Breast cancer tx

Question 1

Breast cancer tx

Answer 1

SERMs– Antiestrogens

• Tamoxifen (Nolvadex)
• Toremifene (Fareston)
• Raloxifene (Evista)

Steroidal estrogen receptor antagonist
- Fluvestrant (Faslodex)

Aromatase inhibitors

• Anastrozole (Arimidex)
• Exemestane (Aromasin)
• Letrozole (Femara)

Question 2

Selective Estrogen Receptor Modulators (SERMS)

Answer 2

• Exert varying effects depending on tissue (antagonist in breast; agonist in endometrium, bone, liver, coagulation system)

Question 3

Tomoxifen

Answer 3

• USES: adjuvant therapy for breast cancer; metastatic breast cancer therapy; ductal carcinoma in situ (reduces risk of invasive cancer); prevention in high risk women
• WARNINGS: hypercalcemia, uterine malignancies, endometrial hyperplasia/polyps, DVT/PE, Liver abnormalities, ocular disturbances
• ADR: vasomotor sx, vaginal atrophy, hair loss, N/V; menstrual irregularities; increased risk of VTE; increased incidence of endometrial cancer; liver; retinal deposits, cataracts
• DI: warfarin, anastrozole/letrozole, Rifampin, Paroxetine/fluoxetine/ bupropion (go back to slide and go through advice)
• Preg cat D
• P450 3A4/2D6
• Only effective in women with ER + tumor
• May have implications with antidepressants

Question 4

Raloxifene

Answer 4

• USES: approved for breast cancer prevention in high risk postmenopausal women (go through STAR trial slide for pros and cons)

Question 5

Ospemifene

Answer 5

• SERM
• INDICATIONS: dyspareunia from vulvovaginal atrophy due to menopauce
• CI: DVT, PE, h/o; CVA, MI, h/o; pregnancy; estrogen dependent neoplasia; undx genital bleed
• ADR: clots, hot flashes, vag discharge, muscle spasms, hyperhidrosis

Question 6

Toremifene

Answer 6

• INDICATION: tx of metastatic breast cancer in postmenopausal women with estrogen-receptor positive or unknown tumors
• Dose dependent QT prolongation
• Hypercalcemia
• Endometrial hyperplasia
• ADRs: hot flashes, sweating, N, dizziness, edema; cataracts; clots; LFT elevation