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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?

A

FOLFOX

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
Q

What are the chemo regimens for Stage 4?

A

FOLFIRI and FOLFOX

26
Q

Follow-up for Stage 4?

A

After every 2 months of tx reassess for possible resection
* All metastatic tumors should be genotypes for RAS and BRAS mutations

27
Q

What are the components of FOLFOX-B?

A

5-FU, leucovorin, oxaliplatin, bevacizumab

28
Q

What are the components of FOLFIRI?

A

5-FU, leucovorin, irinotecan

29
Q

What are the components of FOLFIRI-B?

A

5-FU, leucovorin, irinotecan, bevacizumab

30
Q

What are the components of FOLFOXIRI?

A

5-FU, leucovorin, oxaliplatin and irinotecan

31
Q

Why would FOLFIRI be preferred over FOLFOX?

A

FOLFOX has more PN due to oxaliplatin

32
Q

MOA of bevacizumab?

A

VEGF inhibitors and homanized monoclonal antibodies

33
Q

ADR of bevacizumab?

A

HTN, bleeding, VTE, proteinuria
* Interferes with wound healing

34
Q

When should not bevacizumab be administered?

A

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
Q

What are examples of EGFR inhibitors?

A

Cetuximab/Panitumumab

36
Q

Indications for Cetuximab/panitumumab?

A

Wild-type RAS, wild-type BRAF tumors, left sided tumors
* DON’T use in patients with mutated RAS and BRAF

37
Q

ADR of Cetuximab/panitumumab?

A

Infusion rx, rash, increased risk for VTE
* No benefit combining biologics

38
Q

What are the tx options that are only used because of first line tx failure?

A
  1. Ramucirumab
  2. Regorafenib
  3. Afibercept
  4. Immunotherapy
39
Q

What are the tx options for hepatic mets?

A

Hepatic artery infusion (HAI):
* Chemo infused directly into liver
* Limits tox while being high dose

Hepatic transarterial chemoembolization

40
Q

What needs to be considered prior to irinotecan dosing?

A

Test for genetic variants in UGT1A1
* Reduce dose of irinotecan if homozygous for UGT1A1*28

41
Q

How is rectal cancer treated?

A

May use radiation

Therapeutics IV (39 decks)

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