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Onc boards > Colon > Flashcards

Colon Flashcards

1
Q

Age to start screening for regular risk, 1st degree relative with CRC, HNPCC, and FAP

A

Regular risk- recently changed to 45 from 50
1st degree relative- 40 or 10 years younger than youngest 1st degree relative with CRC
HNPCC- 20-25
FAP- as early as 10 years old

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2
Q

HNPCC (Lynch syndrome) mutations

A

Mutation in DNA mismatch repair enzyme (MSH-2, MLH-1, PMS-2, MSH-6, and EPCAM)

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3
Q

HNPCC (Lynch syndrome) cancers

A 
Colorectal
Ovarian
Endometrial
Pancreatic
Biliary
Gastric/small bowel
GU
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4
Q

Familial adenomatous polyposis mutation

A

Mutation in APC gene

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5
Q

Stage I definition and treatment

A

Stage I = T1 (invades submucosa) or T2 (invades muscularis propria), N0 M0
Treatment is surgery

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6
Q

Stage II definition

A

T3-T4b N0 M0

Invades subserosa or into pericolorectal tissues

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7
Q

Stage II higher risk features

A

T4 disease (invades visceral peritoneum or invades/adheres to adjacent organs)
+LVI, +PNI
Clinical obstruction or perforation
<12 nodes sampled

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8
Q

Stage II adjuvant treatment indications and options

A

High risk = T4, perforation/obstruction, <12 nodes removed, +LVI/PNI

Adjuvant chemo usually given for BRAF mutant
Low risk patients generally observed
MSI-H/dMMR tumors should be observed

Adjuvant options:
3 months CAPEOX
6 months capecitabine or 5-FU or FOLFOX
*No benefit to oxaliplatin if > 70yrs

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9
Q

Stage III definition

A

Node positive disease

N1 = 1-3 nodes
N2 = 4+ nodes
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10
Q

Stage III adjuvant treatment indications and options

A

All stage III should get adjuvant

CapeOx or FOLFOX x 3-6 months
If T4 and/or N2, give 6 months
If giving 3 months, use CapeOx

If > 70 years, no proven benefit for addition of oxali to cape/5-FU
*Don’t substitute irinotecan for oxali

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11
Q

1st line metastatic tx for left sided RAS/RAF WT

A

FOLFOX/IRI + cetuximab/panitumumab

*Don’t use anti-EGFR if potentially resectable

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12
Q

1st line metastatic tx for right sided RAS/RAF WT

A

FOLFOX/IRI + bev

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13
Q

1st line metastatic tx for any side, RAS mutated

A

FOLFOX/IRI + bev

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14
Q

Indication for anti-EGFR antibody tx

A

Only patients that are WT for KRAS exons 2,3,4 and NRAS exons 2,3,4

BRAF V600E unlikely to respond even if RAS WT

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15
Q

1st line metastatic MSI-H/dMMR

A

Pembro

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16
Q

1st line metastatic BRAF mutated

A

FOLFOXIRI + bev

17
Q

2nd line metastatic BRAF V600E mutated

A

Encorafenib + cetuximab

Same median OS as encorafenib + binimetinib + cetuximab

18
Q

2nd line metastatic treatment

A

Switch FOLFOX FOLFIRI
Continue bev
Switch anti-EGFR to bev

Can consider anti-EGFR +/- irinotecan for right sided RAS WT

19
Q

Treatment of metastatic disease in patients treated with fluoropyrimide, oxali, iri, VEGF, and EGFR (if RAS WT)

A

Regorafenib

Trifluridine-tipiracil (TAS 102)

20
Q

Treatment options for metastatic Her2+ disease

A

Trastuzumab + pertuzumab
Trastuzumab + lapatinib
Trastuzumab deruxtecan

Only patients with RAS WT/Her2+ seem to respond to Her2 targeted therapy
Generally consider 2nd line or later

21
Q

5-FU/capecitabine AEs

A 
Diarrhea
Myelosuppression
Mucositis
Hyperbili
Coronary vasospasm

*If severe diarrhea, myelosuppression, mucositis, consider DPD deficiency
Adjust 5-FU for hepatic dysfunction
Adjust capecitabine for renal and hepatic dysfunction

22
Q

Irinotecan AEs

A

Cholinergic toxicity- acute onset salivation, diarrhea, diaphoresis. Can treat with atropine
Myelosuppression
Diarrhea
Alopecia

  • Reduce dose in UGT1A1*28 homozygous or Gilbert’s
  • Avoid if bilirubin > 2
23
Q

Oxaliplatin AEs

A

Peripheral neuropathy/cold sensitivity
Diarrhea
Myelosuppression
Elevated LFTs

Reduce dose for renal dysfunction (Cr Cl < 30)

24
Q

Cetuximab/panitumumab AEs

A

Hypersensitivity reactions (alpha gal)
Acneiform skin rash
Diarrhea

Onc boards (24 decks)

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