breast cancer

what are the major risk factors associated with breast cancer

• female

• no children or had children at later age (>35)

• obesity

• age

• hormonal birth control

• smoking hx (potential)

• family history (20%; small)

what type of drugs are mainly used for hormonal therapy?

• aromatase inhibitors (PO)

• SERM

• SERD

how long is hormonal therapy?

• 5-10 years

what has to be done when using aromatase inhibitors?

• need to remove ovaries if patient is premenopausal

  • can use surgery or drugs to suppress ovaries (GnRH analogs)

what are the ADE of aromatase inhibitors (AI)

• arthralgia/myalgia

• bone fractures/osteoporosis

• hot flashes

which of the following types of drugs causes aphthous ulcers as an ADE?

a) cyclin D kinase inhibitors

b) mTOR inhibitors

c) SERM

d) aromatase inhibitors

• b) mTOR inhibitors

how to treat aphthous ulcers caused by mTOR inhibitors?

• dexamethasone 0.5 mg/5mL mouth rinse

how to enhance hormonal therapy? (in conjunction with an AI or fulvestrant)

• add cyclin D kinase inhibitors

• or

• add mTOR inhibitor

what are the ADE of cyclin D kinase inhibitors?

• myelosuppression

• diarrhea, nausea, vomiting

why are mTOR inhibitors not really used?

• ADE

  • aphthous ulcers (stomatitis)

  • hyperglycemia

  • hypercholesterolemia

how to treat vasomotor symptoms (menopausal ADE)?

• SSRIs

• gabapentin

• CAM

• exercise

what are the main cytotoxic chemotherapy agents used in breast cancer

• doxorubicin

• paclitaxel

• docetaxel

_______-containing regimens are preferred for patients at a higher risk of recurrence (i.e. larger tumor or lymph node involvement)

• anthracycline

what is required for the standard chemotherapy regimen (DDAC)

• growth factor support required (prophylaxis)

  • Pegfilgrastim 6mg SQ x 1

what needs to be monitored with doxorubicin?

• heart failure (LVEF)

• echocardiogram

• total bilirubin

what is the main ADE with doxorubicin?

• cardiotoxicity (LVEF)

• extravasation

what is the maximum lifetime dose of doxorubicin?

• 450-550 mg/m2

what agent can be added to doxorubicin for cardiotoxicity prevention?

• dexrazoxane

  • start around 300 mg/m2 of doxorubicin

  • 10:1 ratio with doxorubicin

what are the 3 strategies for cardiotoxicity prevention of doxorubicin?

1. add dexrazoxane

2. extended infusion of doxorubicin

3. use doxorubicin liposomal (Doxil)

T/F: doxorubicin and doxorubicin liposomal (Doxil) are interchangeable

• false

what is the benefit of adding taxanes?

• increased survival in certain patients

• improved DDFS and improvement of OS in breast cancer

T/F: you can use docetaxel + cyclophosphamide instead of doxorubicin + cyclophosphamide in some situations

• true

what is the main ADE with taxanes?

• neuropathy

how to prevent neuropathy with taxanes?

• keep hands and feet cold

how to premedicate paclitaxel?

• steroid + H1RA + H2RA

  • 30-60 minutes before infusion

how to premedicate docetaxel?

• dexamethasone BID day before, day of, & day after infusion

what type of drugs have hypersensitivity/infusion reactions because of the drug?

• platinum agents

• monoclonal antibodies

what type of drugs have hypersensitivity/infusion reactions NOT because of the drug ?

• taxanes (paclitaxel, docetaxel)

• etoposide

• liposomal doxorubicin

when do hypersensitivity reactions occur for platinum agents?

a) first dose

b) 3rd dose

c) 6th-8th cycle

d) 3rd-5th cycle

c) 6th-8th cycle

when do hypersensitivity reactions occur for monoclonal antibodies?

a) first dose

b) 3rd dose

c) 6th-8th cycle

d) 3rd-5th cycle

a) first dose

when do hypersensitivity reactions occur for pacitaxel, docetaxel?

a) 1st-2nd dose

b) 3rd dose

c) 6th-8th cycle

d) 3rd-5th cycle

a) 1st-2nd dose

T/F: doxorubicin and paclitaxel can be given together

• false

  • too toxic together, need to switch

what is the main drug for targeted HER2 therapy?

• trastuzumab (mAb)

how long is trastuzumab used for?

• 52 weeks following chemotherapy

what is the main ADE with trastuzumab?

a) hepatotoxicity

b) nephrotoxicity

c) hypersensitivity

d) cardiotoxicity

• d) cardiotoxicity

targeted therapy for BRCA1/BRCA2 mutation?

a) trastuzumab

b) PARP inhibitors

c) PI3K inhibitor

d) hormonal therapy

b) PARP inhibitors

targeted therapy for PIK3CA-activating (ER+, HER-) mutation?

a) trastuzumab

b) PARP inhibitors

c) PI3K inhibitor

d) hormonal therapy

c) PI3K inhibitor

targeted therapy for ER+/PR+ mutation?

a) trastuzumab

b) PARP inhibitors

c) PI3K inhibitor

d) hormonal therapy

d) hormonal therapy

T/F: docetaxel causes cardiotoxicity

• false