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Solid Tumor Oncology > Breast Cancer > Flashcards

Breast Cancer Flashcards

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1
Q

First line management for metastatic ER+ breast cancer

A

CDK 4/6 inhibitor + AI

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2
Q

Only CDK 4/6 inhibitor that is approved for monotherapy in the metastatic setting?

A

Abemaciclib

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3
Q

Which CDK4/6 inhibitor has the least incidence of neutropenia?

A

Abemaciclib

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4
Q

Fulvestrant is approved in first line metastatic breast cancer. It is most efficacious in what population?

A

Those without visceral metastases

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5
Q

What CDK4/6 inhibitor(s) have OS benefit in metastatic setting?

A

Ribociclib
and abemaciclib

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6
Q

You have a patient with ER+ metastatic breast cancer, previously treated with with anastrozole and develops progression. No comorbidities. What is best treatment option?

A

CKD4/6 inhibitor + Fulvestrant

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7
Q

Which CDK4/6 inhibitor has good CNS penetration?

A

Abemaciclib

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8
Q

Which CDK4/6 inhibitor has QTc prolongation?

A

Ribociclib

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9
Q

Which CDK4/6 inhibitor causes the most N/V/D?

A

Abemaciclib

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10
Q

What is the difference in treatment schedule between the CDK4/6 inhibitors?

A

Ribo and Palbo are 3 weeks on, 1 week off.
Abemaciclib is continuous

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11
Q

2nd line treatment for metastatic ER+ breast cancer without any targeted mutations?

A

Everolimus + Exemestane

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12
Q

2nd line treatment for metastatic ER+ breast cancer for those with PIK3CA mutations?

A

Alpelasib + fulvestrant

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13
Q

Second line treatment for ER+ metastatic breast cancer who develop ESR1 mutation?

A

Elacestant

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14
Q

SEcond line treatment for metastatic ER+ breast cancer who has a PTEN, PIK3CA, or AKT mutation?

A

Capivasertib + Fulvestrant

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15
Q

First line treatment for HER2+ metastatic breast cancer

A

THP
Docetaxel
Herceptin
Pertuzumab

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16
Q

SEcond line therapy for metastatic HER2+ breast cancer

A

Trastuzumab dereuxtecan

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17
Q

Third line therapy for HER2+ metastatic breast cancer

A

Trastuzumab emtansine TDM-1

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18
Q

Most significant toxicity seen with trastuzumab deruxtecan

A

Pneumonitis

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19
Q

Third line treatment(+) for HER2+ metastatic breast cancer, for those with CNS mets

A

Capecitabine, Tucatinib, Trastuzumab

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20
Q

Patient with metastatic HER2+ breast cancer previously treated with THP, Enhertu, TDM1, and Cape+Tucatinib+Trastuzumab. What are options for next line? (3)

A

Neratinib + Capecitabine
Margetuximab + Chemotherapy
Lapatinib + Chemo

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21
Q

You have a patient with triple positive metastatic breast cancer. You start them on THP. What else can you add for treatment?

A

AI. Don’t add CDK4/6 inhibitor

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22
Q

You have a patient with HER2+ metastatic breast cancer and are treating with THP. They have a BRCA1 mutation and ask about olaparib. can you use it?

A

Not with THP, hasn’t been studied

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23
Q

First line for metastatic TNBC with PD-L1 CPS >=10

A

Pembrolizumab + Chemo (Gem+Carbo or taxane)

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24
Q

First line for metastatic TNBC and PD-L1 CPS <10

A

Single agent chemotherapy
Taxanes, anthracyclines, gem+carbo

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25
Third line treatment for metastatic TNBC who progressed on Chemo+Pembro and another chemo line.
Sacituzumab govitecan
26
Treatment options for patients with HER2- metastatic breast cancer with BRCA1/2 mutation?
Olaparib Talazoparib
27
What is the indication for Enhertu in the HER2 low setting?
1-2 prior lines of chemo in the metastatic setting
28
Ways to stage a pregnant patient with breast cancer?
CXR with fetal shielding RUQ US Suspicious nodal disease: Axillary US and FNA Avoid bone scans, breast MRI
29
What 4 breast cancer treatments is contraindicated during the entirety of a pregnancy?
Radiation Methotrexate Trastuzumab (oligohydramnios) Endocrine therapy
30
You have a pregnant patient with new diagnosis of breast cancer and needs chemotherapy. When do you need to avoid chemo?
In first trimester and Avoid after week 35 to avoid neutropenia during delivery
31
For ER+ male breast cancer, what consideration needs to be made for endocrine therapy?
If using an AI, need to use GnRH agonist. Most use tamoxifen
32
You see a patient with 2 cm ER- PR- pure tubular carcinoma, Grade 3. What is the next step?
Repeat markers. Because tubular is a favorable histology and is almost never ER/PR negative
33
Adjvuant Treatment for <1 cm ER/PR+ tubular or mucinous breast cancer
No adjuvant treatmen
34
Adjuvant treatment for >3 cm ER+ tubular or mucinous breast cancer
Endocrine therapy
35
What 4 breast cancer chemotherapy regimens are at high risk of causing neutropenic fever (>20%)
ddAC-T ACT TC TCH-P
36
How to manage grade 1-2 neutropenia associated with CDK4/6 inhibitors? How do you classify G1-2 neutropenia?
ANC 1000 to LLN Hold drug until recovery, no dose adjustment
37
How to manage grade 3 neutropenia associated with CDK4/6 inhibitors? How do you classify G3 neutropenia?
ANC 500-1000 Hold Ribo until recovery above 1000, then resume at same dose. If recurrent, then dose reduce
38
How to manage grade 4 neutropenia associated with CDK4/6 inhibitors? How do you classify G4 neutropenia?
ANC <500 Stop Ribo until ANC >1000, then resume at lower dose
39
How to manage neutropenic fever associated with CDK4/6 inhibitor?
HOld treatment until ANC >1000, then dose reduce
40
Patient with T2N1 ER-/PR-/HER2+ breast cancer is treated with neoadjuvant TCHP. She undergoes lumpectomy and SLNB and has a pCR. What is treatment in adjuvant setting?
HP for 1 year, no need for RT for those that convert from LN+ to LN- with neoadjuvant chemo
41
What HER2 directed therapy can be given to a patient with any degree of CHF?
Neratinib
42
Two treatment regimens for metastatic HER2+ breast cancer that have good CNS penetration?
Tucatinib + Cape + Herceptin Cape + Neratinib
43
Best treatment option for patient with metastatic ER+ breast cancer who has progressed on CDK4/6i + AI, fulvestrant, then everolimus+exemestane. No targetable mutation, HER2 is 0.
Sacituzimab govitecan
44
3 options for risk recution in post menopausal women with LCIS, DCIS, or ADH?
tamoxifen raloxifene Anastrozole and exemestane are not FDA approved but used
45
What are optimal surgical margins for DCIS?
2 mm
45
Who should get breast cancer screening with breast MRI?
BRCA mutation first degree relative of BRCA carrier Radiation to chest between age 10-30
46
What are the size cutoffs for T1a, b, c, and T2?
T1a: <0.5 cm T1b: 0.6 - 1 cm T1c: 1-2 cm T2: >2 cm but <5 cm
47
What is considered a positive margin for surgery on a stage I-II cancer?
Ink on tumor
48
When can SLNB be safely omitted?
Clinically node negative women >70 with early stage HR+, HER2- cancer
49
Clinically node negative patient is found to have 1 or 2 positive SLNs at time of surgery. Do they need axillary dissection?
No
50
What are the T and N scores that make a patient an Oncotype candidate?
T1b-T2 (0.5 cm to 5 cm) pN1mi or pN1
51
At what Oncotype score should we recommend chemo for a node negative pre-menopausal woman?
>16
52
At what Oncotype score should we recommend chemo for a node negative post-menopausal woman?
>26
53
At what Oncotype score should we recommend chemo for a node positive post-menopausal woman?
>26
54
At what Oncotype score should we recommend chemo for a node positive pre-menopausal woman?
Trick question. Node positive pre-menopausal women shouldn't get Oncotype, go straight to chemo
55
In general, for pre-menopausal women with local ER+ HER2- breast cancer, when should we recommend OS+ET instead of ET alone?
If their disease was significant enough for chemotherapy, they should get OS+AI
56
What are 3 indications for post-mastectomy RT?
Tumor >5 cm Tumor <5 cm and close margins 4+ LNs
57
Indications for adjuvant abemaciclib?
N2 (4+ LNs) or: N1 (1-3 LNs) AND G3, T3 (>5 cm), or Ki67 >20%
58
Indication for adjuvant ribociclib?
Stage II or III If stage II and LN negative, need to be G2 or higher or high genomic risk (Oncotype >26)
59
Indications for adjuvant olaparib in HR+ breast cancer?
Obviously BRCA mutation pN2 (4+ LNs) and if received neoadjuvant chemotherapy, they must have had residual disease
60
What is the use of bisphosphonates in the adjuvant setting for HR+ breast cancer?
Useful for postmenopausal women with nonmetastatic cancer at high risk of recurrence: TxN2 or T2N1 or TxN1 with G3 Decreases bone recurrence, fracture rate, BCSS
61
Side effects of elacestrant (get the unique one)
High cholesterol MSK pain Nuasea, diarrhea HA hot flash AKI anorexia
62
What is a distinct side effect of everolimus and what can be used for prophylaxis?
Stomatitis: use steroid mouth wash
63
Side effects of Sacituzumab govitecan
Hyperglycemia Alopecia Leukopenia, anemia diarrhea fatigue
64
Who shouldn't get adjuvant treatment for HER2+ breast cancer?
T1a, N0
65
What is the appropriate treatment (neo or adjuvant) with T1N0 HER2+ breast cancer?
Adjuvant TH
66
Who should get neoadjuvant TCHP in HER2+ breast cancer?
Any N+ patients
67
Who should have Neratinib added to adjuvant treatment for HER2+ breast cancer?
Those that are HR+
68
Most significant side effect of neratinib?
Diarrhea
69
Patient with HER2+ disease receives neoadjuvant TCHP and has residual disease at time of surgery. What is the adjuvant treatment?
TDM1
70
Patient with HER2+ breast cancer receives neoadjuvant TCHP and has a pCR. What is the adjuvant treatment?
HP to complete 1 year of therapy
71
In early TNBC, who shouldn't receive adjuvant chemotherapy?
T1aN0, T1bN0
72
Indications for neoadjuvant chemotherapy in TNBC
Pretty much everyone. T1c and up, N+
73
Indications for neoadjuvant AC-Pembro, TC-Pembro (KEYNOTE-522)
T2Nx, T1N+ TNBC
74
Treatment for a patient with T1cN0 TNBC?
Neoadjuvant ddAC-T
75
Indications for Adjuvant Olaparib in TNBC?
If treated with adjuvant chemo, require N+ or T2 (>2cm). If treated with neoadjuvant chemo, require residual disease at surgery
76
Indications for adjuvant capecitabine in TNBC
Patients with residual disease after neoadjuvant chemotherapy and surgery. BRCA negative
77
Treatment for localized malignant Phyllodes tumor
Wide local excision to obtain >1 cm margin Consider RT No benefit for chemo
78
Treatment for localized benign Phyllodes tumor
Excisional biopsy
79
How to diagnose Paget's disease of breast
Full thickness skin biopsy of NAC Need to biopsy any breast lesion seen on imaging
80
Treatment of Paget's disease of breast
Mastectomy or central lumpectomy/NAC excision + whole breast RT

Solid Tumor Oncology (20 decks)

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