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Oncology II

Oncology II - Breast Cancer Overview and Hormonal Therapies

TermDefinition
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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