Hem/Onc Exam 3: breast cancer part 2

Treatment of Stage III

-our intent is still ____

-more aggressive treatment!

curative

Treatment of Stage III

-we usually use ___ systemic chemotherapy to shrink tumor prior to surgery

neoadjuvant

Treatment of Stage III- Neoadjuvant Chemo

-no optimal regimen

-anthracycline or taxane-based

-give ___ if Her2neu+

trastuzumab

Treatment of Stage III- Neoadjuvant Chemo Regimens

___ (doxorubicin, cyclophosphamide)

___ (docetaxel, cyclophosphamide)

____ (doxorubicin, cyclophophamide → followed by trastuzumab and paclitaxel)

____ (docetaxel, carboplatin, trastuzumab)

AC, TC, AC→TH, TCH

Treatment of Stage III

-If patient responds to neoadjuvant therapy, perform ___ (masectomy or lumpectomy)

-ALL patients get ___

surgery, XRT

Treatment of Stage III

-If patient does not respond to neoadjuvant therapy, consider ___ neoadjuvant chemo regimens OR neoadjuvant ___

other, XRT

Treatment of Stage III

-After surgery, patients need adjuvant ___ and adjuvant ___ therapy (if hormone receptor positive)

chemotherapy, endocrine

Metastatic Breast Cancer

-goal of therapy = ___

palliation

Metastatic Breast Cancer

-___ and ___ ___ metastases have a better prognosis and are more likely to respond to endocrine therapy if ER+ or PR+ (perhaps can delay chemo)

bone, soft tissue

Metastatic Breast Cancer

-symptomatic ___ metastases require chemotherapy due to need for rapid response

visceral

Metastatic Breast Cancer

-___ metastases generally do not respond to chemo

brain

Metastatic Breast Cancer Treatment in Patient with No Prior Therapy, ER+ or PR+

-If bone metastases only → ___ therapy

endocrine

Metastatic Breast Cancer Treatment in Patient with No Prior Therapy, ER+ or PR+

-If visceral metastases → ___ ___

systemic chemotherapy

Endocrine Therapy

-most useful if ER+ and PR+, ___-menopausal, and bone/soft tissue metastases only

post

Endocrine Therapy

-aromatase inhibitors are 1st line if __-menopausal

post

Endocrine Therapy

-tamoxifen can be used in both ___- and ___-menopausal women

post, pre

Endocrine Therapy

-ovarian ablation can be performed in ___-menopausal women

pre

Another option is ___ (Faslodex), which is a pure antiestrogen

fulvestrant

Fulvestrant (Faslodex)

-___ ___ estrogen expression

-adverse effect = ___ ___ reactions

down regulates, injection site

CDK4/6 Inhibitors

1. ___ (Verzenio)

2. ____ (Ibrance)

3. ____ (Kisqali)

abemaciclib, palbociclib, ribociclib

CDK4/6 Inhibitors

-oral :)

-approved for HR+, Her2neu negative advanced/metastatic breast cancer in combination with an __ ___ or ___

aromatase inhibitors, fulvestrant

CDK4/6 Inhibitors Common ADEs

-_____

-fatigue

-nausea

-diarrhea

myelosuppression

Systemic Chemotherapy

-no clinical characteristics to identify patients who are likely to benefit

-principle of therapy = limit toxicity to improve QOL

-most active agents = ___ and ___

anthracyclines, taxanes

Systemic Chemotherapy

-it is widely debated whether combination vs sequential therapy is better

-combination is associated with ___ response rates at the expense of greater ___

-very complex decision made on an individual basis

higher, toxicity

Metastatic Breast Cancer Treatment in Patient with No Prior Therapy, ER- and PR-

-in this scenario, endocrine therapy is not effective

-must initiate ___

chemotherapy

Metastatic Breast Cancer Treatment in Patient with Prior Therapy, ER+ or PR+

-if bone metastases only, may consider ___ ___ (but need to know what they have gotten in the past)

endocrine therapy

Metastatic Breast Cancer Treatment in Patient with Prior Therapy, ER+ or PR+

-if visceral metastases, must initiate ___ (but need to consider previous chemo regimens)

chemotherapy

Metastatic Breast Cancer Treatment in Patient with Prior Therapy, ER- and PR-

-worst case scenario

-no endocrine therapy

-must initiate ___ (cannot pick agent already used in the past)

chemotherapy