ChemoSH3 Flashcards
(30 cards)
Breast cancer
Mammogram to identify lump. Then biopsy to identify if malignant or benign.
Different typers of breast cancers. ER ( estrogen receptors + ) , ( PR ) progesterone receptor + , ( HER2/ ErbB2 ) human epidermal receptor positive. HER2 have a more aggressive disease and higher risk recurrence
Types of Tx for breast cancer
Radiation, surgery, mastectomy, chemo, hormone therapy, target therapy
Chemo
Taxanes ( most common)
- paclitaxel ( taxol ) and docetaxel ( taxotere )
Anthracyclines
-doxorubicin ( adriamycin ) and epirubicin ( ellence )
Platinum agents
- cisplatin, carboplatin ( paraplatin )
Cyclophosphamide ( cytoxan )
-5FU , capecitabine ( xeloda )
Ixabepilone ( ixempra )
Eribulin ( halaven )
Hormone Therapy
: patients that have sensitivity to estrogen
•Tamoxifen , Raloxifene ( SERMS: selective estrogen receptor modulators ; they are sitting on the receptor of estrogen so wont let estrogen sit there. #1 side effect : CLOTS )
•Aromatase inhibitors ( AI ) : used for post menopausal breast cancer
• Fulvestrant ( IM ) : estrogen receptor antagonists : blocks estrogen completely. Increase in bleeding risk
Targeted therapy :
Hormone Receptor- positive ( ER + )
- Palbociclib ( Ibrance ) , Ribociclib ( kisqali ) , Everolimus ( Afinitor )
HER2+ breast cancer
- Trastuzumab ( herceptin ) , Pertuzaumab ( Perjeta ) , Ado-trastuzumab emtansine ( Kadcycla, TDM-1 ) , lapatinib ( tykerb) ( TINIB: tyrosine kinase inhibitor : always PO )
Tamoxifen ; raloxifene ( Evista ) are SERMS. You worry about
Clots!
Aromatase inhibitors:
Hormone therapy
Anastrozole ( armidex)
Letrozole ( Femara )
Stop production of estrogen in ovaries
no clot issues. Dont sit on R of estrogen. If premenopausal then we can only give tamoxifen and if post menopausal then can give evista or Aromatase inhibitors
Faslodex( fulvestrant ) IM estrogen R antagonists
Tamoxifen
non steroidal anti estrogen
SERM: selective estrogen receptor modulator. causes side effects of estrogen. Worry about CLOTS!
Endrogmetrial cancer( tamoxifen stimulates uterine estrogen receptor; evista does not ) , hyper calcemia.
Dose: 20 mg daily.
Clots: swelling of right leg? Go to md asap if any signs or sx
Tamoxifen goes through cyp2d6 to become active. Watch out of ddi. Cyp2d6 inhibitors ( Prozac , Paxil , ) weak but still watch out for Wellbutrin / Zoloft, duloxetine
Recommend venlafaxine
Raloxifene
Evista
Reduce the risk of breast cancer ( POSTMENOPAUSAL )
Osteoporosis prevention
Worry about clots just like tamoxifen
Tamoxifen vs raloxifene : evista does not causes endometrial cancer.
Aromatase inhibitors
: block production of estrogen
It does simulate estrogen so you dont worry about clots, hypercalcemia, or endometrial cancer.
It blocks production of estrogen.
POSTMENOPAUSAL agents.
Anastrozole ( arimidex ) - 1 mg QD
Letrozole ( femara ) - 2.5 mg QD
Exemestane ( aromasin ) - 25 mg QD
Major source of estrogen is derived from peripheral androgen conversion which requires Aromatase
DDI : never give tamoxifen with Aromatase inhibitors. Tamoxifen may decrease serum levels of Aromatase inhibitors
Target therapy for hormone receptor positive breast cancer
Palbociclib ( ibrance ) : CDK 4/6 inhibitor : watch for pulmonary embolism
Ribociclib ( kisqali ) : CDK 4/6 inhibitor. DDI 3a4 sub.
Everlimus ( afinitor , zortress )
Used for
- hormone receptor positive
- HER2 negative breast cancer
- they are used along with Aromatase inhibitors
FULVESTRANT
Faslodex ( IM )
Blocks estrogen completely. MOA: estrogen R antangoist.
IM once a month.
SE: bleeding, thrombocytopenia. Watch if patient on anticoagulants.
Target therapy for HER2 +
Chemo and HER2+ targeted therapy
targeted therapy : trastuzumab ( HERCEPTIN ) 52 weeks 1 year.
Never had herceptin before: give herceptin plus pertuzumab perjeta ( BBW : cardiac failure )
Lapatinib: tyrosine kinase inhibitor
Trastuzumab ( HERCEPTIN )
HErCEPTIN
IV
Dont get this alone, get in combination. With concurrent paclitaxel or docetaxel
Ado trastuzumab ( kadcyla) last line therapy for HEr2 +
T
Last line IV only therapy
Lapatinib
Tykerb
Tyrosine kinase inhibitor ( PO ) - empty stomach
Eribulin mesylate
Halaven
Can be used for triple negative metastatic breast cancer
Megestrol
Megace
Progestin : advanced breast and endometrial cancer
Also used to stimulate appetite
SE: weight gain thromboemolism HF
Prostate cancer
Males only.
Fueled by testosterone
PSA: if high then do biopsy
LH-RH or GnRH analogs
Lutenizing hormone - releasing hormone agonist
Goseriln ( zoladex )
Leuprolide ( Lupron )
Triptorelin ( Trelstar )
Histrelin ( Vantas )
Not just used for prostate cancer. Used for endometriosis and pre menopausal breast cancer patients
LH - RH analogs SEs:
Bc increasing testosterone you can get a tumor flare ( bone pain, increase tumor size, )
- so give an antiandrogen med : Flutamide, biclutamide, nilutamide
LUTAMIDE: start 2 to 4 weeks.
SE: If you decrease testosterone you can get gynecomastia
Pulmonary embolism
LH-RH analogs
Never given daily.
Im q 1 month, q 3 months, or q 4 months
Degarelix
Firmagon
MOA: LHRH antagonists. ( no neg feedback ). Rapid suppression of testosterone.
SUBQ every 28 days
SE: hot flashes weight gain
Ani androgens
Block testosterone production.
Used with LHRH / GnRH analogues
SE: gynecomastia
