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What are the NCCN recommendations for the use of Tamoxifen and Raloxifene to reduce the risk of breast cancer?
- Tamoxifen:
- Pre and Postmenopausal
- 20mg/d x 5y
- Raloxifene:
- Postmenopausal only
- 60mg/d x 5y
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What are the Antiestrogen meds?
- Tamoxifen
- Raloxifene
- Toremifene
- Fulvestrant
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What are the common SE of Antiestrogens?
- Thromboembolic events (Stroke, PE, DVT)
- Hot flashes
- Endometrial cancer risk
- Ischemic heart disease
- Bone fractures
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What is the method of action of Antiestrogens?
Competes with estrogen for binding sites in breast and other tissues
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What are the Aromatase inhibitor meds?
- Anastrazole
- Exemestane
- Letrozole
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What are the common SE of Aromatase inhibitors?
- Thromboembolic events (Stroke, PE, DVT - possibly less than antiestrogens)
- Hot flashes
- Endometrial cancer risk
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What is the MOA of Aromatase inhibitors?
Block aromatase enzyme from converting androgen to estrogen (only useful Postmenopause because only adipose tissue is making estrogen)
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What antineoplastic agents are used to treat breast cancer?
- Capecitabine
- Cyclophosphamide
- Docetaxel
- Doxorubicin
- Epirubicin
- Fluorouracil
- Lapatanib
- Ixabepilone
- Methotrexate
- Trastuzumab
- Paclitaxel
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What is the treatment for Lobular Carcinoma in situ (LCIS) in breast cancer?
Observation + Tamoxifen or Raloxifene
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What is the tx for Ductal Carcinoma in situ (DCIS) in breast cancer?
Surgery +/- RT +Tamoxifen (if ER positive)
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What is the tx for Stage I or II invasive carcinoma in breast cancer?
- Surgery +/- RT +/- Adjuvant tx (if tumor > 1cm)
- Trastuzumab required if HER2/neu positive
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What is the tx for Stage III invasive carcinoma in breast cancer?
- Operable: Surgery + Adjuvant tx
- Inoperable: Neoadjuvant chemotherapy then Surgery then RT + Chemotherapy +/- Endocrine tx (only if ER/PR positive)
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What is the tx for Stage IV (Metastatic) invasive carcinoma in breast cancer?
- Endocrine tx OR chemotherapy + bisphosphonates (for bony mets only)
- If ER/PR positive, bone or soft tissue disease, or limited asymptomatic visceral disease, you use Endocrine tx
- If ECOG = 3 or more, or if failed 3 sequential chemo regimens, give supportive care only
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What is the adjuvant tx used for Stage I, II, or III breast cancer?
- TAC: Docetaxel, Doxorubicin, and Cyclophosphamide (+CSF)
- Dose-Dense AC (q 14d) + Paclitaxel: Doxorubicin + Cyclophosphamide, then Paclitaxel (+CSF)
- AC (q 21d) + Paclitaxel: Doxorubicin + Cyclophosphamide, then Paclitaxel
- TC: Docetaxel + Cyclophosphamide
- AC: Doxorubicin + Cyclophosphamide
- AC + TH (HER2/neu positive): Doxorubicin + Cyclophosphamide, then Docetaxel + Trastuzumab
- TCH (HER2/neu positive): Docetaxel + Carboplatin + Trastuzumab
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What is the endocrine tx for premenopausal metastatic or recurrent breast cancer?
- Ovarian ablation/suppression, Surgery (oophorectomy), or RT +:
- Aromatase inhibitor
- Antiestrogen
- Megestrol acetate
- Fluoxymesterone
- Ethinyl estradiol
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What is the chemotherapy for metastatic or recurrent breast cancer?
- Single agent:
- Doxorubicin
- Epirubicin
- Liposomal doxorubicin
- Paclitaxel
- Albumin-bound paclitaxel
- Docetaxel
- Capecitabine
- Vinorelbine
- Eribulin
- Combination regimens:
- FAC/CAF (cyclophosphamide, doxorubicin, and 5-FU)
- CEF (5-FU, epirubicin, and cyclophosphamide)
- AC (doxorubicin + cyclophosphamide)
- EC (epirubicin + cyclophosphamide)
- AT (doxorubicin + docetaxel OR paclitaxel)
- CMF (cyclophosphamide, methotrexate, and F-FU)
- Docetaxel/capecitabine
- Gemcitabine/paclitaxel
- Ixabepilone + capecitabine
- HER2/new positive:
- Trastuzumab + Paclitaxel +/- Carboplatin
- Trastuzumab + Docetaxel
- Trastuzumab + Vinorelbine
- Trastuzumab + capecitabine
- Lapatinib + Capecitabine
- Lapatinib + Trastuzumab
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