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General Principles
Chemotherapy/Biologics
Hormone Therapy
Miscellaneous
100
This is the median survival for patients diagnosed with metastatic breast cancer?
What is 18-24 months (up to 3 years)?
100
The available agents which target HER2neu and are approved in the metastatic setting.
What are Herceptin(trastuzumab), Perjeta (pertuzumab), Kadcycla (ado-trastuzumab emtansine), lapatinib **BONUS available**
100
This was the primary outcomes in the BOLERO-2 trial.
What is everolimus plus exemestane significantly improved PFS (10.6 mos to 4.1 mos).
100
This is MOA and major adverse effects of the aromatase inhibitors.
What is inhibition of the aromatase enzyme (inhibiting peripheral conversion of adrogen to estrogen in tissues) and osteoporosis, myalgia/arthralgia, menopausal symptoms
200
These are clinical factors that predict the rate of progression and survivial in patiens with metastic breast cancer.
What is: the interval between initial therapy and relapse (>/=2 years), the number of metastatic sites, presence or absence of visceral invovlement and biologic markers.
200
This was the primary outcome of the CLEOPATRA study.
What is the combination of pertuzumab/trastuzumab/docetaxel vs trastuzumanb/docetaxel significalntly increased PFS (12.4 vs 18.5mos) in first line treatment of metastatic breast cancer (smaller benefit in patients previously treated with herceptin)
200
This is the rationale for the combination of everolimus with exemestane, including the MOA of everolimus.
What is one of the MOA of endocrine resistance is aberrant signaling through the P13K-AKT-MTOR pathway. A substrate of MTOR phosphorylates the activation function domainof the ER receptor which causes ligand independent receptor activation. Everolimus is a sirolimus derivatieve that inhibits MTOR (exemestane steroidal inhibitor).
200
These are the major adverse effects and drug-drug interactions of lapatinib.
What are diarrhea, rash, fatigue (decrease in LVEF, hepatotoxicity, pneumonitis, prolong QT interval) and it is a major substrate of 3A4, prolongs QT interval and inhibits PgP, 3A4 (weak) and 2C8.
300
These are the primary goals of treatment of metastic breast cancer.
What is palliate symptoms, prolong survival and maintain quality of life.
300
These are the most common adverse effects of pertuzumab
What are diarrhea, rash, mucositis, febrile neurtropenia, dry skin, *LVEF dysfunction was more frequent in control group
300
These are the most common toxicities of everolimus.
Stomatitis, fatigue, diarrhea, cough, hyperglycemia (serious: pneumonitis)
300
These are the most common sites of metastasis from breast cancer.
What are bones, liver, lung and brain.
400
Chemotherapy would be the preferred first line therapy for metastatic breast cancer in this/these type(s) of patients.
What are patients with rapidly progessive symptosm, visceral crisis, or HR negative disease. **An older meta analysis showed no change in OS comparing chemo vs HR therapy.
400
This was the primary outcomes of the EMILIA trial.
Trastuzumab emtainsein significantly increased OS (30.9 vs 25.1) and PFS (9.6 vs 6.4 mos) in patients previously treated with trastuzumab and taxane compared to lapatinib/xeloda.
400
These are first line endocrine thearpy options for post and premenopausal women with HR positive metastatic breast cancer, given no previous endocrine therapy.
What is OA or OS with endocrine therapy (post menopausal - AI/Fulvestrant) or SERM for premenopausal. Postmenopausal AI or SERM.
400
This is the MOA, dosing and adverse effects of Capecitabine.
What is a pyrimidine analog (oral prodrug which is converted to 5FU). Incorporated into nucleic acids and a direct inhibitor of thymidylate synthetase - inhibits thymidine production). Approved dose 2500mg/m2 divided twice daily d1-4 Q21 days. AE: diarrhea, HFS, stomatitis, nausea, fatigue, BMS, cardiac toxicity.
500
This is a factor to consider when chosing chemotherapy treatment (combination vs single agent) for metastatic breast cancer.
What is there is no prospective data that shows combination chemotherapy improves overall survival compared with single agent sequential chemotherapy.
500
These are the common/serious AEs of trastuzumab emtansine.
Thrombocytopenia, elevated LFTS, decreased LVEF
500
This is the MOA and major adverse effects of tamoxifen.
What is a selective estrogen receptor modulator and menopausal symptoms, vaginal discharge, risk of VTE, endometrial hyperplasia/cancer, and cataracts?
500
These are examples of chemotherapy agents which commonly require dose adjustment for liver dysfunction in treatment of metastatic breast cancer.
What are doxorubicin/Doxil, docetaxel, paclitaxel, vinorelbine, ixabepilone, eribulin. **BONUS available**