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Breast Cancer
Lecture 16
23
Pharmacology
Professional
04/20/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
What are risk factors for breast cancer?
Definition
- Gender - female
- Age - older
- Hormones - early period or late menopause. Use of HRT
- Genetics - p53, HER2, BRCA1/2
- ALCOHOL INCREASES RISK
Term
What tools assess risk of breast cancer?
Definition
- Gail model
- Claus model
- BRCAPRO
Term
How is screening for breast cancer completed?
Definition
- Exams - self exam once a month, clinical starting at age 20 every 1-3 years
- Mammogram - 40+ once yearly
- Breast MRI - high risk patients
Term
How can breast cancer be prevented?
Definition
- Tamoxifen - ER+, increases endometrial cancers and VTE
- Raloxifene - only in post menopausal women. Less risk of VTE
- Mastectomy
Term
What are types of non-invasive breast cancer?
Definition
- Ductal carcinoma in situ (DCIS) -15-50% progress to invasive, stays unilateral
- Lobular carcinoma in situ (LCIS) - rarely progresses, can affect both breasts
**basement membrane is still intact
Term
What are types of invasive breast cancer?
Definition
- Invasive ductal carcinoma (IDC)- most common, worse prognosis. Metastasis to liver, lung, bone
- Invasive lobular carcinoma (ILC) - harder to detect, metastasis to retroperitoneal
Term
How does breast cancer present?
Definition
- Most common: painless mass
- palpable lymph nodes
- High CEA indicates disease
Term
What receptors are on breast cancer cells?
Definition
- Estrogen receptor
- Progesterone receptor
- HER2 receptor - must be + to benefit from HER2 therapy
Term
What is staging for breast cancer?
Definition
TNM:based on tumor size, nodal progression, and metastasis
Term
What determines breast cancer prognosis?
Definition
- Tumor size
- Nodal involvement
- Young women, african americans have more aggressive disease
Term
What is oncotype?
Definition
Unique to breast cancer:
- Low < 18: low risk of recurrance w/ solo endocrine therapy. Avoid adjuvant chemo
- Intermediate 18-30 - personal decision
- High > 31 - high risk of recurrence despite endocrine, adjuvant chemo needed
Term
What is a sentinel lymph node biopsy?
Definition
Dye injected near tumor, 1st lymph node to take up dye is removed
Term
How is LCIS and DCIS treated?
Definition
- LCIS - observation alone.
- DCIS - Surgery with or without radiation. Tamoxifen only in lumpectomy patients for ER+ tumors
Term
What is the treatment for Early stage (I,II) breast cancer?
Definition
- Surgery with or without radiation
- T = 0.6- 1 cm - Adjuvant endocrine + chemo, HER2+ add trastuzumab
- T = >1 - Endocrine + chemo + trastuzumab
**ER1 - do not use endocrine therapy
Term
When is endocrine therapy warrented in breast cancer?
Definition
In hormone receptor (+) tumors:
- Tamoxifen - SERM, gold standard
- Aromatase inhibitor: post menopausal only. Anastrazole, letrozole, Exemestane. FOR 5 YEARS
**Do not give concurrently w/ chemo
Term
What are the cornerstones of breast cancer chemotherapy?
Definition
Anthracyclines and taxanes within 12 weeks of surgery
- HER2(-) - dose dense doxorubicin + cyclophosphamide --> paclitaxel
- HER2(+) - Paclitaxel + cyclophosphamide + trastuzumab
Term
What therapy should be given to HER2+ breast cancers?
Definition
Trastuzumab/Herceptin - for all HER2+ over 1 cm
Term
What is a therapy for metastatic breast cancer in post menopausal women?
Definition
Exemestane + Everolimus - mTOR inhibitor
Term
What is 1st line therapy for metastatic Her2+ breast cancer?
Definition
Pertuzumab + Trastuzumab + Paclitaxel
Term
What are the side effects of endocrine therapy in breast cancer?
Definition
Hot flashes and fatigue: tx = Effexor ER 75 qd
AI: myalgias and arthralgias. Give vit D and calcium supplements
Term
What are side effects of anthracyclines used in breast cancer?
Definition
Cardiotoxicity - Dexrazoxane decr toxicity.
Alopecia
N/V
Term
When can eribulin be used for breast cancer?
Definition
Failure of 2 chemo regimens for metastatic disease
**Ixabepilone: for tx failure
Term
What biologics can be used for breast cancer?
Definition
- Trastuzumab - for HER2+. Infusion rxns and cardiotoxic
- Pertuzumab - prevents dimerization
- Ado-trastuzumab - HER2 + microtubule
- Lapatinib - kinase inhibitor of EGFR and HER2
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