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Oncology II
Oncology II - Breast Cancer Overview and Hormonal Therapies
| Term | Definition |
|---|---|
| What is the recommended treatment for pt diagnosed with early stage breast cancer (1-III)? | - surgery - radiation - chemotherapy - hormonal therapy |
| why is the use of adjuvant therapy in some pt with early stage breast cancer needed? | - prevent recurrence - improve the long term survival |
| When is the use of trastuzumab indicated in patient with breast cancer? | - if HER2 is positive ( over-expressed in cancer cell) |
| When is the addition of pertuzumab to trastuzumab in breast cancer patient with HER2 positive needed? | - Size of the tumor > 2 cm - local node ( N1) |
| when is the use of adjuvant hormonal therapy in breast cancer patient indicated ? | - in patient with ER+ or PR + or both |
| which adjuvant hormonal therapy in postmenopausal breast cancer with PR + or ER + patient receive ? | - postmenopausal women AI ( aromatase inhibitor) for 5 years |
| which adjuvant hormonal therapy in premenopausal breast cancer with PR+ or ER + patient receive? | - tamoxifen for 5 yrs - additional 5 yrs if still premenopausal |
| which group of breast cancer patients don't benefit from the adjuvant hormonal therapy? | - breast cancer patient with ER or PR being negative |
| What is the main MOA of Hormonal therapies for breast cancer? | - interfering with estrogen stimulated growth of breast cancer cells |
| What is the main organ that produces estrogen in the following: 1- premenopausal women 2- postmenopausal women | - premenopausal women: ovaries - postmenopausal women: adrenal glands |
| Which hormonal therapy is used to treat male with breast cancer? | tamoxifen |
| what is the MOA of AIs ( aromatase inhibitors)? | - Acts peripherally - blocks the enzyme needed to convert the adrenally produced estrogen precursors to estrogen |
| when is the use of AIs is ineffective? | - in premenopausal women b/c the estrogen is produced form the ovaries not peripherally from adrenal gland |
| When is the use of AIs indicated? | - in postmenopausal women |
| If AIs to be used in premenopausal women, what other class of drug should be added to the treatment and why? | - GnRH agonist -- suppress ovarian production of estrogen - AIs: blocks the peripheral production of estrogen |
| when is the use of SERM ( tamoxifen) indicated? | - in premenopausal women |
| what is the MOA of SERM ( tamoxifen)? | selective estrogen receptor modifiers selective means: 1- estrogen blocker @ breast tissue 2- estrogen agonist @ other tissue such as bone |
| When is the use of hormonal therapy SERM ( tamoxifen) indicated? | in premenopausal women with ER or PR positive |
| which breast cancer patients the SERM use indicated? | - premenopausal women ( ER + or PR +) - men with breast cancer - Postmenopausal ( FYI AI is more effective) |
| what is the MOA Of GnRH agonist? | - gonadotropin releasing hormone agonist ( produced from hypothalamus) ---> acts on the pituitary gland ---> release of FSH and LH --> suppression of ovarian estrogen |
| what is the MOA of SERM? | selective estrogen receptor modifiers: blocks breast tissue estrogen only |
| what is the MOA of AI? | aromatase inhibitor: inhibits the enzyme that converts DHEA ( Dehydroepiandrosterone) & androstenedione ---> estrogen |
| list the common SERM drugs ( selective estrogen receptor modulators)? | 1- tamoxifen 2- fluvestrant 3- raloxifene 4- Toremifene |
| Which of the SERM drugs is only IM on days 1,15,29 then monthly? | fulvestrant |
| which SERM drugs increases the risk of uterine or endometrial cancers? | tamoxifen |
| What is the proposed MOA of DDI with tamoxifen? | CYP 3A4, 2C9 and 2D6 - Major DDI is 2D6 |
| which drugs to treat hot flashes should the pharmacist recommends in patient receving tamoxifen? | - as tamoxifen is 2D6 substrates, venlafaxine is the drug of choice ( not 2D6 vs. fluoxetine and paroxetine) |
| what is the active metabolite of tamoxifen? | active metabolite is endoxlifen |
| Which SERMs is the drug of choice in 2D6 slow metabolizer? | Toremifene |
| which SERMs is the drug of choice as breast cancer prophylaxis? | Raloxifene |
| which SERM drug increases the risk of uterine/endometrial cancers? BBW | Tamoxifen |
| which SERM drug increases the risk of thromboembolic such as VTE, PE and stroke? BBW | - Tamoxifen - Raloxifene |
| Which SERM drug induce QT prolongation? BBW | toremifene |
| which SERM drug is C/I in patient receiving warfarin therapy? | tamoxifen |
| which SERM drug is C/I in pt with h/o of DVT/PE? | - tamoxifen - raloxifene |
| which SERM drug is C/I in pregnancy and breast feeding? | - raloxifene |
| Which SERM drug is C/I in patient with h/o of QT prolongation? | toremifene |
| which SERM drug is C/I in patient with HYPO kalemia or HYPO Mg? | toremifene |
| which SERM drug can cause cataracts? | tamoxifen |
| what are the common side effects of SERM? | - DVT/PT - menopausal sxs 2/2 acting on ovaries: 1- hot flashes, flushing, edema, wt changes, mood changes, amenorrhea, vaginal bleeding, discharge, and HTN - pain: arthralgia and myalgia - skin changes - cataract |
| what are the main counseling points for SERM? | - prevent conception for a min of 2 months after tx - hormonal contraceptive may not work effectively --> use different methods: 1- IUD 2- diaphragms 3- condoms |
| what are some considerations for the use of raloxifene as breast cancer prophylaxis ? | - avoid prolonged immobilization 2/2 risk of blood clots - d/c at least 72 hr prior to major surgical/bed rest |
| list the common AI drugs used in treated patient with breast cancer? | - anastrozole - letrozole - exemestane |
| what is the MOA Of AI? | - acts peripherally - inhibits the enzyme that converts adrenals into estrogen - indicated for postmenopausal women - |
| What are some common risk s of using AI in breast cancer patients? | - osteoporosis --> reduction of bone mineral density - high CVD |
| what are some recommendations to minimize the risk of osteoporosis in patient receiving AI? | - start the pt on Ca and VitD - encourage exercise - DEXA screening (Dual-energy X-ray absorptiometry) |
| when is the use of AI is C/I ? | pregnancy |
| what are some common side effects of using AI? | 1- DVT/PE 2- osteoporosis/ bone pain 3- HTN 4- edema 5- menopausal sxs: hot flashes, arthralgia/ myalgia/ lethargy/ fatigue 6- GI: N/V 7- hepatotoxicity 8- dyslipidemia |
| which hormonal therapies can induce dyslipidemia? | - AI |
| which patient population the use of AI is indicated? | - post menopausal women - AI + GnRH agonist in pre menopausal women |
| which hormonal therapies induce osteoporosis? | AI ( postmenopsual) |
| which hormonal therapies causes blood clots? | SERM |
| which hormonal therapies causes hepatotoxicity? | AI |
| which class of drug is considered C/I in patient receiving AI? | any drugs containing ESTROGEN |
| What are the main hormonal therapies for patient with breast cancer? | - SERM - AI - cyclin dependent kinase inhibitors CDKI |
| what is the MOA OF CDKI? | inhibits the downstream signaling pathway and tumor growth |
| list all the CDKI drugs? | - palbociclib |
| what is unique about Palbociclib CDKI drug in breast cancer? | - TAKE WITH FOOOOOOOD |
| Which drugs are used to augment the Palbociclib effect in breast cancer patient? | 1- letrozole (AI) -2- fluvestrant (SERM) |
| what are some common side effects of the use of palbociclib? | 1- myelosuppression --> infection 2- GI ( N/V/D) 3- Thromboembolic 4- fatigue 5- alopecia 6- blurred vision |
| which hormonal therapy causes alopecia? | palbociclib |
| what is the suffix of SERM? | ene except tamoxifen and fulvestrant |
| what is the suffix of AI? | ozole except exemestane |
Created by:
Smoham38
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