Blast from the Past
These are the patients who derive the most benefit from oncotype testing
Who are lymph node negative, ER+ patients?
Consider for node negative and post menopausal 1-3 lymph nodes
This is first line treatment for hormone positive HER2 negative metastatic breast cancer.
Endocrine therapy +/- CDK4/6 inhibitor
Add OFS if premenopausal
Patients who are HER2 low or ultra low can be candidates for this drug
What is Enhertu (TDXD)? Sacizutuzmab is also approved for triple negative second line (though to pick which one to give first)
The CLEOPATRA study added this drug to the combination of docetaxel/traztuzumab for frontline metastatic breast cancer with an improvement of PFS and OS.
What is Pertuzumab?
This is the reason we give bisphosphonates/denosumab to patient's with bone disease.
- prevents skeletal fractures
- reduce risk for pain
- reduce hypercalcemia
- reduce growth in the bones
This is a steroidal aromatase inhibitor
What is exemestane?
This is first line treatment for hormonal+, HER2+ metastatic breast cancer
Taxane + herceptin/perjeta for 6-8 cycles, then drop taxane and add hormonal therapy afterwards
For triple negative with BRCA mutation, what can be offered in frontline setting?
Talozoparib or Olaparib (PARP inhibitor)
The TROPICS02 study approved this drug in patients who have had at least 1 endocrine therapy taxane, and CDK4/6 inhibitor in any setting
What is Sacituzumab Govetecan?
This is the mechanism of action of Everolimus
What is MTOR inhibitor?
These are the side effects of CDK 4/6 inhibitors (distinguish ribociclib vs abemaciclib)
RIBO - QT prolongation, monitor EKG changes, monitor liver enzymes
Abemaciclib - abdominal discomfort, diarrhea, nausea
All can cause fatigue, joint pain, myelosuppresion, ILD (rarely)
This is the CNS active 3rd line regimen for HER2+ metastatic breast cancer based on HER2CLIMB.
What is Tucatinib + capecitabine + traztuzmab?
This is the most common type of breast cancer in males
What is ER/PR+, HER2 -?
Men with breast cancer usually present at a later stage and lobular histology is rare.
Most male breast cancer patients are treated with mastectomy rather than lumpectomy due to limited breast tissue.
Tamoxifen + LHRH agonist therapy needed! Aromatase inhbitor won't work
The EMERALD study approved this drug for patients who have previously received CDK 4/6 inhibitor, two or fewer lines of endocrine therapy and one or no line of chemotherapy with an ESR1 mutation.
What is elecestrant?
Patient's with NTRK mutation can be given this drug
What is entrectonib and lerotrectenib?
What is the other name for Kadcyla? FULL NAME
TDM1 = traztuzumab emtansine
TDXD/famtraztuzumab = enhertu
First line treatment for triple negative breast cancer is chemoimmunotherapy. What is the CPS cutoff for addition of pembrolizumab?
What is CPS > 10?
Of note, atezolizumab is no longer approved! Don't pick this answer choice if option!
This is the ONLY CDK 4/6 inhibitor with single agent activity in ER/PR+ advanced breast cancer
What is abemaciclib?
The ExteNET study (and NALA) approved this pan-irreversible HER2 inhibitor for fourth line treatment
What is neratinib?
Patient's with RET mutation can be given this drug
selpercatanib
The MONARCHE trial showed the addition of abemaciclib increased IDFS for which population of patients
high risk early breast cancer - > 4 positive axillary lymph nodes OR 1-3 ALN and at least one of the following (1. Tumor > 5, histologic grade 3, ki67 > 20)
NATALEE - stage II/III ribociclib for 3 years
These are the drugs you can use in a PIK3CA mutation, AKT, or PTEN
What are everolimus (don't need a mutation for this), capiversitib, alpelisib?
T/F Ribociclib + Tamoxifen is an acceptable first line treatment for metastatic breast cancer
Tamoxifen + ribo was found to have worse QT prolongation. NOT currently recommended
This was the trial that showed that TDXD > TDM1 in second line HER2+ disease
DESTINY BREAST 3
Among patients with HER2-positive metastatic breast cancer previously treated with trastuzumab and a taxane, the risk of disease progression or death was lower among those who received trastuzumab deruxtecan than among those who received trastuzumab emtansine. Treatment with trastuzumab deruxtecan was associated with interstitial lung disease and pneumonitis.
This is the MOA of Margetuximab
What is antiher2 antibody which binds to CD16A