Breast cancer EXAM 2 Flashcards by o e

Which receptors are relevant in breast cancer and determine the aggressiveness of the disease?

ER: estrogen receptor
PR: progesterone receptors
HER2: human epidermal growth factor receptor

How well did you know this?

Not at all

Perfectly

Which breast cancer is the least aggressive and most aggressive, why?

least aggressive Luminal A

bc it still has functional ER, PR, and HER2 receptors
-well differentiated
-slow growing

most aggressive: triple negative: lost function of ER, PR, and HER2 amplified

How well did you know this?

Not at all

Perfectly

What are the risk factors for breast cancer?

-Age
-female sex

-estrogen exposure
-genetics: BRCA1, BRCA2
-Environment: obesity, radiation

How well did you know this?

Not at all

Perfectly

What are the risk factors associated with Estrogen exposure?

-Young age at menarche: < 12 years

-Older age at 1st birth: > 30 years

-Nulliparity (Nuns!)

-Older age at menopause: > 55 years

-Oral contraceptive use

more lifetime estrogen exposure !!!

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

Which genes are associated with a higher risk for breast cancer?

-BRCA1 (higher risk than BRCA2)
-BRCA2
-> repair genes (if mutated, less repairing)

also increase the risk of ovarian cancer

How well did you know this?

Not at all

Perfectly

Why is adipose tissue a risk factor for breast cancer?

because it produces estrogen
-more estrogen means higher risk

How well did you know this?

Not at all

Perfectly

Ductal (DCIS) and Lobular (LCIS) carcinoma in situ are considered invasive or non-invasive?

non-invasive
in situ= in place; they do not have the ability to invade surrounding tissues

How well did you know this?

Not at all

Perfectly

How would a patient with breast cancer commonly present?

-painless breast lump: solid, solitary, unilateral, irregular, immobile
-asymptomatic on mammography screening

less common: pain, nipple discharge, redness, warmth (often aggressive cancer)

How well did you know this?

Not at all

Perfectly

Most women should be screened for breast cancer at what age?

NAPLEX

at age 40

earlier if present risk factors

How well did you know this?

Not at all

Perfectly

Which protein in breast cancer cells is sign for aggressive breast cancer?

Ki-67

highly expressed during proliferation

How well did you know this?

Not at all

Perfectly

Which hormone receptors indicate a poor prognosis for breast cancer?

-non-functional ER and PR

-also when it is spread in the lymph nodes

other factors:
<35 y: the younger, the more likely it is triple negative (aggressive)
-African-American
-large tumor size

How well did you know this?

Not at all

Perfectly

Which stages of breast cancer are considered curable?

Stage I, II, III (stage 4 is incurable)
-use drugs
-use radiation

How well did you know this?

Not at all

Perfectly

A patient’s breast cancer profile is hormonal positive: ER (+) and PR (+). Which type of drugs should be included for anticancer treatment?

Hormonal agents (always if ER or PR positive)
-SERMs (Tamoxifen)
-Aromatase inhibitors

How well did you know this?

Not at all

Perfectly

A patient presents with HER2-amplified cancer cells. Which type of drugs should be included for anticancer treatment?

How well did you know this?

Not at all

Perfectly

When is chemotherapy considered in breast cancer patients?
!!!

-if the cancer has spread into lymph nodes
-aggressive disease (example: triple negative)

How well did you know this?

Not at all

Perfectly

What is the most appropriate approach to treat a patient with Stage I breast cancer?

Surgery
-may consider pre-therapy: HER2 if HER2 amplified or chemo

How well did you know this?

Not at all

Perfectly

What is the most appropriate approach to treat a patient with Stage III breast cancer?

more likely to need Neoadjuvant therapy before surgery

How well did you know this?

Not at all

Perfectly

What is the role of drugs in breast cancer?
!!!

drugs are not as important as surgery (bc it is a solid tumor that can be cut out)

-hormonal therapy is most important for ER or PR-positive disease

-targeted therapy (HER2, CDK 4/6 inhibitor)

-Chemotherapy

How well did you know this?

Not at all

Perfectly

What is the 1st line drug for most hormone metastatic disease?

CDK 4/6 inhibitors

-palbociclib
-Ribociclib
-abemaciclib

How well did you know this?

Not at all

Perfectly

Which hormones of the HPA axis stimulate estrogen production in the ovaries?

-GnRH (from the Hypothalamus)

-FSH (from pituitary glands)

(androgen from the adrenal gland is converted into estrogen too)

How well did you know this?

Not at all

Perfectly

What are the toxicities of Tamoxifen (SERM) and AIs?

-Hot flashes, night sweats !!!
-arthralgia, myalgia (more with AIs)
-fractures
-thrombotic risk

How well did you know this?

Not at all

Perfectly

What are the effects of Tamoxifen and Raloxifen in different tissues?

antiestrogenic in the breast

-estrogenic in the
bones: increases bone density
endometrium: endometrial growth, hyperplasia
blood: increased clotting factor (clotting risk), vasodilation

How well did you know this?

Not at all

Perfectly

Which enzyme converts androgen to estrogen?

Aromatase

How well did you know this?

Not at all

Perfectly

Name the Aromatase inhibitors (AIs).

-Letrozole -Anastrozle -Exemestane

What is the effect of using AIs only in patients who are premenopausal?

the body reacts and bumps up estrogen production, cant use AIs only in premenopausal (positive feedback loop) Why only in premenopausal?? bc in postmenopausal the body cant react bc no estrogen production from the hypothalamus as monotherapy only in postmenopausal!!!

What is the dose of anastrozole and letrozole for breast cancer treatment? What is the brand name?

anastrozole (Arimidex): 1 mg PO daily letrozole (Femara): 2.5 mg PO daily

What is the dose of exemestane and tamoxifen for breast cancer treatment? What is the brand name?

exemestane (Aromasin): 25 mg PO daily tamoxifen (Soltamox): 20 mg PO daily

What are the main differences between Tamoxifen and AIs?

Tamoxifen is used in pre and postmenopause; AIs are only in postmenopausal

What is the most appropriate drug for a 65 yo postmenopausal patient to treat breast cancer?

Aromatase inhibitor - can be used as monotherapy for postmenopausal patients (more efficacy than tamoxifen)

A 60 yo patient needs treatment for breast cancer. She is postmenopausal and complains about hot flashes. Which drug is more appropriate for treatment, AI or tamoxifen? What if they have complained about joint pain (arthralgia) or myalgia? What if they had a history of a broken leg? !!!

for hot flashes: go with AI (fewer side effects) for arthralgia: go with tamoxifen for bone fractures: go with tamoxifen (AI causes more bone fractures since it blocks the last source of estrogen in postmenopausal)

The risk for thrombosis is higher in tamoxifen or Aromatase inhibitors?

Tamoxifen (estrogenic effect in the blood -> risk for blood clots)

How is Tamoxifen metabolized to its active metabolite?

CYP2D6 (1st converted into isoform via CYP3A4) -may check genetics -cautious about CYP2D6 inhibitors

What is the active metabolite of Tamoxifen?

endoxifen

What are common strong CYP2D& inhibitors?

Strong: -Fluoxetine -Paroxetine -Bupropion

Which class of drugs are involved in the HPA axis and used to reduce estrogen production in breast and prostate cancer? Explain the MOA.

GnRH analogs they initially stimulate LH and FSH release -> more estrogen release -negative feedback causes a reduction in estrogen

What are two indications of GnRH analogs?

-combination therapy with AIs for breast cancer (or prostate cancer) -fertility preservation during chemo (chemo can cause premature ovarian failure)

What are the GnRH analogs?

Goserelin Leuprolide often used in combi with AIs (blocks the negative feedback loop caused by AIs)

What is the brand name of Tamoxifen?

Soltamox

The use of chemotherapy in breast cancer depends on what?

-Tumor size > 1 - 2 cm or lymph node spread -OncoTypeDx recurrence score (TAILOR Rx Study*)

What is the recommended duration of hormonal treatment in patients with breast cancer?

at least 5 years (10y are better)

Who benefits from adjunctive therapy?

if high risk for recurrence -present in Lymph nodes -hormonal receptor (-), TNBC -OncoTypeDx score

Which patients is neoadjuvant therapy commonly used?

to make the surgery easier -inflammatory breast cancer -large tumor size it gives feedback if the chemo works (tumor-shrinking) -more likely used with HER2 in HER2-amplified cancer (works so well) -more likely used in triple-negative breast cancer

Risk factors for recurrence

-young age <35 -large tumor size -ER/PR negative, TNBC -poor grade, Grade 3 poorly differentiated -spread in lymph nodes -high OncotypeDx score

What is the MOA of trastuzumab?

prevents dimerization and activation of HER2

How do trastuzumab and Pertuzumab work in combination?

Pertuzumab binds on a different site on HER2 -dual HER2 blockade works better than a single blockade

Which intervention is considered in BRCA1-positive patients?

double sided Mastectomy

Metastatic Disease Treatment

CDK inhibitors + hormonal therapy (if ER or PR positive) + bone modifying agents to prevent SRE bone-modifying agents: + -Denosumab (Xgeva) -zoledronic acid (Zometa)

What is the side effect profile of CDK inhibitors?

mini-chemo some: -myelosuppression -mucositis -N/V -alopecia

Which drugs are considered for Bone metastasis?

Bisphosphonates -Zoledronic acid: 4 mg IV q6h (prostate cancer with mets) -Pamidronate (Aredia)

Patients treated with Zoledronic acid or Pamidronate need which supplements?

500 mg Calcium 400 IU Vitamin D unless Ca is high

What is the brand name of Zoledronic acid?

Zometa

What is the brand name of Pamidronate?

Aredia

What is the brand name of Paclitaxel and Docetaxel?

Paclitaxel: Taxol Docetaxel: Taxotere

What is the brand name of Vinorelbine?

Navelbine

What is the brand name of Gemcitabine?

Gemzar

What is the brand name of Capecitabine?

Xeloda

What is the brand name of Liposomal doxorubicin?

Doxil

What is the brand name of Nanoparticle albumin-bound paclitaxel?

Abraxane

What is the brand name of Eribulin?

Halaven

What is the brand name of Ixabepilone?

Ixempra

Which premeds should you use for Paclitaxel? REMINDER

-dexamethasone -dipehnhydramine (benadryl) -H2RA

Which drugs are used to treat patients with BRCA1 mutations?

PARP inhibitor (-par) -olaparib -niraparib

What is the side effect profile of PARP inhibitors?

-myelosuppression -nausea -risk of secondary leukemias

What are the treatment options to prevent cancer?

-Tamoxifen: 20 mg daily for 5 years -Raloxifene -Aromatase inhibitors -bilateral mastectomies -bilateral oophorectomies benefits are less than adjuvant therapy though

What are the risks of using tamoxifen for breast cancer prophylaxis?

-VTE (estrogenic in the blood) -endometrial cancer (estrogenic in the endometria)

Breast cancer EXAM 2 Flashcards

(66 cards)