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What is the generic name for Arimidex?
What is the generic name for Femara?
What is the generic name for Aromasin?
What are the SE of Aromatase inhibitors?
Hot flashes, arthralgias, myalgias, headaches, diarrhea, mild nausea, DECREASED BONE DENSITY, increased risk of fracture
What is the dose for Anastrazole (Arimidex) and Letrozole (Femara)?
- Anastrazole: 1 mg PO QD
- Letrozole: 2.5 mg PO QD
What special information should you know about Aromatase inhibitors?
- Give: Ca and Vit D
- No effect on the endometrium
- May cause increased Cholesterol
How often are LH-RH agonists used in Breast Cancer?
When should ER/PR and HER2/neu status be re-tested?
Once the disease becomes metastatic
What is the goal of treatment for metastatic breast cancer?
Provide the most benefit with the least amount of toxicity
What treatment is recommended for Pre-menopausal Stage IV breast cancer?
- Antiestrogen (Tamoxifen or toremifene)
- If progresses: Surgical hysterectomy and oophorectomy or LHRH agonist, followed by post-menopausal protocols
Do not use _______________ in pre-menopausal stage IV breast cancer because it does not block ovary production of estrogen.
What treatment is recommended for POST-menopausal Stage IV breast cancer (1st line)?
- Letrozole + palbociclib – unknown if effects survival
- Anastrozole, Letrozole
- Anastrazole + fulvestrant
When are Palbociclib and Everolimus indicated in Breast cancer treatment?
Metastatic, post-menopausal ER+/PR+, HER2/neu negative breast cancer
What special instructions should you give patients taking Palbociclib?
- Take with food
- Avoid Grapefruit
What special instructions should you give a patient taking everolimus?
- CYP3A4 metabolism– dose adjust as necessary
What are the SE of Palbociclib?
- Severe infections
What are the SE of Everolimus?
What is the brand name for Everolimus?
Afinitor (Zortress for renal transplant)
What is the brand name for Palbociclib?
What is the generic name for Ibrance?
What is the generic name for Afinitor?
When is Chemotherapy used in Metastatic breast cancer?
When there is no longer a response to endocrine therapy
In metastatic breast cancer when is Trastuzumab indicated?
Upfront in Her2/neu positive patients
How does Ado-trastuzumab (Kadcycla) compare to Trastuzumab?
- Not interchangeable
- Higher myelosupression and PH
What are the SE of Trastuzumab?
Arthalgias, ventricular dysfunction and PN
What are the preferred regimens for HER2/neu positive treatment of metastatic breast cancer that is refractory to hormone therapy?
- Pertuzumab, trastuzumab, docetaxel
- Pertuzumab, trastuzumab, paclitaxel
What should you know before starting a chemo regimen for HER2/neu positive treatment of metastatic breast cancer?
Get ejection fraction
What are the AE of Pertuzumab (Perjeta)?
- CHF – check ejection fraction before each dose
What is the dosing strategy for Pertuzumab (Perjeta)?
- Flat doses
- Give loading dose then maintenance, if on for more than 6 weeks repeat the loading dose
What is the brand name for Pertuzumab?
What is the generic name for Perjeta?
What is the brand name for Lapatinib?
What is the generic name for Tykerb?
Lapatinib (Tykerb®) delays disease progression, but has unknown effects on ___________.
What are the SE of Lapatinib (Tykerb®)?
When is radiation not indicated postoperatively?
> or = to 70 years old, then get Tamoxifen instead
When is Postoperative Adjuvant radiation indicated?
- Partial mastectomy performed
- Positive/close margins
- Skin involvement
- > 5cm tumor
- > or = to 4 axillary lymph nodes ( may consider with 1-3)
- Neoadjuvant chemotherapy
- Local recurrence treated with chemo
How can you treat bone mets in Breast Cancer?
- Zoledronic acid (preferred) or Pamidronate