Colorectal cancer therapeutics Flashcards
what are the risk factors for colorectal cancer
UC and chrohn’s
Hereditary
what are the two hereditary syndromes with colorectal cancer
FAP (familial adenomatous polyposis)
HNPCC (hereditary nonpolyposis colorectal cancer)
when should screening start for FAP
10-12 years old
when should screening start for HNPCC
40 years or 10 years earlier than youngest familial diagnosis
how is colorectal cancer staged
TNM staging where T is depth of invasion into membrane
what kind of colorectal cancer responds well to immunotherapies
MSI-H/dMMR
what is the intent for stages I, II, III colon cancer
potentially curable
what is the intent for stage IV colon cancer
palliation
what is the treatment for stages I and II colon cancer
surgery alone
NO CHEMO
when should chemo be considered in stage II colon cancer
high risk patients
what is the chemo regimen for stage II colon cancer
FOLFOX
CapeOX
what is in FOLFOX
5-FU, leucovorin, oxaliplatin
what is the disadvantage for FOLFOX
requires infusion pump & port
continuous infusion
what is in CapeOX
capcitabine, oxaliplatin
what are the pros and cons of CapeOX
no port and less infusions
increased side effects
what is the treatment for stage III colon cancer
FOLFOX (high risk)
CapeOX (low risk)
what is the treatment for metastatic colon cancer
chemotherapy
NO SURGERY unless for pain
what should you consider when choosing chemo for metastatic chemo
patient performance status
co-morbidities (neuropathy, UGT1A1 deficiency)
what are predictive biomarkers in colon cancer
K-RAS and BRAF
what does a KRAS mutation in colon cancer indicate
lack of response to EGFR therapies (dont use cetuximab or panitumumab)
what drugs can be used with BRAF mutation
dabrafinib and trametinib
what testing can predict benefit of PD-L1 inhibitors
dMMR/MSI-I
what is 1st line treatment for metastatic colon cancer with no targetable mutations
chemotherapy
FOLFOX +/- bevacizumab
FOLFURI +/- bevacizumab
can use CapeOX
what are unique toxicities of oxaliplatin
neuropathy
cold intolerances
trouble breathingw
what is a dose limiting toxicity of irenotecan
diarrhea and neutropenia
what is the treatment for KRAS wild type, left sided disease
cetuximab, panitumumab
what should you premedicate EGFR targets with
H1 antagonists
what is the treatment option for dMMR/MSI-H
nivolumab + ipilimumab or pembrolizumab
what if a patient cannot tolerate intensive chemo
remove oxaliplatin or irinotecan
how would you treat disease progression with prior oxaliplatin
switch to FOLFIRI
how would you treat disease progression with prior irinotecan
FOLFOX or CapeOX
how do you treat late onset diarrhea from irinotecan
loperamide (immodium) 4mg PO x 1 then 2mg PO Q2h (more aggressive than OTC)
what are the AEs of cetuximab
acenform rash (dose adjust) and hypomagnesemia
what is a significant toxicity of bevacizumab and what should be checked before administered
HTN and proteinuria
check BP and check urinalysis
