Exam 3 - Breast Cancer

Question 1

List non-modifiable risk factors for breast cancer?

Answer 1

female, older age, family history, genetics (BRCA1/2), breast changes on biopsy, radiation, early menarche/late menopause

Question 2

List modifiable risk factors for breast cancer?

Answer 2

nulliparity or older age at first childbirth, postmenopausal HRT or obesity, physical inactivity, alcohol consumption

Question 3

Explain screening recommendations for breast cancer?

Answer 3

all women should have breast awareness, women aged 25-39 exam every 1-3 years, aged 40+ annually

Question 4

List signs/symptoms of breast cancer?

Answer 4

palpable mass, pain, discharge, retraction, dimpling, skin changes (redness, warmth, edema)

Question 5

What are chemo treatments for hormone +/-, HER2- breast cancer? (3)

Answer 5

dose-dense doxorubicin/cyclophosphamide (AC) q2w x4 then paclitaxel q2w x4, dose-dense AC x4 then paclitaxel qw x12, docetaxel and cyclophosphamide q3w x4-6

Question 6

What is treatment for hormone -, HER2- (triple negative) breast cancer?

Answer 6

pembrolizumab q3w x4 plus paclitaxel/carboplatin qw x12 then pembrolizumab plus AC q3w x4 then surgery then pembrolizumab q3w x9

Question 7

What are treatments for HER2+ breast cancer? (2)

Answer 7

docetaxel/carboplatin/trastuzumab plus pertuzumab q3w x6, paclitaxel plus trastuzumab qw x12

Question 8

What is the MoA of trastuzumab and pertuzumab?

Answer 8

inhibits HER2 homodimerization and HER2-mediated signaling

Question 9

What are AEs of HER2 targeted therapies (trastuzumab/pertuzumab)?

Answer 9

cardiotoxicity, diarrhea, infusion-related reactions

Question 10

What is the MoA of SERMs (tamoxifen/raloxifene)?

Answer 10

blocks estrogen binding site in some tissues depending on location in body

Question 11

What is the MoA of aromatase inhibitors (anastrazole/letrozole/esemexane)?

Answer 11

suppress plasma estrogen levels by inactivating aromatase

Question 12

What hepatic enzyme is important for tamoxifen metabolism to active form, endoxifen?

Answer 12

CYP2D6

Question 13

What is treatment for premenopausal women receiving endocrine therapy for breast cancer?

Answer 13

tamoxifen, aromatase inhibitor plus ovarian suppression

Question 14

What is endocrine therapy for postmenopausal women with breast cancer?

Answer 14

aromatase inhibitor, tamoxifen

Question 15

What are treatments for ovarian suppression? (2)

Answer 15

oophorectomy, LHRH agonists (goserelin, leuprolide)

Question 16

What are the AEs of SERMs (tamoxifen/raloxifene)? (3)

Answer 16

menopausal symptoms (hot flashes, vaginal dryness), uterine/endometrial cancers, thromboembolic events, AVOID pregnancy

Question 17

What are the AEs of aromatase inhibitors? (5)

Answer 17

menopausal symptoms (hot flashes, vaginal dryness), musculoskeletal symptoms, bone loss, hypercholesterolemia, CV risks

Question 18

What is additional adjuvant therapy for triple negative breast cancer?

Answer 18

capecitabine

Question 19

What is additional adjuvant therapy for HER2+ breast cancer?

Answer 19

ado-trastuzumab emtansine

Question 20

What is additional adjuvant therapy for hormone +/- HER2- breast cancer?

Answer 20

neratinib

Question 21

What is additional adjuvant therapy for BRCA mutated breast cancer?

Answer 21

olaparib

Question 22

What is additional adjuvant therapy for homone + HER2- high-risk breast cancer?

Answer 22

abemaciclib

Question 23

What is additional adjuvant therapy for postmenopausal patients at osteoporotic risk?

Answer 23

zoledronic acid for 2 years

Question 24

List the cyclin-dependent kinase 4/6 inhibitors? (3)

Answer 24

palbociclib (Ibrance), ribociclib (Kisqali), abemaciclib (Verzenio)

Question 25

What are endocrine therapies for metastatic breast cancer? (3)

Answer 25

CDK 4/6 inhibitors (palbo/ribo/abemaciclib), everolimus, alpelisib

Question 26

What is combined with CDK 4/6 inhibitors, mTORis, and alpelisib after disease progression?

Answer 26

fulvestrant (Faslodex)

Question 27

What is the MoA of everolimus (Afinitor)?

Answer 27

inhibits mammalian target of rapamycin (mTOR)

Question 28

What are AEs of everolimus (Afinitor)? (4)

Answer 28

rash, stomatitis, pneumonitis, metabolic disturbances

Question 29

What is the MoA of alpelisib (Piqray)?

Answer 29

small-molecule phosphatidylinositol-3-kinase (PI3K) inhibitor

Question 30

What is the indication for alpelisib (Piqray)?

Answer 30

hormone +, HER2-, PIK3CA-mutated metastatic breast cancer

Question 31

What are treatments for breast cancer metastases to bone? (2)

Answer 31

bisphosphonates (zoledronic acid, pamidronate), denosumab

Question 32

List the survivorship issues for breast cancer patients? (8)

Answer 32

hot flashes, sexual problems, infertility, lymphedema, osteoporosis, neuropathy, cardiac toxicity, secondary malignancies