3.4 Breast Cancer -Comeau

T or F: Breast cancer can only affect women

F

RF of breast cancer for women (4)

extended length of hormone exposure

getting period before 13 yrs old

starting menopause after 55 yo

nulliparity (not having kids)

what things can increase the risk of BC? (3)

ionizing radiation

increased BMI (in postmenopausal women)

lifestyle choices

name 3 things that can decrease the risk of BC

breast feeding

exercise

increased BMI (premenopausal)

What genes are associated with hereditary breast cancer risk?

BRCA 1 and BRCA 2

5–6% of breast cancer cases are due to…

germline /inherited mutations

which tumor suppressor gene is more common?

a. BRCA 1

b. BRCA 2

a

What is ductal carcinoma in situ (DCIS)?

Abnormal cells that are not invasive yet (precancerous)

if ductal carcinoma in situ is not caught or is not treated it can progress to…

adenocarcinoma

What are the two main types of adenocarcinoma in breast cancer?

ductal or lobular

when should the following age ranges have mammogram screening if they are asymptomatic for BC?

1. ages 40-44

2. ages 45-54

3. ages 55+ AND have 10+ yr life expectancy

1. optional

2. yearly

3. every 2 years

is it recommended to get a yearly breast exam?

nah

pts who DO NOT HAVE BC, but are high risk for developing it should be started on what preventative measure?

endocrine therapy

endocrine therapy is given to prevent BC in high risk pts.

1. what is the drug of choice for premenopausal pts

2. what are the options for post menopausal pts

1. tamoxifen

2. tamoxifen, raloxifene, aromatase inhibitor

what is a mastectomy and a salpingo oophrectomy

removal of the breasts, ovaries, and the fallopian tubes

how long should a pt be on endocrine therapy if they DO NOT have BC but are at high risk?

5 yrs

is a 3D mammography for screening or diagnosis of BC

diagnosis

do you need breast tissue to diagnose BC?

yeah

What receptor statuses are assessed in nonmetastatic breast cancer diagnosis?

Hormone receptors (estrogen/progesterone), HER2/neu, BRCA1/2 germline

What are the hormone receptors evaluated in breast cancer?

Estrogen (ER) and progesterone (PR)

HER2/neu refers to what type of receptor?

Growth factor receptor

what is the most common stage of BC at diagnosis

early (I and II)

what is the o5 yr overall survival rate for stage I-II BC

100%

TX for Ductal Carinoma in Situ:

local treatment options

lumpectomy and XRT

TX for Ductal Carinoma in Situ:

if the pt had a lumpectomy or XRT and is ER+, they should then be started on _____ (drug) if they are premenopausal for _____ (duration)

tamoxifen x 5 yrs

TX for Ductal Carinoma in Situ:

if the pt had a lumpectomy or XRT and is ER+, they should then be started on _____ (drug) if they are postmenopausal for _____ (duration)

tamoxifen or aromatase inhibitor

5 years

what are the systemic therapy options for non metastatic BC

endocrine

chemo

biologic

immuno

what does XRT mean

radiation

what immunotherapy agent is indicated for non-metastatic BC

pembrolizumab

what chemotherapy agents are indicated for non metastatic BC

anthracyclines (DOX)

carboplatin

cyclophosphamide

taxanes

pts with high risk BC qualify for…

chemotherapy

what is considered high risk diseases when it comes to BC?

When do HR+/HER2− patients get chemotherapy?

1. pts with HR+ / HER2 - with high risk of relapse (based on additional testing)

2. HER2+

3. HR- and HER2- (triple negative)

pts with the following criteria all qualify for…

1. pts with HR+ / HER2 - with high risk of relapse (based on additional testing)

2. HER2+

3. HR- and HER2- (triple negative)

chemotherapy

what does ddAC stand for

dose dense doxorubicin and cyclophosphamide

what does TC mean

docetaxel and cyclophosphamide

what does T mean

paclitaxel

adjuvant chemotherapy for HER2- BC:

what are the three options?

1. ddAC x 4 cycles then T q2w x 4 cycles

2. ddAC x 4 cycles then weekly T x 12 cycles

3. TC q21 days x 4 cycles

Which adjuvant chemo regimens for HER2- require growth factor support?

all but weekly T (paclitaxel)

anthracycline ADE

red urine and body fluids

mucositis

cardiac dysfunction (usually permanent)

heart failure (irreversible)

anthracyclines are CI in which pts

low LVEF

pts on anthracyclines require an ECHO every ____ while on tx

3 months

cyclophosphamide ADE

myelosuppression

taxane ADE

alopecia

myelosuppression

paclitaxel ADE

worse peripheral neuropathy

infusion reactions

paclitaxel requires pretreatment with _____ to prevent the infusion related rxns

H1 antihistamine

H2 antihistamine

steroid (dexamethasone)

paclitaxel requires pretreatment with H1 antihistamine, H2 antihistamine, steroid (dexamethasone)to prevent ______

infusion related rxns

docetaxel ADE

alopecia and peripheral edema

pts on docetaxel should be premedicated with ___ to prevent its ADE

dexamethasone

taxane supportive care

use docetaxel instead of paclitaxel for less peripheral neuropathy

consider cryotherapy

consider scalp cooling

What is added in neoadjuvant HR− / HER2− (triple negative) breast cancer? and what stages is this rec for?

pembrolizumab

stage II and III

trastuzumab ADE

heart failure (reversible)

pts on trastuzumab require monitoring for _____ with an _____

HF; ECHO

T or F:

Pertuzumab can be given as monotherapy

F

pertuzumab is ALWAYS given with which other medication?

trastuzumab

pertuzumab ADE

Diarrhea and neutropenia

what does TH stand for

paclitaxel and trastuzumab

describe the TH schedule

weekly paclitaxel and trastuzumab

what does TCH stand for?

docetaxel + carboplatin + trastuzumab

explain the TCH regimen

docetaxel + carboplatin + trastuzumab q 21 days for 6 cycles

what does TCHP stand for

docetaxel + carboplatin + trastuzumab + pertuzumab

TCHP regimen indication

BC pt if they are lymph node positive or getting neoadjuvant treatment

ALL HER2 mabs can only be taken for _____

one year total

name the HER 2 mabs

trastuzumab

pertuzumab

endocrine treatment for BC can be given…

a. neoadjuvant

b. adjuvant

c. outpatient

d. all of the above

d

what is always the last treatment in BC pts

endocrine!

endocrine tx for BC pts is only indicated in which pts?

ER+ and or PR+

endocrine tx options for BC pts who are premenopausal

tamoxifen

aromatase inhibitor + ovarian suppression

tamoxifen regimen for endocrine therapy in premenopausal BC pt

10 mg po daily x 5 yrs

tamoxifen ADE

menopausal ADE

thromboembolic dx

uterine cancer

tamoxifen’s efficacy is decreased if it is given with…

fluoxetine, paroxetine, or bupropion (2D6 inhibitors)

what enzyme metabolizes tamoxifen to its active metabolite?

CYP2D6

if a pt is a poor metabolizer of CYP2D6, what drug would be at risk of decreased efficacy?

tamoxifen

name some aromatase inhibitors

letrozole

anastrazole

exemestane

endocrine tx option for post menopausal BC pt

aromatase inhibitors

aromatase inhibitors for post menopausal BC pts should be given for…

5 yrs

aromatase inhibitors ADE

menopausal ADE

osteoporosis

arthralgia

myalgias

what is the most common reason for d/c of aromatase inhibitors?

arthralgias

how to treat aromatase inhibitor induced arthralgia?

APAP and NSAIDS

pts on aromatase inhibitors should be on which supplements for supportive care?

Ca and Vitamin D

what is the alternative endocrine therapy option if a post menopausal BC pt is CI to all aromatase inhibitors?

tamoxifen

T or F:

goserelin is never given alone for BC treatment

T

chemotherapy can cause temporary ___ in premenopausal pts

amenorrhea

avoid _______ birth control in ALL breast cancer pts

hormone based

what are alternative birth control methods in pts with BC?

barrier methods

copper IUD

if a pt is HER (-) are they indicated for trastuzumab?

nah

if a pt is ER (+) and PR (+), they are indicated for…

endocrine therapy

if a BC pt has a high risk for recurrence, they are indicated for…

chemotherapy

if a pt is on _____ they require Ca and Vitamin D supplements to prevent ADE

aromatase inhibitors

if a pt is on _______ then they require cyanocobalamin and folic acid supplementation to prevent ADE

pemetrexed

if a pt is on _______ then they require diphenhydramine, dexamethasone, and famotidine to prevent ADE

paclitaxel

if a pt is on _____ then they require dexamethasone to prevent ADE

docetaxel

if a pt is on docetaxel they should be on ___ to prevent ADE

dexamethasone

TC is ONLY used in pts who are ____ risk

high

what is the most concerning toxicity with the medication used in all pts that are HER2+

HF (reversible)