Oncology II: Common Types & Treatments Flashcards
(46 cards)
Breast cancer that is estrogen receptor and progesterone receptor positive - how is this treated with adjuvant hormonal therapies?
Premenopausal: tamoxifen x 5 years, reassess menopausal status; if still pre-menopausal, tamoxifen x 5 more years. If postmenopausal, can do tamoxifen x 5 years or an aromatase inhibitor x 5 years
Postmenopausal: AI x 5 years, or if intolerant give tamoxifen x 5 years
AI: anastrazole (Arimidex), letrozole (Femara), exemestane (Aromasin)
What is the preferred treatment of postmenopausal stage IV hormone positive breast cancer?
Fulvestrant with palbociclib
How is metastatic breast cancer typically treated?
Based on metastases
Visceral (vital organs, ie lungs liver brain) metastases that are immediately life threatening are usually treated with cytotoxic chemotherapy plus HER-2 targeted monoclonal antibodies (trastuzumab +/- pertuzumab) if HER-2 positive
Nonvisceral or non-life threatening visceral: hormonal therapy, acts more slowly but is better tolerated than cytotoxic chemo
HER-2 targeted monocloncal antibodies
Trastuzumab
Pertuzumab
SERMS place in therapy?
Used in pre- and postmenopausal women with hormone receptor positive breast cancer
Also used in men with breast cancer
AI place in therapy?
More effective in postmenopausal women, first-line in that case unless they are intolerant to AI’s
Also used in pre-menopausal women who have been on tamoxifen for 5 years and are still pre-menopausal after those 5 years.
FDA approved for postmenopausal women only
Used in pre-menopausal in combination with GnRH agonist only, otherwise it wont work
Tamoxifen drug interactions
Major substrate of CYP3A4, 2C9, and 2D6
Recommend venlafaxine over fluoxetine, paroxetine for hot flashes (strong 2D6 inhibitors)
Underlined
Side effects of SERMs
DVT/PE, menopausal symptoms, hot flashes, flushing, edema, weight gain, hypertension, mood changes, amenorrhea, vaginal bleeding/discharge
(Underlined)
Raloxifene place in therapy
FDA approved for prophylaxis
Not for treatment of breast cancer
Tamoxifen brand, dose
Soltamox
20 mg PO daily
Fulvestrant dose, brand
500 mg IM day 1, 15, 29, then monthly
Faslodex
AI warnings
Anastrazole, letrozole, exemestane
Higher risk of osteoporosis, hyper risk of CVD compared to SERMs
Anastrozole brand, dose
Arimidex
1 mg PO daily
Letrozole brand, dose
Femara
2.5 mg PO daily
Exemestane brand, dose
Aromasin
25 mg PO daily
Side effects of AI
Anastrazole, letrozole, exemestane
Edema, DVT/PE, bone pain, osteoporosis, menopausal symptoms, hot flashes, arthralgia/myalgia, lethargy/fatigue, N/V, rash, hepatotoxicity, hypertension, dyslipidemia
Palbociclib brand, place in therapy
Ibrance
Cyclin-Dependent kinase inhibitor, inhibits downstream signaling and tumor growth
Used with letrozole (Femara, AI) or fulvestrant (Faslodex, SERM) and significantly improves outcomes
Raloxifene counseling
Discontinue at least 72 hours prior to and during prolonged immobilization period due to inc risk of blood clots
Tamoxifen counseling
Can cause some serious but rare side effects such as endometrial cancer, stroke, or blood clot. Can also increase risk of getting cataracts.
GnRH agonist - agents, counseling, notes
Leuprolide (Lupron Depot)
Goserelin (Zoladex)
Increases risk of osteoporosis
Can cause “tumor flare” when given because initially causes surge in testosterone because it works to reduce testosterone by a negative feedback mechanism. Give with antiandrogens for several weeks to prevent tumor flare symptoms.
Side effects: Hot flashes, impotence, gynecomastia, peripheral edema, bone pain, injection site pain, QT prolongation, dyslipidemia, hyperglycemia
Prostate cancer - Antiandrogen options, place in therapy
Used in combination with GnRH agonists to prevent tumor flare
1st generation - Bicalutamide (Casodex) - 50 mg PO daily
2nd generation - Enzalutamide (Xtandi) - 160 mg (4 x 40 mg) daily - different from 1st gen in that they dont cause an upregulation of the expression of androgen receptors, so they can be used as monotherapy
BSA calculations for chemotherapy (2 main formulas)
What are the formulas and what weight do you use? (actual, IBW, or adjusted?)
Dubois and Dubois: BSA = 0.007184 x height^0.725 x weight (kg)^0.425
Mostellar: BSA = sqrt (Ht x Wt / 3600)
Use actual body weight!! (Underlined)
Unique concerns for cyclophosphamide and ifosfamide
Hemorrhagic cystitis (ensure adequate hydration, give mesna)
SIADH (cyclophosphamide) - retain water
Mesna: chemoprotectant, must be given prophylactically with ifosfamide and high doses of cyclophosphamide
Unique concerns for carmustine
Use non-PVC bag and tubing
Can cause pulmonary toxicity
