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Phrx 5044 - Oncology
Exam 3 material
| Question | Answer |
|---|---|
| [i] adenocarcinoma remains in lobe or duct of breast whereas [ii] adenocarcinoma spreads outside of lobe or duct of breast | [1]in-situ [ii] invasive |
| What are the different molecular subtypes of breast cancer? | [1] ER (+) +/- progesterone receptors [2] HER2 overexpression [3] Triple negative |
| List the risk factors for developing breast cancer. | Biologic sex (F>M) Age (older>younger) Endocrine factors Genetic (BRCA1&BRCA2 mutations) Environmental/lifestyle |
| Describe the age range at which breast cancer screening should begin (range), | 45 - 50 years old |
| How often should breast cancer screening be done? | Q1 - 2 years |
| What is the guideline recommended screening tool for breast cancer? | Mammogram |
| What are the preventable treatment options for at risk breast cancer patients? | [i] Genetic counseling [ii] lifestyle modifications [iii] surgery or medications |
| Which treatment option would you recommend for a BRCA1 or BRCA 2 positive patient? | mastectomy (risk reduction by 90%) & bilateral salpingo-oophorectomy (risk reduction by 50%) |
| Which treatment option would you recommend for women >/= 35years + Gail models 5-yr risk >/= 1.7%? | selective estrogen receptor modifier & aromatase inhibitor |
| What are the primary treatment options for stages I&II breast cancer? | [i] surgery + radiation therapy followed by systemic therapy [ii] neoadjuvant systemic therapy followed by surgery + radiation therapy |
| What are the primary treatment options for stages III breast cancer? | [i] neoadjuvant therapy followed by surgery +/- radiation therapy [ii] primary systemic therapy |
| What is the primary treatment options for stage IV breast cancer? | systemic therapy |
| Goal of therapy for breast cancer stages I-III is [i] while breast cancer stage IV is [ii] | [i] cure [ii] palliation |
| [i] is indicated for pre-menopausal women with ER+(+/-)PR+ breast cancer prevention/treatment while [ii] is indicated for post-menopausal women with ER+ (+/-) PR+ breast cancer prevention/treatment. | [i] tamoxifen [ii] aromatase inhibitors |
| What is the typical duration of therapy of endocrine therapy in ER +and/or PR + breast cancer as an adjuvant? | 5 - 10 years |
| What is the typical duration of therapy for endocrine therapy in ER+&/ PR+ breast cancer that has metastasized? | until disease progression |
| What is the MOA of tamoxifen (Nolvadex/Soltamox)? | Bings to ER and modulate ER mediated gene transcription. |
| What is a favorable PD of tamoxifen in ER+ (+/-) PR+ breast cancer? | antiestrogenic to breast tissue but estrogenic to bones & uterus |
| What are the ADEs associated with tamoxifen? | hot flashes, endometrial cancer, thromboembolic events, cataracts. |
| What should you monitor for with the use of tamoxifen? | endometrial cancer, provide annual gynecologic assessment (if uterus present/ no oophorectomy) |
| What is the MOA of aromatase inhibitors? | [i]decrease peripheral estrogen production by inhibiting aromatase enzyme (block conversion of androstenedione --> estrone) [ii] inhibits circulating estradiol in premenopausal women only |
| What are the non-steroidal aromatase inhibitors? | anastrozole (Arimidex) & letrozole (Femara) |
| What are the steroidal aromatase inhibitors? | exemestane (Aromasin) |
| What are the ADEs associated with aromatase inhibitors? | arthralgias/myalgias, osteoporosis/fractures, hot flashes, diarrhea, cardiovascular events |
| What should you monitor for with the use of aromatase inhibitors? | bone health (DEXMA scans @initiation & periodically) cholesterol LDL |
| What is the MOA of ovarian suppression/ablation? | suppress estrogen production in premenopausal women |
| What are the 2 types of ovarian suppression/ablation? | surgery (oophorectomy) medical (LHRH agonist) |
| What is the MOA of fulvestrant (Faslodex)? | Binds to estrogen receptors and down regulates receptor expression. No agonistic activity on ER |
| What are the ADEs associated with fulvestrant? | hot flashes, injection site rxns, headaches, asthenia (lack of energy) |
| What could you recommend to a patient who complains about experiencing hot flashes while on endocrine therapy? | non pharmacologic tx clonidine gabapentin venlafaxine |
| What should you monitor for with the use of medical ablation therapy with LHRH agonist? | increasing pain & hypercalcemia & BMD |
| What could you recommend for a patient who complains about experiencing arthralgias/myalgias while on aromatase inhibitors? | exercise NSAIDs Acetaminophen |
| What is the MOA of CDK4/6 inhibitors ? | inhibits the transition of cells from G0/1 phase to S-phase of the cell cycle by blocking RB protein phosphorylation. |
| What is the dose limiting toxicity associated with the use of CDK4/6 inhibitors palbociclib & ribociclib? | neutropenia |
| What is the dose limiting toxicity associated with the use of CDK 4/6 inhibitor abemaciclib? | diarrhea |
| List the monitoring parameters associated with robociclib toxicity. | neutropenia & ECG (prolong QTc) |
| List the monitoring parameters associated with palbociclib toxicity. | neutropenia |
| List the monitoring parameters associated with abemaciclib toxicity. | Serum creatinine (Scr) |
| What is the MOA of HER2 directed therapy trastuzumab (Herceptin)? | humanized mab that binds to extracellular HER2 subdomain IV with high affinity and mediates antibody dependent cellular cytotoxicity. |
| What is the MOA of HER2 directed therapy pertuzumab (Perjeta)? | recombinant humanized mab that binds extracellular HER2 dimerization domain. |
| What is the MOA of HER2 directed therapy ado-trastuzumab emtansine (Kadcyla)? | antibody conjugate that incorporates trastuzumab with cytotoxic activity of microtubule inhibiting drug emtansine (T-DM1) |
| What is the MOA of HER2 directed therapy fam-trastuzumab deruxtecan-nxki (Enhertu)? | antibody conjugate (trastuzumab + topoisomerase I inhibitor (deruxtecan-nxki) + tetrapeptide cleaver) that binds to HER2 receptor links lysosomal enzymes while deruxtecan causes DNA damage& apoptosis |
| What is the MOA of HER2 directed therapy neratinib (Nerlynx)? | inhibits intracellular kinase domains of EGFR and HER2 as well as irreversibly binds to HER4. |
| What are common ADEs of HER targeted therapy? | cardiomyopathy, infusion-related rxns, diarrhea, interstitial lung disease, QTc prolongation and DDIs |
| Which HER targeted therapy is associated with QTc prolongation and DDIs? | neratinib |
| Which HER targeted therapy has a BBW for interstitial lung disease? | fam-trastuzumab deruxtecan |
| What is the rationale for pre-medication and types of pre-medications used with paclitaxel and docetaxel? | rationale = prevent hypersensitivity reactions pre-medication = corticosteroids (dexamethasone) |
| What is the dose limiting toxicities associated with taxanes, anthracyclines & cyclophosphamide? | myelosuppression |
| Which anticancer therapy is associated with acute myelogenous leukemia (AML) & hemorrhagic cystitis? | cyclophosphamide |
| Which anticancer therapy is associated with cardiotoxicity (myopathies)? | anthracyclines (doxorubicin) |
| What is the indication for antiresorptive therapy? | 1. Adults >/= 50years + T-score (-1.0 to -2.5) at femoral neck, total hip or lumbar spine 2. + 10-yr probability of hip fracture >/= 3% or 10-yr probability of major osteoporosis fracture >/= 20% |
| list the 3 antiresorptive therapy used for cancer (breast or prostate) patients who are indicated, without bone metastases. | denosumab (Prolia), zoledronic acid (Reclast), alendronate (Fosamax) |
| What is the dose of denosumab used for antiresorptive therapy in cancer patients without bone metastases? | 60mg SQ Q6months |
| What is the dose of zoledronic acid used for antiresorptive therapy in cancer patients without bone metastases? | 5mg IV yearly |
| What is the dose of alendronate used for antiresorptive therapy in cancer patients without bone metastases? | 70mg PO weekly |
| List the antiresorptive therapies used for cancer patients with bone metastases. | zoledronic acid (Zometa) & denosumab |
| What is the dose of zoledronic acid for bone modification therapy for cancer patients with bone metastases? | 4mg IV over 15minutes Q3-4weeks however, breast cancer dose frequently is Q12weeks |
| Which bone modifying therapy is more likely associated with hypercalcemia? | zoledronic acid |
| What is a common ADE associated with cancer patients with poor dental care? | Osteonecrosis of the Jaw |
| Which bone modifying therapy requires dose adjustment based on crcl? | zoledronic acid |
Created by:
daneangelo7
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