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Epidemiology/Etiology
Diagnosis/Pathology
Hormone Therapy
Chemotherapy
Miscellaneous
100
This is the most common cancer diagnosed in women in the US (excluding skin cancer).
What is Breast Cancer?, estimated 234,000 cases will be diagnosed in 2015 (232,670 women, 2,360 men)
100
This is the most common presentation of breast cancer. Bonus: the presentation of inflammatory breast cancer differs in this way
What is a painless, immobile mass? Bonus: what is inflammatory breast cancer differs in presentation with an enlarged, firm, red breast with skin changes, often mimicking cellulitis
100
This is the primary pathway of estrogen production in postmenopausal women.
What is enzymatic conversion of adrenal androgens by the aromatase enzyme in peripheral tissues to estrogen?
100
These chemotherapy classes are included in the current 'standard' adjuvant treatment regimens for patients with breast cancer.
What are anthracycline and taxane containing regimens?
100
This is the MOA of the aromatase inhibitors and why its most effective in postmenopausal women. Bonus: With this drug combo, we can give AI's to premenopausal women based on the SOFT/TEXT studies.
AIs block aromatase in converting androstenedione into estrone. In postmenopausal women, estrone is the primary source of estrogen, therefore, it is most effective in this patient population. ii. Bonus answer: data from the SOFT and TEXT studies shows that higher risk pre-menopausal women can be given ovarian suppression (ex. with luprolide) and an AI for 5 years with improved disease free survival vs. tamoxifen with OS.
200
This is the most common cause of cancer related mortality in US women.
What is lung cancer? (breast cancer is second leading cause of death)
200
This is the most common histopathologic subtype of breast cancer.
What is invasive ductal carcinoma (70%) and it carries a worse prognosis compared to lobular carcinoma and DCIS or LCIS?
200
These are toxicities associated with tamoxifen use.
What are increased thromboembolic events including stroke and pulmonary embolism and increased incidence of endometrial cancer in postmenopausal women who had not had a hysterectomy by 2 to 3-fold. Also, hot flashes, vasomotor symptoms, vaginal dryness
200
These were the types of regimens compared and the outcomes of the CALGB9741 trial.
What is the dose-dense regimen (AC) was significantly better than the Q3week regimen in improving DFS (primary endpoint) and OS (secondary endpoint)?
200
This is the most active metabolite of tamoxifen and the primary enzyme responsible for metabolizing tamoxifen to its active form. Bonus: these drugs have important drug interactions with tamoxifen.
What is Endoxifen (other is 4-hydroxytamoxifen) (30-100 times more potent than parent drug and CYP2D6. What are important drug interactions – CYP2D6 inhibitors including SSRIs (fluoxetine, paroxetine, sertraline) interfere with formation of the active metabolites of tamoxifen.
300
This is the average risk of a woman developing breast cancer in her lifetime.
What is 1 in 8 women? This compares to 1 in 6 men for risk of developing prostate cancer. This used to be 1 in 11 in the 1970s
300
This is the percentage of breast cancers which over express HER2-neu.
What is 15-25%? It is associated with a more aggressive disease course but is also a predictive factor for response to HER2 targeted therapy
300
This is the recommended duration of endocrine therapy in post-menopausal women with ER positive breast cancer.
AI for 5 years, or tamoxifen for 2-3 years following an AI to complete 5 years; or tamoxifen for the full 5 years (if contraindications or intolerance to AI) or extended therapy: 4.5-6 years of tamoxifen followed by 5 years of AI.
300
This is the main toxicity increased with dose dense chemo and the supportive care treatment used.
What increased neutropenia with DD chemo and we use primary prophylaxis with growth factor support. The DD regimen also may have increased N/V and fosaprepitant with dex and 5HT3 antagonist should be used.
300
This is a recommendation you would give to the provider if a patient is traveling and misses her adjuvant trastuzumab dosing by 2 weeks.
What is: patient should be re-loaded if more than 1 week late. If getting Q3 week dosing, she should get 8 mg/kg x1, then resume her 6 mg/kg every 3 weeks to complete 1 year
400
The presence of these genetic mutations (in tumor suppressor genes) increases a person's risk of developing breast cancer. Bonus: This tumor progression gene is most often amplified in breast cancer.
What is BRCA1 (incr risk of breast (57% chance by age 70) and ovarian), BRCA2 (incr. risk (49% chance by age 70) of male breast cancer and ovarian cancer), p53 (assoc. w/LiFraumeni syndrome)? Bonus: what is HER2 gene?
400
This positive histology is a good prognostic indicator.
What is HR positivity, usually in 75%? Generally, women with HR-positive breast cancer do better than HR-negative. Predictive of response to endocrine therapy. ER/PR positive tumors are generally less aggressive than ER/PR negative.
400
Based on the ATLAS trial, this is the recommended duration of adjuvant endocrine therapy in pre-menopausal women with ER positive early breast cancer.
What is tamoxifen for 10 years? continuing tamoxifen for 10 years reduces the risk of recurrence (p=0.002), reduces breast cancer mortality (p=0.01), and reduces overall mortality (p=0.01).
400
Name a preferred adjuvant chemotherapy regimen, including dosing for HER2 positive breast cancer and the main toxicities.
What is: ddAC followed by T + trastuzumab +/- pertuzumab (doxorubicin/cyclophosphamide followed by paclitaxel plus trastuzumab +/- pertuzumab, various schedules). OR, TCHP (taxotere, carbo, herceptin, perjeta) ii. Toxicities: cardiac (monitor LVEF prior to initiation of trastuzumab and every 3 mo during therapy), hematologic (ddAC requires growth factor support) iii. Dosing: Doxorubicin 60 mg/m2 day 1, cyclophosphamide 600 mg/m2 day 1 (cycled every 14 days or 21 days x 4 cycles), followed by paclitaxel 175 mg/m2 day 1 (cycled every 14 days x 4 cycles or 80 mg/kg weekly x12) with trastuzumab to complete 1 year of treatment (usually given Q3 weeks for pt convenience). Dose-dense AC followed by paclitaxel : doxorubicin 60mg/m2, Cytoxan 600mg/m2 D1 every 14 days for 4 cycles, followed by paclitaxel 175 mg/m2 D1 every 14 days for 4 cycles, given with G-CSF. Dose-dense AC followed by weekly paclitaxel: doxorubicin 60mg/m2, Cytoxan 600mg/m2 D1 every 14 days for 4 cycles, followed by paclitaxel 80 mg/m2 D1 weekly for 12 weeks. TC: docetaxel 75mg/m2 D1, Cytoxan 600mg/m2 D1 every 21 days for 4 cycles, given with G-CSF. TCH: docetaxel 75mg/m2 D1, Carboplatin AUC 6 Q21 days x 6 cycles w/weekly Herceptin during chemo then Q3 week Herceptin to complete one year
400
This is a 21-gene assay which has been validated in clinical trials to help predict the risk of recurrence in patients with hormone receptor positive (HER2 -) breast cancer and to guide use of chemotherapy.
What is OncotypeDX?
500
These are established risk factors for developing breast cancer (List four).
What are female gender, increasing patient age, family history of breast cancer at a young age, early menarche, late menopause, older age at first live childbirth, prolonged hormone replacement therapy, previous exposure to therapeutic chest wall irradiation, benign proliferative breast disease, increased mammographic breast density, genetic mutations (BRCA 1/2 genes), --heavy alcohol use, obesity, and smoking can increase risk of developing second breast cancer
500
For women over 40 at standard risk of developing breast cancer, this is the frequency of mammogram recommended by the American Cancer Society and NCCN.
What is annual mammogram?
500
These are four complications commonly caused by aromatase inhibitor therapy and their management.
What are Hot flashes (may consider SNRI, SRI or gabapentin), Vaginal dryness/loss of libido (lubricants, topical vaginal estrogen preparations), Arthralgia/myalgia (PT, massage, anti-inflammatory agents, weight loss, opioid analgesic, switch to alternative AI or tamoxifen), osteopenia/osteoporosis (bisphosphonate, Prolia, exercise, Calcium/vitamin D)
500
This regimen was found to be superior in the NEOSPHERE study in regards to pCR.
What is Her/Per/Taxotere x4 cycles in the neoadjuvant setting?
500
These are the main differences in MOA and dosing of trastuzuamb compared to pertuzumab.
What are: Pertuzumab targets the specific binding site on HER2 that is involved with ligand dependent binding and HER2/HER3 heterodimerization and has some affinity for blocking HER2/HER1. Trastuzumab inhibits ligand independent binding to the HER2 receptor and homodimierization. Trastuzumab is dosed based on wt (mg/kg), pertuzumab is a flat dosing scheme