Onco - BCA Bk Tx Flashcards by 18 22

ER (+++)
PR (+++)
Her2 (-)
Low Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

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ER (-)
PR (-)
Her2 (-)
Low Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

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ER (-)
PR (-)
Her2 (-)
High Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

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ER (+++)
PR (+/-)
Her2 (+/-)
High Ki67

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

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ER (+/-)
PR (+/-)
Her2 (+++)
Variable

a. Luminal A
b. Luminal B
c. HER 2
d. Basal
e. claudin low

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Luminal A

a. Good prognosis, responds well with hormonal therapy
b. poor prognosis, responds well with chemotherapy
c. Poor prognosis, trastuzumab with chemotherapy
d. Associate with BRCA1
e. Associated with lymphocyte infiltration

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Claudin Low

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Basal

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Her 2

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Luminal B

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Tumors with gene expression profile reminiscent of nonmalignant “normal” breast epithelium. Prognosis similar to luminal B group

Normal Breast-like

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High grade tumors that express cytokeratins 5/6 and 17 as well as vimentin p63, CD10, alpha smooth muscle actin and EGFR

Basal

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Treatment of brast cancer depends on whether patient does or does not have evidence of distant mets. Distant mets are detected via…

Scintigraphic or radiologic imaging

biopsy

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For patients with no evidence of detectable distant metastases the goal of therapy is

a. cure
b. at least substantial survival prolongation
c. both
d. neither

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The following are considered primary therapies for breast CA

a. surgery
b. radiation therapy
c. chemotherapy
d. A and B
e. A, B and C

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ALL treatments for breast cancer are based on this/these factor/s:

a. prognostic
b. predictive
c. both
d. neither

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factors used to determine if a given treatment is likely to work or not

Predictive factors

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provide indication of how likely a cancer will recur either locally or in distant organs, in the future if a patients is not treated with the respective treatments

Prognostic factors

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True about prognostic features in breast CA treatment EXCEPT:

a. Prognostic features guide what type of primary treatment should be pursued, but does not contribute in decision making regarding adjuvant systemic treatments
b. Anatomic prognostic features include visual but not physical examination findings of locally advanced breast cancer
c. Histologic tumor grade as well as ER PgR and HER2 influence treatment but are not prognostic
d. AOTA

a. it help decide on adjuvant systemic treatment
b. Anatomic prognostic features
c. Histologic tumor grade as well as ER PgR and HER2 influence treatment and are also prognostic

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Standard treatment of choice for early-stage breast CA

Halsted radical mastectomy

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procedure in which breast, chest wall muscles, and complete axillary nodal contents were removied

Halsted radical mastectomy

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t/f less disfiguring modified radical mastectomy in which the chest wall muscles were preserved and only a sampling of axillary lymph nodes were removed is called modified radical mastectomy. Recurrence and survival rates were the same with modified radical mastectomy and Halsted radical mastectomy for early stage breast CA

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T/F
Breast conserving treatments such as lumpectomy, quandrantectomy, or partial mastectomy show equal if not slightly superior results with mastectomy in early stage breast CA, especially if postlumpectomy radiation is done.

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Patient with early stage ER (+), node (-) breast CA, chose lumpectomy. Which is more appropriate adjuvant therapy?

a. radiation
b. endocrine tx
c. chemo

B; their risk of in-breast recurrence is quite low with surgery and endocrine therapy

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Contraindications to breast-conserving therapy in early stage breast CA (5)

1. large tumor to breast ration 2. inability to achieve clear margins with adequate cosmesis after extensive surgery 3. multifocal cancers 4. extensive 4-quadrant DCIS 5. inability to receive radiation

Patients unable to receive radiation (3)

1. women with dermal autoimmune disease (e.g. SLE) 2. prior radiation to the site 3. lack of available radiation tx facilities

Patient with early stage breast CA, with extensive 4-quadrant DCIS, treatment of choice? a. radical mastectomy without radiation b. breast conservation surgery with radiation c. radiation therapy only d. NOTA

Patient with early stage breast CA, with SLE. Treatment of choice? a. lumpectomy + radiation b. radical mastectomy without radiation c. chemotherapy d. NOTA

B patients not able to receive radiation 1. women with dermal autoimmune disease (e.g. SLE) 2. prior radiation to the site 3. lack of available radiation tx facilities

Patients with high risk of local-regional recurrence benefit from postoperative chest wall and regional nodal radiation in terms of survival. These patients include (3)

Tumors >=5cm 4 or more positive axillary lymph nodes postoperative positive margins

Postmastectomy radiation is not indicated in women with cancers (3)

T <2cm negative lymph nodes negative margins

Post mastectomy radiation is beneficial in the ff EXCEPT a. patient with 6cm tumor with SLE b. patient with 2cm tumor, 5 positive axillary lymph nodes c. patient with 2cm tumor, negative lymph nodes, positive post op margins d. patient with 5cm tumor, 4 positive axillary lymph nodes, negative post op margins E. AOTA

This can be done and is currently the standard of care for women with localized breast CA and clinically negative axilla.

Sentinel lymph node mapping and biopsy

If SLNB is negative, a. extensive axillary surgery should be done b. extensive axillary surgery is not required

SLNB (+) a. further axillary surgery should be done in all patients b. axillary surgery is not required in all patients c. axillary surgery is required for older women and those with ER (+) cancers d. NOTA e. AOTA

D;axillary surgery may not be required for older women and those with ER (+) cancers

who has worse prognosis a. adequate surgery and radiation, but patient had recurrence b. no recurrence c. local-regional recurrence after mastectomy

True about local-regional recurrence a. it is a negative prognositc variable b. it is a cause of distant metastasis c. both d. neither

A; it is not a cause of distant metastasis

True about adjuvant systemic therapies a. almost all patients with metastatic breast CA are destined to die with, if not of their cancer b. It is better to wait until symptomatic documented metastases to occur before treatment to spare patient from toxicity of adjuvant systemic therapies c. both d. neither

A; it is better to treat right away

5 year survival rate for breast CA | stage 0

99%

5 year survival rate for breast CA | stage I

92%

5 year survival rate for breast CA | stage IIA

82%

5 year survival rate for breast CA | stage IIB

65%

5 year survival rate for breast CA | stage IIIA

47%

5 year survival rate for breast CA | stage IIIB

44%

5 year survival rate for breast CA | stage IV

14%

The ff. needs imaging for distant mets a. patient with no signs or symptoms of widespread b. patient with T3 or less tumor c. fewer than four involved axillary lymph nodes d. NOTA e. AOTA

D; no imaging necessary

The ff does not need adjuvant systemic therapy a. <1cm tumor b. negative lymph nodes c. both d. neither

C; but still at risk for distant metastases therefore might still benefit

3 types of adjuvant systemic therapies

chemotherapy endocrine anti-HER2 therapies

patient with positive lymph nodes and/or T4 is adjuvant chemotherapy recommended?

Yes

<1cm tumor, axillary lymph nodes negative, ER + adjuvant therapy? if yes, what kind?

adjuvant endocrine therapy

<1cm tumor, axillary lymph nodes negative, HER2+ adjuvant therapy? if yes, what kind?

adjuvant chemo and trastuzumab

<1cm tumor, axillary lymph nodes negative, triple negative adjuvant therapy? if yes, what kind?

adjuvant chemo to reduce risk (from 15%, reduced by 1/3)

T2-3, node negative, ER (+) | adjuvant therapy? if yes, what kind?

it is unclear if this small but real benefit is sufficient to justify adjuvant chemotx

Detection of breat cancer cells either in the circulation or bone marrow is associated with an increased relapse rate. However, finding of bone marrow micrometastases only portens a slightly worse prognosis, especially in node negative patients. For these patients, are bone marrow biopsies recommended?

is the use of Ki67 as a proliferation marker. is this recommended?

The important predictive factors that should be ordered in all breast CA biopsies are

ER | HER2

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. Endocrine therapy is recommended for any patient with what percent positive cells?

>=10%

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. patient with 1% positive cells? is endocrine tx recommended?

no, 0-1% not recommended

ER is most commonly measured by counting the percent of positive cells within the cancer after IHC staining. patient with 1-9% staining, is endocrine therapy recommended?

yes, but low threshold for discountinuation

IHC staining for HER 2: | value for positive

IHC staining for HER 2: | value for negative

0-1+

IHC staining for HER 2: | what does 2+ mean?

must do reflex FISH

These chemotherapeutic agents have higher activity in patients with triple negative breast CA and in patients with HER2 positive disease

platin salts (carbo-, cis-)

Duration of trastuzumab tx

1 year

after trastuzumab, preliminary data support pertuzumab for how long?

at least 3 months

Endocrine tx adminestered to px with ER + breast CA following completion of chemotx and administered for at least how long?

5 years, probably longer

True about endocrine tx EXCEPT a. tamoxifen reduces risk of distant recurrence and death due to invasive breast CA by 40% b. it is more effective in premenopausal women c. it is less effective in <40 years old d. antagonist in breast and brain, agonist in bone, liver, and uterus

B. same effectivity in pre and postmenopausal

Side effects of tamoxifen EXCEPT a. hot flashes b. thrombosis c. osteopenia d. NOTA

C; reduces osteopenia

tamoxifen increases risk for which cancers?

liver uterus endometrial

Medical ovarian ablation can be achieved by GnRH agonist such as

goserelin

the following still produce small amounts of estrogen EXCEPT a. women with non functioning ovaries by oophorectomy b. women with non functioning ovaries by goserelin c. menopause d. NOTA

D estrigen production by adrenal synthesis of estrogen precursors (testosterone and DHEA convereted to estrone by aromatas activity in peripheral fat, and possible cancer cells)

how to reduce circulating estrogen to nearly imperceptible levels in postmenopausal women?

use of oral AIs

give 3 examples of aromatase inhibitors

anastrozole letrozole exemestane

T/F AIs are equally effective as tamoxifen

F; more effective

duration recommendation for treatment of AI in postmeopausal women with ER + breast CA with no contraindications?

3-5 years

what percent of patients cannot tolerate AIs due to musculoskeletal syptoms mimicking OA and arthralgias?

15-20%

postmenopausal breast CA ER + treated with AI but developed musculoskeletal syptoms mimicking OA and arthralgias. What can be done?

shift to tamoxifen assuming no contraindications exist

tamoxifen contraindications, most important

thrombosis or high risk Cerebrovascular disease

True of chemotherapy EXCEPT a. multiple agent is more effective than single agent b. sequential single-agent chemo is as effective as simultaneous combination chemotherapy c. dose escalation above an optimal dose is more effective d. NOTA e. AOTA

C; it is not more effective

optimal number of cycles of chemotherapy

4-6, above 6, too toxic

True about neoadjuvant treatment EXCEPT a. it involves administration of adjuvant systemic therapy before definitive surgery and radiation therapy b. many patients will be "downstagd" by neoadjuvant chemotx c. overall survival has not been improved using drugs given before, compared to given after surgery d. NOTA e. AOTA

D; all are true

T/F all patients, regardless of response to neoadjuvant chemotx should receive adjuvant endocrine therapy if they have an ER + breast CA and Adjuvant anti-Her 2 if they have HER2 +

Secondary myelodysplasia and leukemia occur in 0.5-1% of patients treated with a. alkylating agents b. anthracyclines c. antimetabolites d. taxanes

major dose-limiting and life-changing toxicity of taxanes

peripheral neuropathy

trastuzumab in HER2 positive breast CA is optimally delivered with which chemotherapeutic durg class?

taxanes

trastuzumab in HER2 positive breast CA is should not be given simultaneously with which chemotherapeutic durg class?

anthracyclines; since main toxicity of trastuzumab is cardiac dysfunction that worsens if delivered with doxorubicin

single agent paclitaxel plus trastuzumab is adequate regiment for patients with T1 or 2 node negative, good prognosis. T/F

How is trastuzumab given?

IV weekly or every 3 weeks, for 12 months

At present, routine use of bisphosphonates as adjuvant therapy is recommended. T/F

F no consensus but if patient has advancing osteopenia, or confirmed osteoporosis, tey should be treated accordingly

Poly-ADP ribose polymerase (PARP) inhibitors are being tested for what type of breast CA patients?

BRCA1 BRCA2 triple negative

Onco - BCA Bk Tx Flashcards

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