breast K?

Answer 30

HER2 positive and negative ER and PgR

Question 31

Which drug for **breast cancer** is the most frequently used in **pre-menopause**?

Answer 31

Tamoxifene

Question 32

What is the indication for Tamoxifene ? is it pre/post menopausal?

Answer 32

both prevention and treatment of breast K **ER+**, **pre menopause**

Question 33

what is the MOA of Tamoxifene ?

Answer 33

**Inhibiting the AF2 domain**

Question 34

what is the most important **side effect** of Tamoxifen?

Answer 34

**Increased risk of endometrial cancer**, by stimulating the proliferation of the uterine mucosa

Question 35

How efficient are the aromatase inhibitors?

Answer 35

**Like tamoxifen**, but without the estrogenic activity on the endometrial mucosa.

Question 36

what generation is **Anastrazole** (aromatase inhibitor) ?

Answer 36

III

Question 37

Main indication for **aromatase inhibitors**?

Answer 37

**ER positive** breast cancer

Question 38

Important side effects of Aromatase inhibitors ?

Answer 38

**Osteoporosis** **Arthralgia** (especially in the small articulations)

Question 39

what is the purpose of systemic neoadjuvant therapy?

Answer 39

Reduce the dimensions of the tumor **before** the surgical operation

Question 40

Targeted therapies in metastatic breast cancer? | "TAAL"

Answer 40

Trastuzumab Ado-trastuzumab Anti-VEGF Lapatinib

Question 41

When do we use aromatase inhibitors? post/pre menopause?

Answer 41

**post menopausal**