Metastatic Mayhem
This is what should be offered to patients with bone disease?
Bisphosphonates/Denosumab
T/F Ovarian function suppression and an aromatase inhibitor are favored for patients at higher risk and for younger women
What is True?
Per the ATLAS trial, this is how many years of tamoxifen that is recommended for early ER/PR+ breast cancer.
What is 10 years
This is the ER/PR % cutoff needed to be classified as "positive"
What is 1%?
This is the MOA of anastrozole
What is an aromatase inhibitor?
What is the standard first line treatment for premenopausal metastatic ER/HR+ breast cancer?
Aromotase inhibitor + CDK 4/6 inhibitor
This is the adjuvant treatment for T1A, No disease in HR+ER+HER2- Breast Cancer
Endocrine Therapy Alone
Per the SOFT/TEXT Trial, disease free survival was increased when what was added to hormonal therapy?
What is Ovarian Suppression?
This consitutes size cutoff T2 disease in breast cancer
What is 0.5 mm?
This is the MOA of fulvestrant.
What is selective estrogen receptor degrader (estrogen antagonist)
What can be added to standard therapy for first line therapy if a BRCA 1/2 mutation is found?
What is a PARP inhibitor (i.e. olaparib)?
This is the Oncotype DX score cutoff for need for adjuvant therapy.
What is 25?
The MonarchE study showed improvement of DFS when this drug was added to endocrine therapy
What is abemaciclib?
Name 3 antiestrogenic side effects
Increased incidence of endometrial cancers ( no data support routine screening)
Increased incidence of VTE (risk of stroke was not consistently increased among the tamoxifen studies, and this association is not supported by large population studies
Increased incidence of cataracts
Vasomotor symptoms, vaginal discharge
Bone loss in premenopausal women
Breast Cancer Prevention Trial P1 - reduction in the incidence of osteoporotic bone fractures by 29% was seen among women age 50 years or older
This is the creatinine clearance at which Zoledronic Acid cannot be given.
What is Creatinine clearance < 30?
What is second line chemotherapy for HR+ HER2- metastatic breast cancer with visceral crises?
Sazituzumab govitecan
T/F There is an overall survival benefit with the addition of anti-estrogen therapy for DCIS
What is False?
The role of ribociclib in the adjuvant setting was established through this study.
What is the NATALEE study?
Eligible patients include women, regardless of menopausal status, and men aged ⩾18 years. Select patients with stage IIA, stage IIB, or stage III disease were eligible. Patients underwent 1:1 randomization to Ribociclib 400 mg/day (3 weeks on/1 week off) + ET (letrozole 2.5 mg/day or anastrozole 1 mg/day [investigator’s discretion] plus goserelin [men or premenopausal women]) or ET alone. Ribociclib treatment duration is 36 months. ET treatment duration was for ⩾ 60 months. The primary end point is invasive disease-free survival. Data shows that the 3-year iDFS rate was 90.4% with Ribociclib plus endocrine therapy vs 87.1% with endocrine therapy alone.
This is the best studied and most effective anti estrogen therapy in male breast cancer patients.
What is tamoxifen?
This is the MOA of Everolimus.
What is mTOR inhibitor?
This is second line therapy in patients who have a PIK3CA-mutated tumors
What is Alpelisib + Fulvestrant?
Name 2 adjuvant chemotherapy regimens for ER/PR+ HER2 negative breast cancer
DDAC (doxorubicin/cyclophosphomide) followed or proceeded by paclitaxel (every 1 week or every 2 weeks)
Olaparib if BRCA 1/2 mutation
AC
CMF
AC followed by weekly paclitaxel
This was the seminal publication that evaluated the prognostic and predictive utility of the 21-gene breast-cancer assay to inform on systemic therapy for women with positive lymph-node disease.
What is the Rx Ponder Study?
Name 3/4 high risk breast cancer characteristics
High-risk breast cancer is defined as:
--Patients with ≥4 positive lymph nodes
--1-3 positive lymph ndoes with one or more of the following
--Grade 3 disease
--Tumor size ≥5 cm in size
This is the latency period for treament related leukemias for alkylating agents
What is 5-7 years?
1-3 years for topoisomerase inhibitors