Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oncology Therapeutics > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What are some risk factors for Breast Cancer?

  1. Sex?
  2. Age
  3. Family history such as ?
  4. Certain genetic mutations such as?
  5. Benign prolif ___
  6. Hx of ?
  7. High ____
  8. ___ to chest wall
  9. Exposure to hormones such as ?
  10. Post menopausal ___
  11. ___ consumption
  12. E
  13. D
  14. S
A
  1. Female
  2. Age
  3. 1st degree relative, dx at young age
  4. BRCA 1/2 genes
  5. Breast disease
  6. contra-lateral BrCa
  7. breast tissue density
  8. radiation
  9. early menarche < 11 yrs
    late menopause > 55yrs
    HRT
    Age at 1st birth > 30yrs
    Duration of breast feeding can REDUCE risk
  10. obesity
  11. Alcohol
  12. Exercise
  13. Diet
  14. Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Tx options based on stage : FOr each , state the tx options and goal

  1. Stage 0
  2. Stage 1
  3. Stage 2
  4. Stage 3
  5. Stage 4
A
  1. Surgery +/- radiation , hormonal therapy
    Goal : Prevent invasive disease / CURE

2-4 : Surgery +/- radiation, +/- Chemotherapy,
hormonal therapy , and targeted therapy
Goal : Cure

  1. Hormonal therapy
    Chemotherapy
    targeted therapy
    radiation
    Palliative Care
    Goal : Palliation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Doxorubicin :
1. Ae’s (2)
2. AC regimen notes?
3. Monitoring/Counseling

Cyclophosphamide
4. Ae’s
5. AC regimen notes
6. Monitoring/counseling

A
  1. Cardiomyopathy/CHF (reversible or irreversible), extravasation
  2. High emetogenic potential
  3. Myelosuppression , NV, LVEF, cumulative lifetime dose, vesicant, 2ndary malignancies, red urine
  4. Hemorrhagic cystitis (use mesna)
  5. HEC
  6. Myelosupression, N/V, I/O, blood in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Taxanes : Paclitaxel and Docetaxel

  1. Whats DLT/BBW ?
  2. Can cause N___ which is higher in Paclitaxel. It’s also ___ and w/higher cumulative doses
    -More of sensory than motor
    -If severe may require ___
  3. Emetogenic risk ?
  4. Nail changes ?
  5. ___, but may be less common with ?
  6. D/M
  7. F, A
A
  1. MYELOSUPPRESSION (BBW)
  2. neuropathy
    - dose dependent
    -dose reduction by 20%
  3. LOW
  4. Yellow/brown discoloration
  5. Alopecia (full body)
    - Docetaxel
  6. Diarrhea, mucositis
  7. Fatigue, asthenia (lack of energy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Paclitaxel Pre-Meds
1. Why do we pre-medicate?
2. What drugs do we use to pre medicate?
3. example of a regimen

Docetaxel Pre-meds
1. WHy do we pre medicate? (2)
2. Monitor ____
3. Pre meds with ? (example)

A
  1. Hypersensitivity rxns (BBW) –> Infusion rxns
  2. Steroid + H1 blocker + H2 blocker
  3. Dexa 20mg PO x1 12 hr prior, Dexameth 20mg PO x1 6 hr prior, diphen 50mg IV X1 + famotidine 20mg IV x 1 30-60 min prior
  4. Hypersensitivity rxns (BBW) and Fluid retention syndrome (manifests as periph edema)
  5. Weight (fluid retention)
  6. Steroids (Day prior, day of , and day after dextamethasone 8 mg PO BID)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Trastuzumab (Herceptin) and Pertuzumab : mAB against HER2

  1. Route for both
  2. Dosing frequency?
  3. Needs pre meds?
  4. Can cause cardiomyopathy/CHF?
  5. Pertuzumab can cause ___ especially with Loading Dose

CARDIOMYOPATHY/CHF
1. Manifests like ?
2. Can decr ___
3. Is it reversible?
4. What do u need to monitor and when?
5. When would u hold the drug ?
6. NEVER give with ___ bc of additive toxicity

A
  1. IV
  2. Trastuzumab : can be q3wks, or week
    Pertuzumab : q3wks
  3. No unless hx of rxn
  4. trastuzumab&raquo_space;» Pertuzumab
  5. Diarrhea
  6. CHF
  7. LVEF
  8. Yes
  9. LVEF, Baseline, q3months, completion , q6months for 2 yrs post tx
  10. LVEF >=16% decr from baseline
    LVEF <45% or LVEF 45-49% with decr of 10% from pre-tx value
  11. Anthracyclines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hormonal Agents : SERM ,Tamoxifen
1.What is its use in BC?
2. AE’s? (common)
3. BBW for?
4. What does it do to bone density?
5. Cholesterol?
6. RIsk of other cancers?

Hormonal Agents : AI’s : Anastrazole, Exemestane, Letrozole

  1. Use in BC?
  2. Ae’s?
  3. What does it do to bone density?
  4. Cholesterol ?
  5. Risk of other cancers?
A
  1. Adjuvant tx in Er/PR+ pre or post menopausal pt’s
  2. hot flashes, myalgias, arthalgias
  3. THROMBOSIS
  4. INCR bone density
  5. decr LDL, incr HDL
  6. incr risk uterine sarcoma/endometrial CA (BBW)
  7. ADjuvant tx in ER/PR+ post menopausal pts
  8. hot flashes, myalgias, arthalgias, can cause thrombosis (less)
  9. decr
  10. incr LDL (bad)
  11. minimal uterine/endometrial cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tamoxifen : DDI’s
1. With what enzymes?
2. Caution with which drugs?
3. Avoid which
4. consider which

A
  1. CYP 2d6 and 3A4
  2. SSRI’s and SNRI’s
  3. Mod 2D6 inhibs : wellbutrin, dulox, fluox, fluvox, parox
  4. Mild 2d6 inhibs : cital, lexapro, sert, venlafax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stage 0 : TX overview

GOAL : Cure or prevent invasive disease

  1. Primary Tx for DCIS vs LCIS ?
  2. Adjuvant Tx for DCIS vs LCIS ?
A
  1. DCIS :Surgery +/- radiation

LCIS : Observation or surgery (high risk)

  1. DCIS : if ER/PR+ –> hormonal tx using tamox for premeno and an AI for postmenopausal

LCIS : Everyone gets hormonal tx . Premeno = tamoxifen
Postmeno = Raloxifene or AI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage 1 and 2 TX overview :
GOAL is CURE

  1. Primary tx?
  2. Adjuvant tx?
  3. How do we decide who gets Chemo?
A
  1. surgery
  2. Chemotx, radiation, and hormonal therapy (if ER/PR+)
  3. only If they’re Node + (cancer has spread) . if they’re node (-) we’d only give chemo if high risk oncotype Dx score (For her2 neg pt’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dose Dense Concept :
1. Using ____ in ___
2. Relative to the q3weeks dosing for standard therapy, what is the dose dense frequency
3. What does it do to tumor growth during cycles?
4. Dose dense tx must be given with ?

A
  1. Higher doses, short time period
  2. weekly dosing (higher total doses)
  3. Limits tumor regrowth between cycles by exposing tumor cells to chemotx when they’re in most active growth phase
  4. GCSF (To stim pt’s bone marrow to produce neutrophils to assist in recovery prior to next tx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

For each regimen state the drug
1. TC
2. ddAC –> ddT
3. T+H
4. TCH –> H

A
  1. Docetaxel + cyclophosphamide
  2. dose dense Adriamycin (Doxorubicin) + Cyclophos folowed by dose dense paclitaxel
  3. Paclitaxel + Trastuzumab
  4. Docetaxel + carboplatin + trastuzumab fb Trastuzumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage 1 and 2 HER2 (-)

  1. If ER/PR+ , and N0 or N1, what tx for low risk vs high risk ?
    - DO they receive hormonal tx?
  2. if ER/PR + with N2, N3, whats tx?
    -Hormonal tx?
  3. If ER/PR - and N0?
    -Hormonal tx?
  4. If ER/PR (-) and N1,2,3 ?
    -Hormonal tx?
  5. Whats a benefit to TC over AC?
A
  1. Low = No chemo
    High = CHemo using TC (Docetaxel + Cyclophos)
    -YES hormonal tx
  2. Chemo ddAC –> ddT (Doxorubicin + cyclophos fb Paclitaxel)
    - Yes
  3. Chemo using TC (Docetaxel + Cyclophos)
    -No
  4. Chemo ddAC –> ddT
    -No
  5. TC less aggressive bc no anthracycline (No cardio issues and secondary malignancies such as AML)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stage 1 and 2 : HER2+

  1. If ER/PR (+/-) and N0 what tx?
    -hormonal tx?
  2. If ER/PR (+/-) and N1,2,3 what tx?
    -hormonal tx?
  • Do not give hormonal tx with chemo, p sure u give it after*
A
  1. Chemo using T+H (Paclitaxel + Trastuzumab )
    -If ER/PR +
  2. Chemo ddAC (doxo + cyclophos) –> T+H (Paclitaxel and Trastuzumab) –> H (Trastuz) or can do TCH (Docetaxel +Carboplatin + Trastuz) –>H (Trastuz)
    -Only if ER/PR +
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What hormonal tx do u give in premenopausal with low risk /high risk?

what hormonal tx do u give with post menopausal pt’s?

A
  1. Low risk : tamoxifen
    High risk (young, node +, high tumor grade) : AI + ovarian suppression
  2. AI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage 3 TX overview :

GOAL : CURE
1. Primary therapy?
2. Neo Adjuvant therapy ?
3. ADjuvant therapy ?

A
  1. surgery
  2. Chemotherapy (shrink tumor so surgery more effective)
    -Radiation to consider if pt cant tolerate chemo
  3. Radiation
    -Hormonal TX : not given neo adjuvantly but give post surgery if er/pr +
17
Q

STAGE 3 TX Regimen :

  1. HER 2 +
    -Neoadjuvant tx?
    -Surgery yes
    -Adjuvant or maintenance for no residual vs residual disease
  2. Her 2 (-) and ER/PR (+)
    -Neoadjuvant ?
    -Surgery yes
    -Adjuvant/Maintenance
  3. Her 2 (-) and ER/PR (-)
    -Neoadjuvant
    -Surgery yes
    -Adjuvant/Maintenance
A
  1. PTCH x 6 cycles for total of 18 weeks
    - No resid : Trastuz +/- Pertuzumab to complete 1 yr
    -resid : Ado-Trastuz emtansine to complete 14 cycles
  2. ddAC –> ddT x 4 cycles each (total 16weeks)
    - Only if residual disease = Capecitabine x 6-8 cycles
  3. Paclitaxel + Carboplatin + Pembrolizumab x 4 cycles –> AC (Doxo + cyclo) + Pembro x 4 cycles
  • all pt’s get pembrolizumab x 9 cycles
18
Q

Stage 4 TX overview

  1. Goal?
  2. Primary tx? (3)
  3. MBC Chemo : There’s no survival advantage to ?
  4. Chemo works faster than ?
  5. What would be our first choice?
  6. If ER/PR + start with ?
  7. If ER/PR (-) or ER/PR (+) and has sx’s start with ?
  8. if HER2+ …. add ?
A
  1. improve QOL , minimize toxiicties , incr survival
  2. Hormonal if ER/PR + , preferred first line bc less AE’s
    Chemotx : Used for ER/PR (-) , non responders to hormonal tx symptomatic visceral mets
    Radiation : for palliation
  3. Starting chemo sooner
  4. Hormonal tx
  5. Anthracyclines and taxanes

6.Hormonal tx

  1. Chemotx
  2. Anti-Her2 agent
19
Q

MBC Bone Mets - Palliative TX

For each drug, state Dose/Route/Freq, Infusion time, Renal dose adj, ae’s and ancillary meds

  1. Zoledronic Acid
  2. Pamidronate
  3. Denosumab
A
  1. 4mg IV q4wks or q12wks
    -15 mins
    -CrCL < 60 dose adjust, if < 30 avoid
    CrCL 50-60 = 3.5
    40-49 3.3
    30-39 3
    -Osteonecr of jaw (need dental exam prior), Hypophos, hypocalcemia

-Add calcium 500mg + VitD 400 IU PO daily

  1. 60-90 mg IV q4wks
    -120 mins
    -CrCL <30 dose reduce to 30-60mg over 4-6 hrs
    -Same AE’s and Ancillary meds as above
  2. 120mg SQ q4weeks
    -No infusion time cuz SQ
    -CrCL <30 no data maybe avoid
    -SAme AE’s and ancillary meds as above

Oncology Therapeutics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions