E2 Colorectal Cancer Flashcards
all of the risk factors for this one are self explanatory so im not typing them
maybe just recognize crohns and colitis and FAP (not that fap)
T or F:
>95% of colorectal cancers are adenocarcinomas
true
2 testing-work up options
microsatellite instability (MSI)
and
DNA mismatch repair (DNA MMR) (testing for loss of genes involved with that)
T or F:
pts with stage II disease have increased benefit from adjuvant 5-FU compared to stage III
false, stage III benefits from 5-FU, stage 2 does not
T or F:
chemo is the gold standard in stage II colon cancer and above
false, dont do it in stage II
T or F:
radiation therapy is well established for rectal cancer and not colon cancer
true
what stages of colorectal cancer are potentially curable
stage I, II, III
T or F:
surgery alone is definitive therapy in stages I and II
true
what is FOLFOX
5-FU
leucovorin
Oxaliplatin
what is CapeOX
capecitabine
oxaliplatin
what is in FOLFIRI
5-FU
leucovorin
irinotecan (theres I’s in folfiri) and it ends with iri
T or F:
Capecitabine is = to bolus 5-FU and leucovorin in stage III
true
T or F:
Bevacizumab, cetuximab, panitumumab, and irinotecan play a major role in stage III
false, they do not play a role at all
what stages do you use FOLFOX or FOLFIRI
stage II
T or F:
FOLFOX has more toxicities due to oxaliplatin
true (paresthesia and neutropenia) + GI oops
NCCN preferred regimens in low risk
capeox 3 months
folfox 3-6 months
NCCN preferred regimens in high risk
capeox 3-6 months
FOLFOX 6 months
requires port for administration
A. FOLFOX
B. CapeOX
A
hand foot syndrome
A. FOLFOX
B. CapeOX
B
which drug used in capeox requires renal dose adjustments *
capecitabine
T or F:
capecitabine is IV bolus administered
false, oral
what 3 things listed on slide 39 determine which chemo regimen to use?
neuropathy
UGT1A1 deficiency (irinotecan)
1 vs 2 vs 3 drugs (?)
T or F:
pembro and nivolumab show benefit in the metastatic setting
true
T or F:
pembro and nivolumab are approved for patients before FOLFOX and FOLFIRI
false, after
2 predictive biomarkers
K-RAS
BRAF
Mutations predict lack of response to anti-egfr mabs
A. KRAS
B. BRAF
A. KRAS
DO NOT USE cetuximab and panitumumab
A. KRAS
B. BRAF
A. KRAS
when is bevacizumab appropriate in colorectal cancer?
in stage IV -> metastatic
1st line metastatic disease regimens: no targeted mutations (2 choices)
5-FU + leucovorin
OR
capecitabine +/- bevacizumab
1st line metastatic disease KRAS wild type, left sided
cetuximab
or
panitumumab
(EGFR targets) -> these two are only effective when there are no mutations to KRAS
1st line metastatic disease: dMMR/MSI-H
nivolumab +/- ipilimumab
or
pembro
1st line metastatic disease:
HER2 positive
trastuzumab +/- pertuzumab/lapatinib/tucatinib
2nd line therapy:
disease progression with prior oxaliplatin based regimens. *
FOLFIRI*
OR
irinotecan (this was the first in the list out of 7 so im sure just know this one)
2nd line therapy:
disease progression with prior irinotecan-based regimen *
FOLFOX or CapeOX
(this was the first in the list out of 5 so im sure just know this one)
disease progression with prior oxaliplatin based regimens
A. FOLFIRI
B. FOLFOX
A. FOLFIRI
disease progression with irinotecan based regimens
A. FOLFIRI
B. FOLFOX
B. FOLFOX
2 screening tests she told us to know that PRIMARILY detect cancer *
fecal occult blood test (FOBT)
and
fecal immunohistochemical test (FIT)
detects hemoglobin:
A. FIT
B. FOBT
A. FIT
2 tests to primarily detect cancer AND advanced lesions
endoscopy
and
colonoscopy -> gold standard
what age do you get screened if you have a 1st degree relative with colorectal cancer hx
40 instead of 45
T or F:
calcium-rich diet decreases proliferative response to fatty acids and bile acids
true
3 things listed under colon cancer prevention (not including diet stuff which is obvious -> high fiber, less fat)
- cyclooxygenase inhibitors -> says FDA indication removed in 2011 so thats odd
- NSAIDS or aspirin
- colectomy
5-FU:
- converted in vitro to _____ and ____
- FUTP incorporates into ____ and impairs protein synthesis
- ______ binds thymidylate synthase and reduces rate of dna synthesis, replication, and repair
- FUTP, FdUMP
- RNA
- FdUMP
5-FU extensively metabolized by _____ in the liver
DPD (you should remember this)
a few common toxicities with 5-FU
diarrhea, mucositis, myelosuppression
Leucovorin stabilizes the binding of _____ to _______ resulting in enhancement of the toxicity of fDUMP
fDUMP to thymidylate synthase (TS)
SN-38
irinotecan
cholinergic symptom of irinotecan that is treated with atropine *
early onset diarrhea
okay so if you see irinotecan and you’re thinking about side effects and shit what do you think of
diarrhea
unique toxicities oxaliplatin (3) *
neuropathy, COLD INTOLERANCES, sensation of not being able to breathe
dose limiting toxicity of Capecitabine *
hand-foot syndrome and diarrhea
Cetuximab binds to the (intracellular/extracellular) domain of EGFR
extracellular
2 underlined adverse events for cetuximab * (both of these also had **)
acneiform rash
hypomagnesemia
pre-medicating with an ___ ___________ is recommended with Cetuximab
H1 antagonist
Recombinant IgG2 monoclonal antibody and binds specifically to EGFR
Panitumumab
2 underlined and asterisked toxicities of Panitumumab
acneiform rash
hypomagnesemia
binds VEGF
Bevacizumab
T or F:
Bevacizumab is given in combo with 5-FU, leuco, and irino
True, not a solo drug
significant toxicities (a few but one main one i think) for bevacizumab
BLEEDING
htn
proteinuria
thromboembolism
GI perforations
decreased wound healing (bleeding)
T or F:
Cetuximab has many black box warnings
false, bevacizumab does (i mean the name sounds kind of scary so i guess it makes sense)
