Describe Radiation.
Classically follows surgery
Indicated for patients with a high risk of local recurrence (e.g., positive lymph nodes, cancer in deep margin)
When can chemotherapy be given?
Can be given as neoadjuvant (rare) or adjuvant chemotherapy
Usually combination therapy
List indications for chemotherapy.
Tumor size > 2 cm
Triple-negative breast cancer and tumor size ≥ 0.5 cm
HER-2 positive breast cancer and tumor size > 1 cm
Positive lymph nodes
Aggressive tumor histology
What are the 2 regimens of chemotherapy?
FEC-D: 5-fluorouracil PLUS epirubicin PLUS cyclophosphamide, followed by docetaxel
CMF: cyclophosphamide PLUS methotrexate PLUS fluorouracil
What is the contraindication for chemotherapy?
pregnancy (first trimester) —> in the second or third trimester is considered safe.
What is the indication for hormone therapy?
all ER/PR-positive tumors
What is the goal of hormone therapy?
suppression of extraovarian hormone production and blockade of estrogen receptors in order to decrease the risk of breast cancer recurrence
Contraindication of hormone therapy?
pregnancy
Which agents can be given for hormone therapy in the premenopausal period?
Tamoxifen (Selective estrogen receptor modulators)
GnRH agonists
Which agents can be given for hormone therapy in the postmenopausal period?
aromatase inhibitors
Which agents can be given for hormone therapy in a preventive setting?
raloxifene
Which agent is used for targeted therapy?
Trastuzumab
Define the principle of targeted therapy in breast cancer.
humanized monoclonal antibody against the HER2 tyrosine kinase receptor that is used in the treatment of HER2-positive breast and gastric cancer
Describe the mechanism of action of Trastuzumab.
targets HER2/neu (c-erbB2) tyrosine kinase receptor → ↓ of HER2 initiated cellular signaling and ↑ antibody-dependent cytotoxicity → ↓ tumor growth
What is the indication for targeted therapy with trastuzumab?
all HER2-positive tumors
What is the contraindication of targeted therapy?
List side effects of tastuzumab.
Cardiotoxicity (e.g., dilated cardiomyopathy with systolic CHF): An echocardiogram is recommended prior to initiating treatment to evaluate cardiac function.
—> The cardiotoxic properties of trastuzumab are aggravated by simultaneous administration of anthracyclines, which are also cardiotoxic.
Gastrointestinal symptoms (e.g., diarrhea, nausea)
Mnemonics targeted therapy:
Trastuzumab causes dilated cardiomyopathy: If you trust trustuzumub, it might break your heart.
For the most important indication of trastuzumab (breast cancer) and its target (HER2), think: Her two (HER2) breasts can be treated with trastwozumab.
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