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Fall 2021: Therapeutics III > Therapeutics of Breast Cancer (Weddle) > Flashcards

Therapeutics of Breast Cancer (Weddle) Flashcards

(70 cards)

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1
Q

Provide some risk factors for breast cancer.

A
  • age
  • 1st- and 2nd-degree relatives with breast cancer
  • personal history
  • prior treatment for lymphoma with mediastinal XRT or environmental radiation exposure
  • endogenous estrogen exposure (early menarche, late menopause)
  • exogenous estrogen (oral contraceptives, HRT)
  • alcohol
  • prior breast biopsies
  • nulliparity or age >30 before 1st birth
  • elevated BMI
  • diet
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2
Q

BRCA 1 and 2 are ________________.

A

tumor suppressor genes

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3
Q

Which BRCA type has a high prevalence of variants in Askenazi Jews?

A

BRCA1

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4
Q

Which BRCA type is more often implicated in male breast cancers?

A

BRCA2

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5
Q

What is the purpose of the GAIL model?

A

determines relative risk (RR) of developing breast cancer

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6
Q

Data on clinical exams was shown to be ___________ to demonstrate benefits.

A

insufficient

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7
Q

Which organization is more supportive of annual mammograms?

A

American Cancer Society

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8
Q

At what age does the American Cancer Society endorse annual mammograms?

A

45-54

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9
Q

What three agents have been studied for breast cancer prevention?

A

tamoxifen, raloxifene, and exemestane

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10
Q

What was the most important conclusion of the NSABP Breast Cancer Prevention Trial?

A

tamoxifen decreased the risk of invasive/noninvasive breast cancer in all women (50% risk reduction)

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11
Q

Although tamoxifen has been shown to decrease risk of breast cancer, what were some drawbacks from the Breast Cancer Prevention Trial?

A
  • increased endometrial cancer
  • increased risk of stroke/PE/DVT
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12
Q

Which agent did the MORE Trial evaluate?

A

raloxifene

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13
Q

What did the STAR trial reveal?

A

that raloxifene was just as effective as tamoxifen (both drugs showed 50% reduction)

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14
Q

Which agent is known to have more toxicities: tamoxifen or raloxifene?

A

tamoxifen

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15
Q

Which agent did the NCIC-CTG MAP.3 Study investigate?

A

exemestane

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16
Q

True or false: both exemestane and anastrazole are FDA-approved for breast cancer prevention

A

false; neither is FDA-approved, although they do appear to be reasonable prevention options

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17
Q

Most invasive carcinomas of the breast are ________.

A

ductal (IDC)

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18
Q

How will a patient with inflammatory breast cancer present?

A
  • edema
  • redness
  • warmth
  • inflammation
  • peau d’orange
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19
Q

Why would inflammatory breast cancer be delayed in diagnosis?

A

it is often misdiagnosed as cellulitis

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20
Q

Which breast cancer type is typically seen as microcalcifications on a mammogram?

A

ductal carcinoma in situ (DCIS)

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21
Q

When might an ultrasound be useful in diagnosing breast cancer?

A

in younger women with denser breasts; can distinguish between a solid mass or cyst

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22
Q

Define fine needle aspiration.

A

fluid and/or cells are removed from the breast lump using a thin needle

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23
Q

Define core biopsy.

A

a thick needle is used to remove tissue from the breast (gold standard, helps determine if invasive)

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24
Q

Define surgical biopsy.

A

removal of the entire lesion for pathological examination

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25
What are the two ways that we can test a patient's HER2 status?
immunohistochemistry or FISH
26
In which breast cancer groups is Oncotype DX validated for use?
* newly-diagnosed * stage I or II * lymph node -/+ * ER+
27
What TAILORx score would warrant chemotherapy and hormonal therapy?
26 or greater
28
True or false: breast cancer can metastasize anywhere.
true
29
What are the two breast cancer tumor markers?
CA 27.29 and CA 15-3
30
Describe the general treatment strategy for stage I, II, and IIIA breast cancer.
* **lumpectomy + XRT OR mastectomy +/- XRT** * some stage II and IIIA may have neoadjuvant chemo, and most will receive adjuvant chemotherapy, hormonal therapy, biologic therapy, and/or immunotherapy
31
Describe the general treatment strategy for stage IIIB and IIIIC breast cancer.
neoadjuvant therapy followed by MRM or lumpectomy + XRT
32
Describe the general treatment strategy for stage IV breast cancer.
palliative chemo/hormone therapy +/- biologics/immunotherapy
33
During an SLN dissecton, the first lymph node that the blue dye reaches is considered the \_\_\_\_\_\_\_\_\_\_\_\_\_.
sentinel node
34
XRT should always be done in conjunction with modified radical mastectomy (MRM), *except* in what case?
patients 70+ (ER+, node-, T1 disease)
35
What treatment modality is NOT used as neoadjuvant therapy for breast cancer?
radiation
36
What adjuvant therapy would you recommend for a hormone(+), lymph node(+/-), HER2(-) tumor **≤** 0.5 cm?
consider adjuvant endocrine therapy
37
What adjuvant therapy would you recommend for a hormone(+), lymph node(+/-), HER2(-) tumor \> 0.5 cm or 1-3 positive lymph nodes?
**strongly consider 21-gene assay** * if not done: adjuvant endocrine therapy or adjuvant chemo followed by endocrine therapy * if \<26: adjuvant endocrine therapy * if 26+: adjuvant chemo followed by adjuvant endocrine therapy
38
What two factors must be assessed if a patient presents with a breast tumor \> 1 cm, node negative?
ER and HER2 status
39
Recommended adjuvant therapy for a breast tumor \> 1 cm, node(-), ER(+), HER2(+)?
chemotherapy, HER2 therapy, endocrine therapy
40
Recommended adjuvant therapy for a breast tumor \> 1 cm, node(-), ER(+), HER2(-)?
chemotherapy + endocrine therapy
41
Recommended adjuvant therapy for a breast tumor \> 1 cm, node(-), ER(-), HER2(+)?
chemotherapy + HER2 therapy
42
Recommended adjuvant therapy for a breast tumor \> 1 cm, node(-), ER(-), HER2(-)?
chemotherapy + immunotherapy
43
What are the three major toxicities associated with tamoxifen use?
hot flashes, endometrial cancer, DVT
44
Ideally, aromatase inhibitors should only be used in ___________ patients.
postmenopausal
45
What needs to happen if you want to use an aromatase inhibitor in a premenopausal woman?
ovarian suppression
46
What is a pro of using an aromatase inhibitor over tamoxifen?
fewer adverse effects
47
How long should tamoxifen/aromatase inhibitors INITIALLY be used for in breast cancer patients who are premenopausal at diagnosis?
5 years
48
What is the next logical treatment step after a woman has completed her 5 years of tamoxifen/AI, but remains premenopausal?
5 more years of tamoxifen (10 years total) OR no further endocrine therapy
49
What is the next logical treatment step if a woman who has initiated tamoxifen/AI when premenopausal is now postmenopausal 5 years later?
consider tamoxifen/AI for 5 more years (10 years total)
50
What adjuvant hormonal therapy is recommended for women who are postmenopausal at the time of breast cancer diagnosis?
AI for 5 years, then consider AI for an additional 5 years
51
What are the two NCCN preferred adjuvant chemotherapy regimens for HER2- breast cancer?
* dose-dense AC (doxorubicin + cyclophosphamide) + paclitaxel * TC (docetacel + cyclophosphamide)
52
The CALBG trial demonstrated that \_\_\_\_\_\_\_\_\_\_\_\_.
sequential vs. concurrent chemotherapy did not show any difference (although sequential was less toxic)
53
What is the most prevalent risk to be concerned about with using an anthracycline-based regimen for breast cancer?
cardiac risks; if cardiac problems, consider TC chemotherapy
54
HER2+ disease benefits greatly from the incorporation of which biologic?
trastuzumab
55
Give an example (or 3) of an adjuvant HER2+ regimen.
* APT (paclitaxel + trastuzumab) * TCH (docetaxel + carboplatin + trastuzumab) * TCH + pertuzumab
56
What did the standard of care for HER2 therapy become after the HERA trial?
1 year of adjuvant trastuzumab/pertuzumab therapy
57
What should the plan of care be if a HER2(+) patient shows residual disease after surgery?
stop trastuzumab/pertuzumab and start ado-trastuzumab emtansine
58
What is the likely course of treatment in a patient with triple negative breast cancer?
anthracycline and taxane chemotherapy regimen
59
What did the CREATE-X study demonstrate?
that capecitabine can be used as adjuvant therapy for TNBC residual cancer
60
What did the KEYNOTE-522 study demonstrate?
that pembrolizumab should be added to a TNBC regimen and continued for 1 year if PD-1+
61
When would metastatic breast cancer warrant chemotherapy?
if symptomatic
62
Which is preferred in metastatic breast cancer: combination or sequential chemotherapy?
sequential
63
What are the two first-line agents for metastatic TNBC?
single-agent platinums (carboplatin/cisplatin)
64
What therapy is 1st line for HER2- and postmenopausal/OS metastatic breast cancer?
AI + CDK4/6 (abemaciclib, palbociclib, or ribociclib)
65
True or false: palbociclib is the preferred CDK 4/6 inhibitor for metastatic breast cancer.
false; no one agent is preferred
66
List the four monitoring parameters for palbociclib.
1. neutropenia 2. pulmonary embolism 3. diarrhea 4. pneumonitis
67
What is everolimus' mechanism of action?
mTOR inhibitor
68
Which two agents did the BOLERO-2 trial evaluate?
everolimus + exemestane
69
What is the most notable side effect of everolimus?
mucositis
70
What drug should be avoided in combination with tamoxifen (to avoid heat flashes)?
strong - moderate CYP2D6 inhibitors

Fall 2021: Therapeutics III (25 decks)

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