Breast Cancer Therapeutics

Question 1

what are risk factors for breast cancer

Answer 1

Age
Family history
Radiation
Estrogen Exposure (endogenous)
Alcohol
Nulliparity
Elevated BMI

Question 2

what are the tumor suppressor genes associated with breast cancer?

Answer 2

BRCA-1 and BRCA-2

Question 3

what are the two most common invasive cancer spots in breast cancer?

Answer 3

lobes
ducts

Question 4

what is an invasive carcinoma

Answer 4

invaded beyond the basement membrane of the duct or lobule

Question 5

what are the non invasive breast cancers

Answer 5

ductal carcinoma in situ
lobular carcinoma in situ
inflammatory

Question 6

what is the most aggressive form of breast cancer

Answer 6

inflammatory

Question 7

describe inflammatory breast cancer

Answer 7

aggressive, rapid onset
poor prognosis
onset is days and weeks
orange peel look

Question 8

how to test for HER2 status

Answer 8

IHC or FISH testing

Question 9

what is oncotype DX

Answer 9

-genetic test for expression of 21 genes which fives recurrence score
-can determine if cancer will return and if patient will benefit from chemo

Question 10

what is treatment for a low risk (< 26) for oncotype DX

Answer 10

hormonal therapy only

Question 11

what is treatment for a high risk (>=26) for oncotype DX

Answer 11

chemo and HRT

Question 12

will women < 50 w/ score of 16 to 25 benefit from chemo?

Answer 12

yes they will benefit

Question 13

general treatment strategies for breast cancer stages I, II, IIIA

Answer 13

breast conserving surgery
mastectomy
neoadjuvant chemo
adjuvant chemo

Question 13

what is the goal of BC stages I, II, IIIA

Answer 13

goal is to cure

Question 13

what is the goal for breast cancer stages IIIB and IIIC?

Answer 13

goal is to cure

Question 14

what is the general treatment strategy for breast cancer stages IIIB and IIIC?

Answer 14

neoadjuvant chemo
adjuvant therapy as needed

Question 15

what is the treatment goal for stage IV breast cancer

Answer 15

palliative

Question 16

what is the general treatment strategy for breast cancer

Answer 16

chemo
HRT
biologics
immunotherapy

Question 17

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor less than/equal to 0.5mg

Answer 17

consider adjuvant endocrine therapy

Question 18

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor greater than 0.5mg with an oncogene score of less than 26

Answer 18

adjuvant endocrine therapy

Question 19

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 - woman with a tumor greater than 0.5mg and an oncogene score of greater than or equal to 26

Answer 19

adjuvant chemo followed by endocrine therapy

Question 20

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor less than 0.5mg

Answer 20

consider adjuvant endocrine therapy +/- chemotherapy with HER2 targeted therapy

Question 21

what is the adjuvant therapy plan for a HR+ LN -/+, HER2 + woman with a tumor greater than 0.5mg

Answer 21

adjuvant chemo with HER 2 targeted therapy followed by endocrine therapy

Question 22

what is an adjuvant hormonal therapy option in breast cancer

Answer 22

SERMs
LHRH analogs (ovarian suppression)
Aromatase Inhibitors

Question 23

what is the SERM for breast cancer

Answer 23

Tamoxifen (pre and post meno) anti-estrogen effect major toxicity - Hotflashes

Question 24

what is the LHRH analogs in breast cancer

Answer 24

Leuprolide or Goserelin will initially cause a "flare" due to increase in FSH and LH

Question 25

what is the Aromatase Inhibitor (AI) in breast cancer

Answer 25

Nonsteroidal: anastrozole, letrozole Steroidal: exemestane

Question 26

who can and can't use AIs

Answer 26

used only in post menopause, if pre must give ovarian suppression first

Question 27

If premenopausal at diagnosis, what is the first step in the hormone treatment therapy pathway

Answer 27

Tamoxifen x 5 years +/- OS AI x 5 years + OS

Question 28

If premenopausal at diagnosis, and still premenopausal after 1st round of adjuvant HRT treatment, what is the next step?

Answer 28

1. Tamoxifen for 5 more years (total 10 years) or 2. No further HRT

Question 29

If premenopausal at diagnosis, and now postmenopausal after 1st round of adjuvant HRT treatment, what is the next step?

Answer 29

1. could consider an additional 5 years of AI (total 10) or tamoxifen for 5 years

Question 30

If postmenopausal at diagnosis, what are the 3 adjuvant HRT options?

Answer 30

AI x 5 years then maybe another 5 T x 2-3 years then AI for 5 or vice versa T x 4-5 years then AI x 5 years or T x 5 years

Question 31

what should you consider when doing an additional 5 years of HRT adjuvant treatment?

Answer 31

toxicities and tolerance for patient

Question 32

what is the ideal length of adjuvant chemotherapy

Answer 32

3 to 6 months

Question 33

what are the common chemos in adjuvant therapy

Answer 33

Doxorubicin Cyclophosphamide Methotrexate 5-FU Carboplatin Paclitaxel Docetaxel

Question 34

what are the standard chemo lengths and cycles?

Answer 34

4-6 cycles every 3-4 weeks

Question 35

what are the 2 adjuvant chemo regimens for HER2 negative disease

Answer 35

Dose Dense AC to Paclitaxel or TC

Question 36

what is dose dense AC

Answer 36

Doxorubicin and cyclophosphamide followed by paclitaxel

Question 37

what is TC

Answer 37

docetaxel and cyclophosphamide

Question 38

what is the risk of dose dense AC

Answer 38

cardiac risks

Question 39

what are the 3 adjuvant therapies for HER2 positive

Answer 39

APT TCH TCH to pertuzumab

Question 40

what is APT

Answer 40

Doxarubicin paclitaxel trastuzumab

Question 41

what is TCH

Answer 41

docetaxel carboplatin trastuzumab

Question 42

what is TCH to pertuzumab

Answer 42

docetaxel carboplatin trastuzumab pertuzumab

Question 43

what is the standard of care for triple negative breast cancer

Answer 43

immunotherapy

Question 44

what is the preferred adjuvant chemo regimen for triple negative breast cancer

Answer 44

Paclitaxel Carboplatin Pembrolizumab followed by AC + pembrolizumab

Question 45

in ER/PR+ metastatic breast cancer, where should therapy start?

Answer 45

hormonal therapy

Question 46

in ER/PR- HER2+ metastatic breast cancer where should therapy start

Answer 46

anti-HER2 therapy +/- chemo

Question 47

in ER/PR- HER2- metastatic breast cancer where should therapy start

Answer 47

chemotherapy

Question 48

in metastatic breast cancer, what should you do if the disease-free period becomes shorter?

Answer 48

switch from HRT to chemo

Question 49

what is first line regimen for HER2+ metastatic breast cancer?

Answer 49

Trastuzumab + Pertuzumab + Docetaxel

Question 50

what is second line regimen for HER2+ metastatic breast cancer?

Answer 50

fam-trastuzumab deruxtecan-nxki

Question 51

what drug can be used in HER2 low patients

Answer 51

fam-trastuzumab deruxtecan

Question 52

what is the first line regimen for triple negative metastatic breast cancer

Answer 52

carboplatin or cisplatin single agent or pembrolizumab + chemo

Question 53

what is the first line hormonal therapy in metastatic breast cancer

Answer 53

AI + CKD4/6 inhibitor

Question 54

what are the CDK4/6 inhibitors

Answer 54

abemaciclib palbociclib ribociclib

Question 55

what is 2nd line HRT in metastatic breast cancer

Answer 55

fulvestrant + CDK4/6 inhibitor if not used before Everolimus + endocrine therapy

Question 56

what is a monitoring parameter for abemaciclib?

Answer 56

CBC diarrhea

Question 57

what is a monitoring parameter for palbociclib?

Answer 57

CBC (if low decrease dose)

Question 58

what is a monitoring parameter for ribociclib?

Answer 58

CBC and QTc prolongation (get ekg baseline)

Question 59

at what age does annual mammograms become available

Answer 59

40-44

Question 60

at what age do annual mammograms become mandatory

Answer 60

45-54

Question 61

at what age do mammograms become every other year if healthy

Answer 61

55