Therapeutics - Breast Cancer 2
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. What would you like to do?
What drugs are used to phrophlax for breast cancer in high risk patients?
Tamoxifen if ER+/PR+
What are the ACS screening recommendations?
- Self-exam = monthly in 20s
- Clinical exam: Q3Years 20-40
- Mammogram – yearly after 40
How is Ductal Carcinoma in Situ treated?
Pre-malignant lesion usually treated with mastectomy followed by tamoxifen in ER/PR+ Patients
What is the most important prognostic factor for breast cancer?
Number of nodes: lower survival with over 4 nodes
What does ER/PR stand for?
Estrogen Receptor/Progesterone receptor
Anthracycline containing regimens have better outcomes with _______ positive patients.
Breast preserving therapy should be followed with what?
What is the goal of adjuvant therapy?
Eradicate micrometastatic disease
Why should Endocrine/Hormone therapy and Chemotherapy never be given at the same time?
Hormone therapy reduces the growth rate and chemo works best when tumors are growing rapidly
Can you give Endocrine/Hormone therapy at the same time as radiation?
Yes, just not chemo
(T/F) Age should never prevent a patient from getting chemo?
- Morbidities are more relevant
When do you follow Chemo with Endocrine/hormone therapy?
If chemo is not used and a patient is ER/PR + should you give hormone therapy?
What is the treatment for HR positive, HER2 positive, node positive stage 1 or 2 breast cancer with a tumor > 1 cm?
Chemotherapy + Trastuzumab ± Pertuzumab + Endocrine therapy
What is the treatment for HR positive, HER2 negative, node positive stage 1 or 2 breast cancer with a tumor > 1 cm?
Chemotherapy + endocrine therapy
What is the treatment for HR negative, HER2 negative, node positive stage 1 or 2 breast cancer with a tumor > 1 cm?
What is the treatment for HR negative, HER2 positive, node positive stage 1 or 2 breast cancer with a tumor > 1 cm?
Chemotherapy + Trastuzumab ± Pertuzumab
What adjuvant therapy is preferred for Stage I-II Node + breast cancer?
- Anthracycline containing regimens
- - Rubicin
Anthracycline-containing regimens may be more effective in _________ patients.
___________ also decrease recurrence and increase survival – most regimens will have one.
__________________-containing regimens may be more effective in Her2/neu+ patients.
Why should you not used Trastuzumab or Pertuzumab at the same time as an anthracycline?
Cardiotoxicity is additive, can be used in the same regimen, just not at the same time
When you have a HER2/neu and >1 cm tumor, what should you add to chemotherapy to enahance outcomes/survival?
Trastuzumab +/- Pertuzumab
What are the preferred adjuvant regimens for Stage 1-2, HER2/neu negative breast cancer?
- Dose-dense AC → weekly paclitaxel
- Dose-dense AC → q2week paclitaxel
- Docetaxel, cyclophosphamide (TC) – for patients who cannot tolerate an anthracycline
What are the preferred adjuvant regimens for Stage 1-2, HER2/neu postiive breast cancer?
- AC → paclitaxel + trastuzumab ± pertuzumab
- Docetaxel, carboplatin, trastuzumab (TCH) ± pertuzumab -for patients who cannot tolerate an anthracycline
What drugs should be used to perform Neoadjuvant Chemotherapy in stage 2-3?
- Traditional chemo drugs
- HER2/neu + = include trastuzumab +/- pertuzumab
When receiving neoadjuvant treatment, what is the order of therapies?
- Neoadjuvant chemo
What is the duration of therapy for Endocrine/Hormone therapy after surgery or chemo (Stage 1-3)?
What is the benefit of Endocrine/Hormone therapy after surgery or chemo (Stage 1-3)?
Decreased recurrence by 40% and death by 31%
In a Pre-menopausal woman what adjuvant endocrine therapy should be employed if she remains pre-menopausal throughout treatment?
- Tamoxifen for 5 years +/- ovarian suppression
- Consider Tamoxifen for full 10 years if still premenopausal after 1st 5
In a Pre-menopausal woman what adjuvant endocrine therapy should be employed if she becomes Post-menopausal during treatment?
- Tamoxifen 2-3 years followed by aromatase inhibitor for 2-3 years = total of 5 years
- Tamoxifen 5 years followed by aromatase inhibitor for 5 years = total of 10 years
If a woman is postmenopausal at the onset of adjuvant endocrine therapy what protocols may be followed?
- Tamoxifen 2-3 years + Aromatase inhibitor 2-3 years
- Tamoxifen 2-3 years + Aromatase inhibitor 5 years
- Tamoxifen 5 years + Aromatase inhibitor 5 years
- Aromatase inhibitor 2-3 years + Tamoxifen 2-3 years
What are the antiestrogens?
- Tamoxifen (Nolvadex)
- Toremifene (Fareston)
- Fulvestrant (Faslodex)
What is the brand name for Tamoxifen?
What is the brand name for Toremifene?
What is the brand name for Fulvestrant?
What is the generic name for Nolvadex?
What is the generic name for Fareston?
- What is the generic name for Faslodex?
What is a normal dose of Tamoxifen (Nolvadex)?
20 mg PO QD
What are the side effects of Antiestrogens?
- Hot flashes
- Depression, thromboembolism, weight changes, endometrial or uterine cancer, fluid retention
- Metastatic disease: tumor flare, hypercalcemia
What drugs are CI with Tamoxifen (Nolvadex) and Toremifene (Fareston) and what drugs can be used instead?
- Paroxetine or Fluoxetine
- Venlafaxine and Citalopram
When is Fluvestrant (Faslodex) used?
When disease progression occurs
What are the Aromatase Inhibitors?
- Anastrazole (Arimidex)
- Letrozole (Femara)
- Exemestane (Aromasin)
What is the brand name for Anastrazole?
What is the brand name for Letrozole?
What is the brand name for Exemestane?
What would you like to do?
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