Breast Cancer - Evans

What reproductive factors increase breast cancer risk?

Early menarche, late menopause, nulliparity

What hormone exposure increases breast cancer risk?

Exogenous estrogen

What type of cancer is associated with BRCA1?

Triple-negative breast cancer

What type of cancer is associated with BRCA2?

ER-positive breast cancer

What age at breast cancer diagnosis warrants germline testing?

50 years or younger

Does TNBC warrant germline testing regardless of age?

Yes

What family cancers raise hereditary breast cancer suspicion?

Early breast, ovarian, pancreatic, high-risk prostate

What age should BRCA-positive women begin annual MRI?

25 years

What age should BRCA-positive women add mammography?

30 years

What is the most common invasive breast cancer histology?

Invasive ductal carcinoma

What does HER2 IHC 3+ indicate?

HER2-positive

What does HER2 IHC 2+ require?

Confirmatory FISH testing

What does HER2 IHC 2+ with negative FISH indicate?

HER2-negative

What does HER2 IHC 1+ indicate?

HER2-negative, HER2-low

What makes breast cancer hormone receptor positive?

ER or PR positivity

What tumor features increase recurrence risk?

High grade, large size, positive nodes, high Ki-67

What does Oncotype DX help determine?

Recurrence risk and chemotherapy benefit

When is Oncotype useful in premenopausal HR+/HER2− disease?

Node-negative early disease

When is Oncotype useful with 1-3 positive nodes?

Postmenopausal HR+/HER2− disease

Premenopausal HR+/HER2− with 1-3 positive nodes: chemotherapy?

Recommended regardless of Oncotype

Postmenopausal RS below 26 with 1-3 nodes: treatment?

Endocrine therapy generally favored

Postmenopausal RS 26 or greater: treatment?

Chemotherapy plus endocrine therapy

Does having 4 or more positive nodes require Oncotype DX?

No; chemotherapy benefit already established

What is neoadjuvant therapy?

Treatment before surgery

What is adjuvant therapy?

Treatment after surgery

Which breast surgery usually requires radiation?

Lumpectomy

What is the role of sentinel lymph node biopsy?

Assess regional lymph-node involvement

What is the endocrine treatment backbone for HR+ cancer?

Endocrine therapy

What is the preferred endocrine class after menopause?

Aromatase inhibitors

Name the three major aromatase inhibitors.

Anastrozole, letrozole, exemestane

What endocrine drug is commonly used before menopause?

Tamoxifen

When can a premenopausal patient use an AI?

With ovarian function suppression

Name two ovarian suppression drugs.

Goserelin and leuprolide

What is the usual duration of adjuvant endocrine therapy?

At least 5 years

What is the preferred high-risk HR+/HER2− chemo regimen?

AC followed by a taxane

What drugs are in AC?

Doxorubicin and cyclophosphamide

What drugs are in TC?

Docetaxel and cyclophosphamide

When is TC considered instead of AC-T?

Lower risk or anthracycline contraindication

What treatment is used in lower-risk node-negative HER2+ disease?

Paclitaxel plus trastuzumab

What does TCHP stand for?

Docetaxel, carboplatin, trastuzumab, pertuzumab

When is pertuzumab added in early HER2+ disease?

Tumor 2 cm or larger and/or LN-positive

How long is adjuvant trastuzumab-based therapy generally continued?

About 1 year

What extra treatment is required for HR+/HER2+ cancer?

Endocrine therapy

What is KEYNOTE-522's neoadjuvant regimen?

Paclitaxel/carboplatin/pembrolizumab then AC/pembrolizumab

Does pembrolizumab continue after surgery in KEYNOTE-522?

Yes; adjuvant pembrolizumab

HER2+ residual invasive disease after neoadjuvant therapy: treatment?

Adjuvant T-DM1

Metastatic endocrine-sensitive HR+/HER2−: treatment?

CDK4/6 inhibitor plus AI

Premenopausal metastatic HR+/HER2−: what must accompany AI?

Ovarian function suppression

Metastatic endocrine-resistant HR+/HER2−: lecture option?

CDK4/6 inhibitor plus fulvestrant

Metastatic visceral crisis: treatment approach?

Systemic chemotherapy

What is palbociclib's main toxicity?

Neutropenia

What is ribociclib's distinguishing toxicity?

QT prolongation and hepatotoxicity

What is abemaciclib's distinguishing toxicity?

Diarrhea

What is palbociclib's standard schedule?

Daily days 1-21, then 7 days off

What is fulvestrant's mechanism?

Estrogen receptor degradation

What medication targets germline BRCA-associated disease?

Olaparib

What medication targets PIK3CA mutation?

Alpelisib

What medication targets ESR1 mutation?

Elacestrant

What is T-DM1's hallmark toxicity?

Thrombocytopenia and elevated LFTs

What is T-DXd's hallmark toxicity?

Interstitial lung disease/pneumonitis

Can T-DXd treat eligible HER2-low metastatic disease?

Yes

What are tamoxifen's serious toxicities?

DVT/PE and endometrial cancer

What is the major long-term AI toxicity?

Bone loss and fractures

What cardiac monitoring is needed with trastuzumab?

Baseline LVEF and every 3 months

What labs are monitored with ribociclib?

CBC, BMP, LFTs, plus ECG

What is palbociclib CBC monitoring in the case key?

Day 1 and 14 cycles 1-2, then day 1

What drugs reduce skeletal events in bone metastases?

Zoledronic acid or denosumab

What serious jaw complication occurs with bone agents?

Osteonecrosis of the jaw

How long is SQ pertuzumab/trastuzumab loading administration?

8 minutes

How long is SQ pertuzumab/trastuzumab maintenance administration?

5 minutes