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PHM 703- Oncology, Hematology > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Treatment considerations for CRC

A

Stage of disease
Age of patient
Comorbidities
Pharmacogenomics: KRAS wild-type, MSI status
Metastatic setting: previous treatments used, toxicity profiles of various chemo regimens

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2
Q

General principles of CRC treatment: chemo in adjuvant setting

A

5-FU-based regimens are the standard of care

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3
Q

General principles of CRC treatment: surgery

A

Treatment of choice in patients with potentially curable disease

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4
Q

How many lymph nodes must be samples to determine node positive or negative disease?

A

At least 12

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5
Q

CRC treatment based on stage: Stage I

A

no adjuvant chemo; surgery and monitoring

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6
Q

CRC treatment based on stage: Stage II

A

no treatment OR adjuvant chemo based on risk factors

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7
Q

CRC treatment: Stage IIA, no high-risk factors

A

consider adjuvant chemo, clinical trial, or observation

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8
Q

CRC treatment: Stage IIB or C

A

adjuvant chemo or observation

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9
Q

Adjuvant chemo options in CRC

A

single-agent capecitabine or 5-FU/leucovorin for low risk; FOLFOX or CAPEOx for high risk

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10
Q

FOLFOX components

A

5-FU, leucovorin, oxaliplatin

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11
Q

CAPEOx components

A

Capecitabine, oxaplatin

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12
Q

CRC treatment: Stage III

A

adjuvant chemo

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13
Q

What shouldn’t be used in the adjuvant setting in CRC?

A

Targeted therapies, irinotecan

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14
Q

Stage III CRC adjuvant regimens

A

FOLFOX q2w x12 cycles
CapeOx: 6 months for high-risk; 3 months for low-risk
RT and capecitabine/5-FU used pre-op for rectal cancer
FOLFOX and CapeOx are superior to 5-FU/leucovorin in Stage III
If oxaliplatin toxicity is intolerable, dose-adjust or remove from the regimen after 3-4 months of therapy or sooner if neurotoxicity is grade 2 or higher

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15
Q

CRC treatment: Stage IV

A

Chemo, targeted therapy, immunotherapy

Surgery is NOT primary treatment

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16
Q

Stage IV CRC: resectable liver only or lung-only metastases

A

Surgical excision along with synchronous resection of liver or lung metastases, followed by adjuvant chemo with FOLFOX or CapeOx (preferred)

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17
Q

Stage IV CRC: regimen options

A

FOLFIRI, CapeOx, or FOLFOX +/- bevacizumab
(D/C bevacizumab at least 4 weeks prior to surgery)

FOLFIRI or FOLFOX +/- panitumumab or cetuximab if KRAS wildtype

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18
Q

Stage IV CRC: unresectable liver or lung-only lesions

A

Chemo, evaluate disease q2months to determine respectability and/or lung metastases

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19
Q

CRC: Anti-HER2 therapy

A

Now recommended as subsequent therapy options in patients with tumors that are RAS/BRAF wild-type and have HER2 overexpression

20
Q

Anti-HER2 regimens

A

Trastuzumab + [pertuzumab or lapatinib] (initial or subsequent line)
Fam-trastuzumab deruxtecan (subsequent line)

21
Q

CRC: BRAF mutation treatment

A

Doublet therapy: second or third-line treatment
Cetuximab 250 mg/m2 IV qweek + Encorafenib 300mg PO QD

22
Q

5-FU and leucovorin AEs

A

Bolus: myelosuppression
Continuous infusion: hand-foot syndrome, diarrhea, mucositis

23
Q

Capecitabine is the prodrug for what?

A

5-FU

24
Q

Capecitabine AEs

A

Dose-limiting

Hyperbilirubinemia
Diarrhea
Hand-foot syndrome
Mucositis

25
Q

Capecitabine is CI’ed in what?

A

DPD deficiency

26
Q

Capecitabine dose adjustments

A

CrCl 30-50ml/min: 25% reduction
<30: CI’ed

27
Q

Capecitabine DDI

A

2C9 inhibitor; watch out with warfarin and phenytoin

28
Q

Oxaliplatin AEs

A

Peripheral neuropathy
Cold intolerance/sensitivity
Myelosuppression

29
Q

Oxaliplatin cold sensitivity management

A

Eating/drinking at room temperature
GABA analogues, but poor efficacy
SNRIs like duloxetine

30
Q

Irinotecan AEs

A

DIARRHEA
Fatigue
Alopecia
Myelosuppression/neutropenia

31
Q

Irinotecan-induced diarrhea management

A

Acute: atropine or diphenoxylate atropine
Delayed: loperamide

32
Q

Bevacizumab, Ziv-aflibercept, ramucirumab AEs

A

HTN
Delayed wound healing → D/C 4 weeks before surgery, restart 4 weeks after
Proteinuria
Hemorrhage
Arterial thrombosis
Diarrhea
Neutropenia

33
Q

Cetuximab, panitumumab AEs

A

Infusion reactions: premedicate!
Hypomagnesemia
Paronychia
Acneiform rash

34
Q

EGFR inhibitor acneiform rash management

A

Limit sun exposure, wear sunscreen
Avoid overdrying the skin, avoid hot baths
Moisturize!
Avoid OTC acne products

35
Q

Criteria to use EGFR inhibitor

A

KRAS wild-type

36
Q

Regorafenib BBW

A

hepatotoxicity

37
Q

Regorafenib AEs (common)

A

fatigue, anorexia/weight loss, hand-foot syndrome, diarrhea, mucositis, infection, HTN

38
Q

Regorafenib DDI

A

3A4 inhibitors and inducers

39
Q

Trifluridine and tipiracil AEs (Lonsurf)

A

Anemia
Neutropenia
Fatigue
N/V
Thrombocytopenia
Decreased appetite
Diarrhea
Abdominal pain

40
Q

Lonsurf dose adjustments

A

Reduce dose and/or hold doses as clinically indicated if there is severe myelosuppression

41
Q

Lonsurf administration

A

Take within 1 hour of the end of breakfast and dinner

42
Q

Pembrolizumab, nivolumab AEs

A

Colitis
Rash
Hepatitis
Nephritis
Pneumonitis
Thyroid disorders

43
Q

Pembrolizumab, nivolumab indication

A

MSI-H tumors only in Stage IV disease

44
Q

EGFRi acneiform rash: grade 1

A

No dose changes
General precautions/nonpharm care
Topical clindamycin 2% +/- hydrocortisone 1%

45
Q

EGFR acneiform rash: grade 2

A

Topical clindamycin 2% +/- hydrocortisone 1%

Minocycline BID or doxycycline BID

46
Q

EGFR inhibitor rash: grade 3

A

Hold treatment until grade 2
Dose reduce if 2nd or 3rd incident; D/C if 4th occurrence

47
Q

EGFR inhibitor rash: grade 4

A

D/C drug, systemic treatment with PO retinoids, IV steroids, ABX, and hydration

PHM 703- Oncology, Hematology (15 decks)

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