Colorectal cancer therapeutics

Question 1

what are the risk factors for colorectal cancer

Answer 1

UC and chrohn’s
Hereditary

Question 2

what are the two hereditary syndromes with colorectal cancer

Answer 2

FAP (familial adenomatous polyposis)
HNPCC (hereditary nonpolyposis colorectal cancer)

Question 3

when should screening start for FAP

Answer 3

10-12 years old

Question 4

when should screening start for HNPCC

Answer 4

40 years or 10 years earlier than youngest familial diagnosis

Question 5

how is colorectal cancer staged

Answer 5

TNM staging where T is depth of invasion into membrane

Question 6

what kind of colorectal cancer responds well to immunotherapies

Answer 6

MSI-H/dMMR

Question 7

what is the intent for stages I, II, III colon cancer

Answer 7

potentially curable

Question 8

what is the intent for stage IV colon cancer

Answer 8

palliation

Question 9

what is the treatment for stages I and II colon cancer

Answer 9

surgery alone
NO CHEMO

Question 10

when should chemo be considered in stage II colon cancer

Answer 10

high risk patients

Question 11

what is the chemo regimen for stage II colon cancer

Answer 11

FOLFOX
CapeOX

Question 12

what is in FOLFOX

Answer 12

5-FU, leucovorin, oxaliplatin

Question 13

what is the disadvantage for FOLFOX

Answer 13

requires infusion pump & port
continuous infusion

Question 14

what is in CapeOX

Answer 14

capcitabine, oxaliplatin

Question 15

what are the pros and cons of CapeOX

Answer 15

no port and less infusions
increased side effects

Question 16

what is the treatment for stage III colon cancer

Answer 16

FOLFOX (high risk)
CapeOX (low risk)

Question 17

what is the treatment for metastatic colon cancer

Answer 17

chemotherapy
NO SURGERY unless for pain

Question 18

what should you consider when choosing chemo for metastatic chemo

Answer 18

patient performance status
co-morbidities (neuropathy, UGT1A1 deficiency)

Question 19

what are predictive biomarkers in colon cancer

Answer 19

K-RAS and BRAF

Question 20

what does a KRAS mutation in colon cancer indicate

Answer 20

lack of response to EGFR therapies (dont use cetuximab or panitumumab)

Question 21

what drugs can be used with BRAF mutation

Answer 21

dabrafinib and trametinib

Question 22

what testing can predict benefit of PD-L1 inhibitors

Answer 22

dMMR/MSI-I

Question 23

what is 1st line treatment for metastatic colon cancer with no targetable mutations

Answer 23

chemotherapy
FOLFOX +/- bevacizumab
FOLFURI +/- bevacizumab
can use CapeOX

Question 24

what are unique toxicities of oxaliplatin

Answer 24

neuropathy
cold intolerances
trouble breathingw

Question 25

what is a dose limiting toxicity of irenotecan

Answer 25

diarrhea and neutropenia

Question 26

what is the treatment for KRAS wild type, left sided disease

Answer 26

cetuximab, panitumumab

Question 27

what should you premedicate EGFR targets with

Answer 27

H1 antagonists

Question 28

what is the treatment option for dMMR/MSI-H

Answer 28

nivolumab + ipilimumab or pembrolizumab

Question 29

what if a patient cannot tolerate intensive chemo

Answer 29

remove oxaliplatin or irinotecan

Question 30

how would you treat disease progression with prior oxaliplatin

Answer 30

switch to FOLFIRI

Question 31

how would you treat disease progression with prior irinotecan

Answer 31

FOLFOX or CapeOX

Question 32

how do you treat late onset diarrhea from irinotecan

Answer 32

loperamide (immodium) 4mg PO x 1 then 2mg PO Q2h (more aggressive than OTC)

Question 33

what are the AEs of cetuximab

Answer 33

acenform rash (dose adjust) and hypomagnesemia

Question 34

what is a significant toxicity of bevacizumab and what should be checked before administered

Answer 34

HTN and proteinuria
check BP and check urinalysis