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Therapeutics IV > Colorectal Cancer - Block 4 > Flashcards

Colorectal Cancer - Block 4 Flashcards

1
Q

What are the RF of CRC?

A
  1. > 50YO
  2. Family hx
  3. Colon polyps
  4. T2DM
  5. IBD
  6. Genetic predisposion
  7. Hx of other cancers
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2
Q

What is the hereditary autosomal dominant predisposition of CRC?

A
  1. Familial adenomatous polyposis (FAP)
  2. Lynch syndrome
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3
Q

When should you screen for FAP?

A
  1. Starts between 10-11 YO
  2. Total colectomy when polyps are found
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4
Q

What are the risks of having lynch syndrome?

A
  1. Increased risk for endometrial, overain, stomach, and colon
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5
Q

Gene that codes for lynch syndrome?

A

Germline mutation in MMR gene

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6
Q

When is lynch syndrome most suspected?

A
  1. Early age of diagnosis or family hx
  2. Multiple generations in a family can be affected
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7
Q

What lifestyle factors increase the risk of CRC?

A
  1. Western diet
  2. Alcohol
  3. Smoking
  4. Sedentary lifestyle
  5. Obesity/overweight
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8
Q

What lifestyle factors decrease the risk of CRC?

A
  1. NSAIDs/ASA
  2. Calcium
  3. Vit D
  4. Postmenopausal hormone use
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9
Q

Who should be screened and what does screen look like? Which does not require bowel prep?

A

Starting at age 50:
* Colonoscopy every 10 yrs
* Fecal occuly blood test (FOBT): yearly
* Fecal immunochemical test (FIT-No bowel prep): yearly

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10
Q

What are the presentations of CRC?

A
  1. Change in bowel habits
  2. Rectal bleeding
  3. Abdominal pain
  4. Weight loss
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11
Q

Wha is the tumor marker used for CRC?

A

CEA (Carcinoembryonic antigen): oncofetal protein expressed in embryonic development
* Elevation -> metastatic
* However, not all CRC produce CEA therefore it is not used for screen only treatment

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12
Q

How many nodes should be biopsied for CRC diagnosis?

A

12 minimum

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13
Q

Differentiate the gene mutations tested for CRC diagnosis?

A

KRAS/NRAS: wild type = normal
* Mutated is unresponsive to EGFR inhibitors

BRAF: EGFR inhibitors can still be used, but it provided the worst prognosis

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14
Q

How do the stages of CRC differ in terms of curability?

A

Stage 1-3: potentially curable
Stage 4: incurable unless metastases is resectable

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15
Q

Tx options for CRC?

A
  1. Surgery
  2. Chemotherapy
  3. Radiation
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16
Q

What is the tx option for Stage 1 CRC?

A
  1. Watch and wait based on polyptype
  2. Surgery (90% cure rate as monotx)
  3. Adjuvant chemotherapy NOT indicated
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17
Q

How often should you follow up for stage 1?

A

Colonoscopy 1 yr after tx
* Advanced adenoma: repeat colonoscopy in 1 yr
* Not advanced adenoma: repeat colonoscopy in 3 yrs, then 5 yrs

18
Q

What are the recommended tx options for Stage 2-3?

A

Surgery and neoadjuvant chemotherapy:
Stage 2: may not require adjuvant chemo
Stage 3: Adjuvant starts right after surgery for 3-6 months

19
Q

What is the preferred adjuvant chemo for Stage 3?

20
Q

What are the components of FOLFOX? How long is the course?

A
  1. Oxaliplatin on day 1
  2. Leucovorin on day 1
  3. 5-FU on day 1 after leucovorin

Repeat every 2 weeks for 24 weeks

21
Q

What are the components of CapeOx? How long is a course?

A
  1. Oxaliplatin on day 1
  2. Capecitabine BID on days 1-14

Cycle lasts 3 wks for 24 wks

22
Q

What is the tx plan for capecitabine monotherapy for adjuvant stage 3 tx?

A

Capecitabine BID on days 1-14

Cycle lasts 14 days and repeats every 3 wks for 24 wks

23
Q

What are the tx options for metastatic/stage 4?

A
  1. Surgery then adjuvant chemo
24
Q

Describe the progression of resectable metastases?

A

Mets to the liver are most common then progress to the lungs and bones
* May require to neoadjuvant chemo

25
What are the chemo regimens for Stage 4?
FOLFIRI and FOLFOX
26
Follow-up for Stage 4?
After every 2 months of tx reassess for possible resection * All metastatic tumors should be genotypes for RAS and BRAS mutations
27
What are the components of FOLFOX-B?
5-FU, leucovorin, oxaliplatin, bevacizumab
28
What are the components of FOLFIRI?
5-FU, leucovorin, irinotecan
29
What are the components of FOLFIRI-B?
5-FU, leucovorin, irinotecan, bevacizumab
30
What are the components of FOLFOXIRI?
5-FU, leucovorin, oxaliplatin and irinotecan
31
Why would FOLFIRI be preferred over FOLFOX?
FOLFOX has more PN due to oxaliplatin
32
MOA of bevacizumab?
VEGF inhibitors and homanized monoclonal antibodies
33
ADR of bevacizumab?
HTN, bleeding, VTE, proteinuria * Interferes with wound healing
34
When should not bevacizumab be administered?
Surgery should not occur within 6 wks of last dose * Don't re-start for 6-8 wks after surgery due to increased bleeding risk and complications with wound healing
35
What are examples of EGFR inhibitors?
Cetuximab/Panitumumab
36
Indications for Cetuximab/panitumumab?
Wild-type RAS, wild-type BRAF tumors, left sided tumors * **DON'T** use in patients with mutated RAS and BRAF
37
ADR of Cetuximab/panitumumab?
Infusion rx, rash, increased risk for VTE * No benefit combining biologics
38
What are the tx options that are only used because of first line tx failure?
1. Ramucirumab 2. Regorafenib 3. Afibercept 4. Immunotherapy
39
What are the tx options for hepatic mets?
**Hepatic artery infusion (HAI):** * Chemo infused directly into liver * Limits tox while being high dose **Hepatic transarterial chemoembolization**
40
What needs to be considered prior to irinotecan dosing?
Test for genetic variants in UGT1A1 * Reduce dose of irinotecan if homozygous for UGT1A1*28
41
How is rectal cancer treated?
May use radiation

Therapeutics IV (39 decks)

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