For each question, choose the answer you think is correct. See the end of this page for the answers.
A.P. is a 50-year-old female diagnosed with metastatic breast cancer with a primary lesion in the left breast and disease involving bones, lungs and liver. Tumour is ER-positive, PR-positive, and HER2-negative. She has pain in her right upper quadrant radiating towards the left scapula. She is also on pamidronate. She will be starting treatment with UBRAVPALAI.
Lab results taken 24 hours prior to first treatment:
Lab value
| Patient's labs
| Normal range
|
WBC
| 3.3
| 4 – 10 x 109/L
|
ANC
| 1.7
| 2 – 7.5 x 109/L
|
Hgb
| 142
| 115 – 155 g/L
|
Plt
| 190
| 150 – 400 x 109/L
|
SCr
| 54
| 45 – 90 umol/L
|
eGFR
| 93
| ≥ 60 mL/min/1.73m2
|
GGT
| 34
| <49 U/L
|
AST
| 26
| <36 U/L
|
ALT
| 32
| <36 U/L
|
ALP
| 128
| 35 – 120 U/L
|
Total bilirubin
| 7
| <17 umol/L
|
LD
| 156
| <225 U/L
|
Weight = 53.8 kg, Height = 160 cm
- Post-menopausal women with ER-negative, HER-2 positive advanced breast cancer with no prior systemic treatment for metastatic disease
- Women receiving concurrent ovarian suppression with no prior treatment for metastatic disease
- Post-menopausal women with ER-positive, HER-2 positive advanced breast cancer with prior systemic chemotherapy for metastatic disease
- Post-menopausal women with ER-positive, HER-2 negative advanced breast cancer with no prior systemic treatment for metastatic disease
- Options 1 and 2 are correct
- Options 2 and 4 are correct
- One tablet PO once daily continuously until disease progression or unacceptable toxicity
- One tablet PO once daily for 3 weeks, then 1 week off until disease progression, unacceptable toxicity, or a maximum of 2 years of treatment
- One tablet PO once daily for 3 weeks, then 1 week off until disease progression or unacceptable toxicity
- One injection given subcutaneously every 3 months until disease progression or unacceptable toxicity
- Nothing; there are no dose modifications based on Cycle 1 Day 22 bloodwork
- Delay the start of Cycle 2 by 1 week; provided ANC recovers to ≥ 1 x 109/L, resume treatment at the same dose
- Delay the start of Cycle 2 by 1 week; provided ANC recovers to ≥ 1 x 109/L, resume treatment at the next lower dose
- Keep treatment as scheduled (without delay); provided ANC recovers to ≥ 1 x 109/L prior to Cycle 2, resume treatment at the same dose
- Keep treatment as scheduled (without delay); provided ANC recovers ≥ 1 x 109/L prior to Cycle 2, resume treatment at the next lower dose
- Resume treatment at the same dose as previous, 125 mg/day
- Resume treatment at the next lower dose, 100 mg/day
- Delay treatment for 1 more week, then resume at the same dose as previous, 125 mg/day
- Resume treatment at the next lower dose of 75 mg/day
- She has symptomatic hypocalemia
- She has a history of atypical femoral fracture
- She is experiencing acute bone pain
- She has a diagnosis of osteopenia
- Yes; after cycle 7, CBC monitoring is no longer required
- Yes; results from Cycle 7 are available and CBC won't be repeated again until Cycle 10
- No; CBC should be monitored with each subsequent cycle
- Yes; results from Cycle 7 are available and CBC won't be repeated again until Cycle 9
The correct answer is 6.
Rationale: As per the revised eligibility of UBRAVPALAI after PALMOA-3 trial results were published, women who are on concurrent ovarian suppression (with LHRH agonists) are also eligible to receive treatment.
The correct answer is 3.
Rationale: According to the UBRAVPALAI protocol, palbociclib is taken orally once daily for 21 days on, 7 days off with one cycle being 28 days long until disease progression or unacceptable toxicity.
The correct answer is 4.
Rationale: Based on the UBRAVPALAI dose modification table, if ANC is between 0.5 to less than 1 x 109/L on days 15 and 22, treatment can be resumed at the same dose level.
The correct answer is 2.
Rationale: Based on the UBRAVPALAI dose modification table, if the patient experiences grade 4 neutropenia (ANC < 0.5 x 109/L), hold treatment until ANC ≥ 1 x 109/L, and resume treatment at next lower dose.
The correct answer is 3.
Rationale: The BRAVPAM protocol indicates that patients with acute pain secondary to metastatic breast cancer are eligible for treatment.
The correct answer is 3.
Rationale: As per the tests section of the protocol, CBC monitoring requirements for Cycle 7 onwards are based on ANC values from Cycles 1-6, with the ANC threshold being 1 x109/L. During the first 6 cycles of treatment, A.P.'s ANC dropped below 1 x109/L, and therefore, per protocol, CBC should continue to be monitored with each cycle of treatment.