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GI > Colon > Flashcards

Colon Flashcards

1
Q

CEA

A

not sufficient to sufficient or initiate Tx

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2
Q

CEA>20

A

99% chance of cancer

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3
Q

CEA 5-10

A

50% FP rate, repeat in 4-6 wk

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4
Q

first line Tx

A

FOLFOX or FOLFIRI, equal OS and PFS

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5
Q

when to stop oxali

A

3 months is equivalent to continuing

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6
Q

oxali neuropathy

A

gets worse for 3 months; 12% permenant

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7
Q

addition of bev

A

no statistically sig placebo controlled proof of added benefit. maybe increase PFS but no RR change

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8
Q

bev tox

A

HTN, albuminuria, GI perf, thrombotic events, impaired wound healing

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9
Q

albuminuria with bev

A

don’t bother looking

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10
Q

GI perf

A

1.5%,

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11
Q

when to stop beva prior to surg

A

6-8wk

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12
Q

aflibercept

A

fusion of VEGF1,2R to IgG Fx

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13
Q

VELOUR study

A

2nd line FOLFIRI +/- aflibercept –> OS 13.5 v. 12mo, p=0.003

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14
Q

beg beyond progression in 2nd line

A

TML trial: continue with switch in chemo or no, Lancet Oncol 2013; 1.4mo survival benefit

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15
Q

aflibercept following bev

A

NO: not new lines, only replacement

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16
Q

cetuximab front line

A

FOLFIRI +/- cetux: PFS 1month increase; 37d improvement in kras wt. OS benefit, but you don’t have to start it in first line

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17
Q

RAS mutations

A

genotype for exon 2(12,13), and NRAS, non-exon2 as they confer resistance

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18
Q

BRAF in CRC

A

doesn’t work

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19
Q

FOLFIRI/bev v. FOLFIRI/cetux

A

no difference in response rate, no PFS benefit

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20
Q

cetuximab rash

A

no rash no benefit, d/c after 6 wks

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21
Q

perioperative FOLFOX/cetux

A

addition of cetux did worse

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22
Q

CAIRO-2 study

A

cape/ox/bev +/- cetux–> combined did worse

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23
Q

regorafenib

A

TKI against VEGF, dirty: CORRECT trial: regorefenib v. placebo in ECOG 0-1 PS–> 1.4mo OS benefit; difficult drug 2/2 fatigue at 160mg; 1% PR, 43% stablization

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24
Q

Adjuvant options

A

FOLFOX or CapeOX (both acceptable), HlLWE SX

25
Q

Stage II adjuvant

A

no benefit to oxaliplatin in MOSAIC study

26
Q

Stage III benefit adjuvant

A

4.4%

27
Q

higher risk stage 2

A

MOSAIC didn’t show benefit to oxali; think about it and discuss with patient. maybe if 2+ risk factor you can add

28
Q

adjuvant oxali in older

A

Don’t do if age 70+, no benefit

29
Q

do we need 12 doses FOLFOX?

A

probably not; complete 6months 5-FU, d/c oxali based on tox

30
Q

MMR deficiency and adjuvant or PCR

A

more common in stage 2 patients; majority of patients do better. if stage 2 and deficient, do not give adjuvant therapy. observe, do not treat with adjuvant; stage III–> still give adjuvant, treat with FOLFOX

31
Q

rectal cancer

A

TME- total mesorectal excision is right surgery: sharp excision outside fascia, remove all relevant encased lymph nodes

32
Q

rectal management

A

pre-op staging CT CAP, endorectal US or MRI, PET not recommended;

33
Q

stage I rectal

A

surgery alone

34
Q

stage II/III

A

standard: preop chemo/RT–>surg–>4mo CAPEOX/FOLFOX

35
Q

rectal chemorad

A

Sauer NEJM 2004: pre-op better than post-op

36
Q

chemorad rectal regimen

A

either cape or infusional 5-FU, oxaliplatin adds toxicity and not benefit

37
Q

colon cancer survival endpoings

A

3-year DFS is a surrogate for 5-yr OS

38
Q

adjuvant therapy colon

A

5-FU for stage II, FOLFOX for high risk stage II (undid, T4, perf, obstruct,

39
Q

adjuvant options

A

FOLFOX, FLOX(bolus 5-FU + ox) or XELOX x 6 months

40
Q

adjuvant in elderly colon

A

MOSAIC trial: less benefit in >70y for Oxali.

41
Q

stage II adjuvant chemo for colon

A

can use adjuvantonline or mayo clinic tool. individualize decision to the patient

42
Q

associations with colon cancer recurrence

A

increased exercise, avoidance of western diet, ASA/COX2 inhibitors, increased vitD all associated with reduced risk,

43
Q

ASA for prevention of colon cancer recurrence

A

profound effect in PIK3CA mutation carriers (12% of cancers)

44
Q

leukovorin mechansim

A

binds 5-FU that permits prolonged inhibition of thymidylaste synthase.

45
Q

capecitabine mechanism

A

converted to 5-FU in 3 cteps. same efficacy as 5-FU, slightly higher response rate.

46
Q

irinotecan for colon ca

A

superior to infusional 5-FU;

47
Q

metastatic colon ca

A

bolus 5-FU + irinotecan regimens are superior to 5-FU alone. FOLFOX comparable to FOLFIRI, but FOLFOX>IFL (non-infusional)

48
Q

FOLFOXIRI for colon

A

only for exceptional cases when rapid shrinkage necessary (borderline resectable liver mets)

49
Q

bevacizumab mechanism

A

binds VEGF-A, prevents binding to VEGF-R1/R2. R2 more significant effect

50
Q

metastatic colon ca for elderly

A

5-FU + bev is an option based on dramatic PFS benefit compared to 5-FU alone. use in pts with contraindicated oxali/irino

51
Q

how long to give bevacizumab in metastatic CRC

A

prolonged maintenance with 5-FU is standard. drop the oxali. can also continue at progression with another agent (improved survival)

52
Q

cetuximab for mCRC

A

can give with irino at progression (benefit even if irino-experienced)

53
Q

cetuximab anaphylaxis

A

pre-existing IgE antibodies to galactose-alpha-1,3-galactos (found in Fab of cetuximab). 21% of pts in tennessee, versus 1% in boston

54
Q

KRAS in CRC

A

1) occur early in oncogenesis; 2) binary variable; 3) robust biomarkers; 4) 40% frequency (exon 2 mutation). exon 3,4 or NRAS mutations also confer EGFRi resistance

55
Q

BRAF mutant colon cancers

A

5-10% of CRC, poor prognosis, early data that FOLFOXIRI+bev may be beneficial

56
Q

regorafenib use in CRC

A

1.4 month survival benefit to placebo. hand-food, fatigue, diarrhea, HTN. only for people treated with all other options

57
Q

ligand to EGFR

A

amphiregulin, epiregulin

58
Q

bevacizumab surgical considerations

A

must wait 6 weeks

59
Q

irinotecan metabolism

A

metabolized to SN-38(potent topoI inhibitor), inactivated by glucorinidation by UGT1A1 enzyme. Polymorphism of UGT1A1 –>reduced expression–>Gilbert’s. If homozygous, need irinotecan dose reduction.

GI (7 decks)

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