Back Pain After Cancer Treatment Flashcards
Treatment of metastatic breast cancer
Symptomatic and palliative
Options: endocrine therapy, chemotherapy, HER2 targeted therapy (pertuzumab/trastuzumab), bone therapy (zolendronic/denosumab - RANK ligand inhibitor)
How does endocrine therapy work?
Prevents tumour cells being stimulated to divide by circulating oestrogen
Drug classes used in hormone therapy
Selective oestrogen receptor modulator (SERM) - Tamoxifen
Fulvestrant (SERM) - post-menopausal women (not first line)
Aromatase inhibitors (Letrozole) - prevent conversion of androgens into oestrogen (only effective in post-menopausal women)
When is chemotherapy offered for metastatic breast cancer?
HER2 negative
Oestrogen receptor negative
Gemcitabine is used first line
Treatment of HER2 receptor positive metastatic breast cancer
Pertuzumab (prevents dimerisation of HER2 with other receptors)
Trastuzumab (prevents HER2 stimulation by growth factors)
Chemotherapy - Docetaxel
Precautions with Trastuzumab and Pertuzumab
Can affect cardiac function
Patient need assessment of LVEF prior to starting the drugs and @ regular intervals
Measured by echocardiogram or Multi-gated acquisition scan
Side effects of Denosumab
Hypocalcaemia - blood test before and soon after starting treatment, patients are given calcium supplements
Osteonecrosis - patients need dental check up before starting treatment
Percentage of breast cancer ER positive
80%
Percentage of breast cancer HER2 positive
15%
Another name for Trastuzumab
Herceptin
What is epirubicin?
Chemotherapy drug (anthracycline) used to treat breast cancer
What is bicalutamide?
Anti-androgen used in prostate cancer
Treatment options in MSCC
Neurosurgical decompression
Radiotherapy - helps with pain. Used as a mono therapy or alongside surgery
Vertebroplasty (khyphoplasty) - injection of cement into collapsed vertebrae can help control pain