Hormone Receptor- Positive Tx for Breast Cancer (Endocrine Therapy) Flashcards
(26 cards)
List drug classes and drugs used for possible Tx for breast cancer
- SERM (tamoxifen)
- SERD (fulvestrant; IM injection)
- AIs (anastrozole- Arimidex, letrozole- Femura, exemestane-Aromasin)
Q: SERD drug
Q: how administered
Q: safety concerns
- fulvestrant
- IM injection
- Hot flashes
Increased LFTs
Injection site rxn
Q: SERM drug
Q PRODRUG converted via ____
Q: which drug preferred to tx hot flashes
Q: Boxed warnings
Q: Side effects
Q: teratogenic y or n
- Tamoxifen (Soltamax)
- prodrug converted via CYP-2D6 to potent metabolite endoxifen
- Venlafaxine
- Increased risk of UTERINE & ENDOMETRIAL CANCER
THROMBOEMBOLIC events - Hot flashes/ Night sweats/ Vaginal bleeding/disharge/ Decreased bone density (supplement with Ca and Vit D)
- yes teratogenic
Q: AI drugs
Q: Safety concerns
Q: s/e
- ANASTROZOLE (ARIMIDEX)*
Letrozole (Femura)
Exemestane (Aromasin) - Higher risk of osteoporosis (supplement with Ca and Vit D)*, DEXA scan, weight bearing exercises
HIGHER RISK of CVD compared to SERMS - Hot flashes/ night sweats/ arthralgia/ myalgia*
Prostate Specific Antigen (PSA)
Q: normal range
Q: suspicious
Q: likely indicate cancer
- 0 - 4 ng/mL
- > 4 requires further evaluation with biopsy
- > 10 likely indicates prostate cancer
note: BPH drugs can impact PSA levels by increasing PSA levels and 5 alpha reductate inhibitors (finasteride/dutasteride) can decrease PSA levels
active metabolite for testosterone
dihydrotestosterone
what is prostate cancer tx called
Androgen Deprivation Therapy (ADT) or Chemical Castration**
Q: which class of prostate cancer tx initally causes a TUMOR FLARE
Q: what must be given with this class since it CANNOT be given as monotherapy
- Gonadotropin Releasing Hormone AGONISTS* (GnRH agonists)
- antiandrogens must be given with GnRH agonists such as Bicalutamide
Q: List GnHR agonists
Q: safety concerns
Q: s/e
- Leuprolide (Lupron Depot)*
Goserelin (Zoladex)* - risk of osteoporosis (supplement w/ Ca & Vit D), TUMOR FLARE**
- Hot flashes/ IMPOTENCE/ GYNECOMASTIA, BONE PAIN, QT PROLONGATION
List GnRH ANTAGonists
Degralex (Firmagon); SC
Relugolix (Orgovyx); PO
~ NO TUMOR FLARES ~
List Antiandrogens 1st Generation
Bicalutamide (Casodex)
Flutamide (Eulexin)
Nilutamide (Nilandron)
List drug classes and drugs used for hormone therapies for Prostate Cancer (Androgen Deprivation Therapy)
- GnRG agonists (Leuprolide, Goserelin)
- GnRH anTAGonists (Degralix, Relugolix)
- Anti-androgens (Bicalutamide, flutamide, Nilutamide)
- Androgen Biosynthesis inhibitor; interferes with CYP 17 enzymes (Abiraterone)
Tx for hypercalcemia of malignancy
HYDRATION w/NORMAL SALINE**
- IV Bisphosphonates: Zolendronic Acid (Zometa), Pamidronate
- Calcitonin (Miacalcin)*
- Denosumab (Xgeva): mAb RANKL inhibitor*
Pts with MILD hypercalcemia (corrected calcium of what #) do NOT require immediate tx, but what can be considered
- Ca 10.6 - < 12
- IV hydration can be considered
moderate calcium range
≥ 12
severe hypercalcemia
> 14
Sx’s of hypercalcemia
N/V
Fatigue
Dehydration
Confusion
what is considered FIRST LINE for mod-severe hypercalcemia
IV bisphosphonates:
ZOLENDRONIC ACID (ZOMETA)
PAMIDRONATE
IN SEVERE CASES of hypercalcemia of malignancy, what may be added for up to 48 hours to IV bisphosphonates
Calcitonin (Miacalcin)
Nasal spray formulation is NOT effective*
Limit duration of therapy to 48 H due to TACHYPHYLAXIS**
what may be used for hypercalcemia REFRACTORY to IV bisphosphonates
mAb RANKL inhib: Denosumab (Xgeva)*
TLS is considered an ___
Oncologic emergency*
definition of TLS
RAPID BREAKDOWN (lysis) of TUMOR CELLS and the RELEASE of INTRACELLULAR COMPONENTS into the bloodstream
What does TLS lead to
- Hyperkalemia*
- Hyperphosphatemia
- HypOcalcemia*
- Hyperuricemia* (can damage the kidneys**)
- Acute Renal failure
management for TLS
- aggressive IV hydration w/ Normal saline
- urate lowering therapies (allopurinol, rasburicase)
