Cancer 1st Line Tx Flashcards
Breast:
- ER/PR(+)
- HER2(-)
RS <26: EndoTx
- PreMeno: Tx5yr +/- OS or AIx5yr + OS (Still PreMeno: Tx5yr or stop // Now PostMeno: AI or T x5yr)
- PostMeno: AIx5yr then AIx5yr OR Tx2-3yr then AIx5yr
RS >26: ChemoTx then EndoTx
- Dose Dense AC then Paclitaxel or TC (Docetaxel + Cytoxin)
Breast:
- ER/PR(+)
- HER2(+)
Tumor <0.5cm: adju EndoTx (PreMeno: Tx5yr +/- OS or AIx5yr + OS (Still PreMeno: Tx5yr or stop // Now PostMeno: AI or T x5yr)
- PostMeno: AIx5yr then AIx5yr OR Tx2-3yr then AIx5yr) +/- Chemo +HER2Tx (APT (adju Paclitaxel +Trastuzumab) or TCH+/- P (Docetaxel + Carbo + Trastu +/- Pertuzumab)
Breast:
- TNBC
Pembrolizumab + Paclitaxel + Carbo then Prembro + Doxorubucin + Cytoxin
Breast:
- Meta-HER2(+)
1st: Trastuzumab + Pertuz + Docetaxel
2nd: Trastu-Deruxtecan
Breast:
- Meta-HER2(-)
1st: AI + CDK4/6-i (Palbociclib)
2nd: Fulvestrant + CDK4/6-i
Prostate:
- Localized
ADT (GNRH agonist) +/- Anti-androgen Tx (Abiraterone or Enzalutamide)
Prostate:
- M0HSPC
GNHR agonist +/- ADT
Prostate:
- M0CRPC
Continue ADT and add ONE of: Enzalutamide, Apalutamide, Darolutamide
Prostate:
- M1HSPC
- LOW Volume: ADT or ADT + Abiraterone and Prednisone, Enzalutamide, or Apalutamide
- HIGH Volume: Docetaxel + ADT +/- Abiraterone or Daralutamide
Prostate:
- M1CRPC
1st: Docetaxel + Prednisone
2nd: Cabazitaxel + Prednisone
- IF PSMA(+) use: Pluvicto
Lung:
- SCLC
- Limited: Radiation + EP or EC (Etop, cisP/Carbo)
- Extensive: EC + Atezolizumab or Durvalumab
Lung:
- NSCLC (Resectable)
- Non-Squamous: Cisplatin + Pemetrexed (or Carbo)
- Squamous: Cisplatin + Gemcitabine or Docetaxel (or Carbo)
Lung:
- NSCLC (UnResectable)
- Non-Squamous: Carbo/Cis + Pemetrexed OR Cis + Etop
- Squamous: Paclitaxel + Carbo OR Cis + Etop
(If any Tx not working: Durvalumab x1yr)
Lung: NSCLC
- Metastatic (Mutations Present)
Osimertinib (EGFR), Dabraf/Tramet (BRAF), Sotoasib (K-RAS)
Lung: NSCLC
- Metastatic (NO mutations)
- Non-squamous: Carbo + Pemetrexed + Pembrolizumab
- Squamous: Carbo + Prembrolizumab + Paclitaxel
Colorectal:
- Stage II (high risk)
FOLFOX or CapeOX
Colorectal:
- Stage III
FOLFOX or CapeOX
Colorectal:
- Metastatic
FOLFOX, CapeOX, FOLFIRI, FOLFIRINOX +/- Bevacizumab
- No K-RAS mut: + cetuximab or panitumumab
- dMMR or MSI-H (+): Nivolumab + Ipilimumab or Pembrolizumab
- HER2(+): Tastu +Pertu/Lapatinib or Trastu-Deruxtecan
Melanoma:
- Stage 1B or 2A
Clinical trial, observation
Melanoma:
- Stage 2B or 2C
- Clinical trial, observation, or Pembrolizumab
Melanoma:
- Stage III
Nivolumab, Prembrolizumab, or Dabraf/Tramet (if BRAF mut)
Melanoma:
- Metastatic
- Anti-PD1 MonoTx or BRAF mut Tx
- if high risk: Nivoumab/ipilimumab
-2nd Line: Pembro/Low dose Ipilimumab
Ovarian:
- Initial
Paclitaxel + Carbo (Carbo dose= AUCx(GFR + 25)
- if BRCA mut: PARP-i
Ovarian:
- Metastatic
- Plat Sensitive: Carb/Cis + Paclitaxel
- Plat Resistant: Liposomal Doxorubucin
Hodgkin Lymphoma:
- Stage I-II Favorable
- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)
- Radiation
Hodgkin Lymphoma:
- Stage I-II Unfavorable
- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)
- Radiation
Hodgkin Lymphoma:
- Stage III-IV
- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine) +/- Radiation
- If young pt: AAVD (Swap Bleo for Brentuximab Vendotin) (more toxic)
Hodgkin Lymphoma:
- Relapse
- Autologous stem cell rescue
Non-Hodgkin Lymphoma:
- Diffuse Large B-Cell Lymphoma (DLBCL) All stages
R-CHOP (Rituximab, Cytoxin, Doxorubicin, Vincristine, Prednisone)
Non-Hodgkin Lymphoma:
- DLBCL Stage III/IV + IPI >2 or Bulky Stage II
Pola-R-CHP (Polatuzumab Vedotin, Rituximab, Cytoxin, Doxorubicin, Prednisdone)
Non-Hodgkin Lymphoma:
- Relapsed DLBCL/Aggressive NHL
- Salvage chemo then autologous stem cell rescue
- CAR-T
- Epcoritamab or Glofitamab (BiTE’s)
Multiple Myeloma
Autologous stem cell transplant candidate?
- Yes: 3 drug regimen, then stem cell harvest
- No: 3 drug regimen
Chronic Myeloid Leukemia (CML)
BCR-ABL-i: Dasatinib, Nilotinib, Bosutinib, or Imatinib
- if T3151 mut: Ponatinib or Ascimib
Chronic Lymphoid Leukemia (CLL)
- Stage III/IV
- Zanubrutinib or Acalabrutinib (ATK-i) +/- Obinutuzumab (or Rituximab)
- Venetoclax + Obinutuzumab
Acute Myeloid Leukemia (AML)
- Induction
- High intensity: Cytarabine (7d) + Anthracycline (3d) (7+3)
- Low Intensity: Venetoclax + Azacitidine or Decitabine
- if FLT3 mut: Midostaurin, quizartinib, or gilteritinib
Acute Myeloid Leukemia (AML)
- Consolidation
- HiDAC (High dose Cytarabine)
- or Continue Venetoclax +Aza/Decitibine
Acute Lymphoblastic Leukemia (ALL)
- Induction
- HyperCVAD (PART A: Hyper-fractionated Cytoxin, Vincristine, Doxorubicin, Dexamethasone –> PART B: High dose Methotrexate, Cytarabine, Methylprednisolone)
- If BCR-ABL(+): add TKI
- Peds: +/- Pegaspargase
Acute Lymphoblastic Leukemia (ALL)
- Maintenance
- BCR-ABL (+): TKI, Vincristine, Prednisone
- BCR-ABL (-): Methotrexate, 6=MP, Vincristine
Lymphoma: Non-Hodgkin L
- maintenance for high risk after stem cell transplant
Brentuximab vedotin