Pharmacist Learning Objectives:
At the end of this continuing education module, pharmacists will be able to
- Discuss current treatment guidelines for advanced, recurrent, and metastatic breast cancer and discuss how the CDK4/6 inhibitors fit in the guidelines in metastatic/advanced setting
- Compare approaches to the treatment of breast cancer in older vs. younger patients
- Recognize high-risk patients using knowledge of genetic predisposition and select methods of secondary prevention
- Identify how to monitor and treat side effects
- Anticipate and detect polypharmacy in breast cancer patients, including identification of untreated side-effects of cancer therapy
1.Which of the following treatments is appropriate for a postmenopausal woman with recurrent breast cancer who has been receiving tamoxifen therapy as adjuvant therapy for early-stage breast cancer?
a.Anastrazole 1 mg po daily
b.Toremifene 60 mg po daily
c. Goserelin 3.6 mg SC q 28 days
2.In which of the following patients is abemaciclib an appropriate breast cancer therapy?
a.A premenopausal woman with metastatic breast cancer who has progression while on letrozole therapy
b.A premenopausal woman just diagnosed with metastatic breast cancer
c. A postmenopausal woman just diagnosed with metastatic breast cancer
d. A postmenopausal woman with metastatic breast cancer who has progression while on letrozole therapy
3.Ovarian suppression is one the mainstays of hormonal therapy in premenopausal advanced breast cancer patients because the main source of estrogen in these women is
a. aromatization of estrogens and androgens
b.aromatization of exogenous and endogenous androgens
b.peripheral production of estrogens
c.peripheral production of estrogens and androgens
4.Which of the following statements about the use of hormonal therapy in postmenopausal women with advanced, recurrent, or metastatic breast cancer is true?
a.Single agent hormonal therapy is preferred as first-line therapy
b.Ovarian suppression + hormonal therapy is preferred as first-line therapy
c.CKD4/6 inhibitor + aromatase inhibitor is an appropriate first-line therapy
d.Fulvestrant + ovarian suppression is an appropriate first-line therapy
5. Which of the following factors is used to determine whether an early-stage breast cancer patient should receive hormonal therapy as secondary prophylaxis?
b. lymph node status
c. HER2 status
d.none of the above
6.Which of the following side effects is most commonly associated with CDK4/6 inhibitors?
7.Which of the following is the most appropriate monitoring plan for a postmenopausal woman with metastatic breast cancer receiving ribociclib + letrozole during the first month of therapy?
a.Complete blood count, liver function tests, QTc interval, BMD, and electrolytes at baseline and at day 14
b.Complete blood count, liver function tests, QTc interval, BMD, and electrolytes at baseline and CBC, LFTs, QTc interval and electrolytes at day 14
c.Complete blood count, liver function tests, and QTc interval, BMD, VTE risk, and electrolytes at baseline and at day 14
d.Complete blood count, liver function tests, QTc interval, BMD, VTE risk, and electrolytes at baseline and CBC, LFTs, QTc interval and electrolytes at day 14
8.Which of the following is an appropriate pharmacologic first-line management of hot flashes associated with tamoxifen?
a.Paroxetine 20 mg po daily
b.Venlafaxine 37.5 mg po daily
c.Gabapentin 100 mg po daily
d. Clonidine 0.5 mg po BID
9.A 58-year-old woman with metastatic breast cancer to the bone receiving palbociclib and letrozole comes to the pharmacy counter to ask if you for an over-the-counter drug consultation. She has a swollen leg that came on suddenly within the last 24 hours and is associated with warmth. Which of the following response may be most appropriate?
a.This could be a DVT and the patient should be instructed to call her physician immediately to receive diagnosis
b.Recommend the patient elevate the leg and apply cold compresses and then if not better in 24 hours, to call physician
c.Recommend to the patient take a nonsteroidal anti-inflammatory medication like ibuprofen 200 mg by mouth every 6 hours and if not better in 24 hours to call physician
d.This is a common side effect of palbociclib and the patient should treat symptomatically with ice until swelling decreases
10. A 67 yo woman with advanced breast cancer receiving ribociclib and letrozole comes into the pharmacy with a prescription for a metoprolol from her primary care provider, a common medication used to treat prolonged QTc interval. Her other medications include: venlafaxine (used for hot flashes with letrozole), albuterol (for exercise-induced asthma), loratiadine (for seasonal allergies), and levothroyxine (for hypothyroidism). Which of the following statements is correct?
a. Albuterol prolongs QTc interval and may be interacting with ribociclib, which also prolongs QTc interval and metoprolol may not be needed if these DDIs are avoided.
b.Venlafaxine prolongs QTc interval and may be interacting with loratadine, which also prolongs QTc interval and metoprolol may not be needed if these DDIs are avoided.
c.Venlafaxine and albuterol both prolong QTc interval and may be interacting with ribociclib which also prolong QTc interval and metoprolol may not be needed if these DDI are avoided.
d.No drug-drug interactions are present