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FINAL EXAM Flashcards

1
Q

What are the risk factors for Prostate Cancer?

A
  1. Older Age
  2. African American
  3. Family History
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2
Q

What are the symptoms of Early Prostate Disease?

A

Asymptomatic

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3
Q

What are the symptoms of Late Prostate Disease?

A
  1. Frequent Urination
  2. Weak/Slow Urine Flow
  3. Dysuria
  4. Nocturia
  5. Hematospermia
  6. Erectile Dysfunction
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4
Q

What are the symptoms of Metastatic Prostate Disease?

A
  1. Back Pain
  2. Spinal Cord Compression
  3. Pathological Fracture
  4. Anemia
  5. Fatigue
  6. Weight Loss
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5
Q

What is the Goal of Prostate Cancer Screening?

A

Identify: High Risk - Localized Prostate Cancer that can be successfully treated, thereby preventing the morbidity/mortality

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6
Q

Screening and Early Detection of Prostate Cancer is most beneficial for men aged what?

A

55-69 yrs

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7
Q

What is the Diagnosis Test for Prostate Cancer?

A

PSA Test

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8
Q

Define PSA

A
  1. Total PSA
  2. Prostate specific antigen is a glycoprotein produced by both epithelial cells and cancer cells of the prostate gland
  3. Liquifies Seminal Secretions
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9
Q

PSA is specific to the prostate bu not specific for ____.

A

Cancer

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10
Q

T/F: A single PSA measurement is NOT diagnostic

A

True

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11
Q

T/F: A PSA Test is NOT a valuable tool to predict recurrence

A

False

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12
Q

What are factors that can INCREASE PSA?

A
  1. BPH
  2. Infections
  3. Prostatitis
  4. Age
  5. Prostatic Manipulation
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13
Q

How long should men abstain from ejaculation to prevent a false increased PSA?

A

48 hours

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14
Q

What are factors that can DECREASE PSA?

A

5-AIRS:
1. Finasteride
2. Dutasteride

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15
Q

Finatsteride and Dutasteride can cause a ____ decrease in PSA?

A

50%

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16
Q

Define PSA Velocity

A

Rate of Change in PSA over time

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17
Q

How do you determine a PSA Velocity?

A

3 Separate PSA values calculated over at least an 18 month period

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18
Q

How long does it take for PSA to Double: PSA Doubling Time?

A

< 10 months = progressing quickly

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19
Q

Define Percent Free PSA

A

% PSA is significantly lower in men who have prostate cancer
-Approved in men >50

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20
Q

If PSA is < ___%, Biopsy is recommended

A

25

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21
Q

Define PSA Density

A

Size of prostate gland measured by TRUS and divide PSA by prostate volume

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22
Q

Ideally PSA Density should be < ____ ng/ml/g

A

0.15

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23
Q

Large Prostates tend to have ____ PSA values

A

Higher

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24
Q

For Observation in Prostate Cancer, when is it preferred?

A
  1. Low Risk Patients AND
  2. Life Expectancy <10 years
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25
Q

How often do you monitor PSA in the Observation Treatment Modality?

A

Monitor PSA NOT more than every 6 months

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26
Q

Define the Active Surveillance Treatment Modality of Prostate Cancer

A

Monitor the course of disease with the intent to deliver potentially curative therapy upon progression of disease

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27
Q

When is Active Surveillance preferred in Prostate Cancer?

A
  1. Very Low Risk Disease AND
  2. Life Expectancy >20 years
    OR
  3. Low Risk Disease AND
  4. Life Expectancy >10 years
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28
Q

How often do you monitor PSA in Active Surveillance Treatment Modality

A

Monitor PSA NOT more than every 6 months unless clinically indicated

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29
Q

Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection] is a Treatment Modality in Prostate Cancer, but when is it appropriate?

A

Radical Prostatectomy RP is appropriate if the tumor is confined to prostate and is definitive curative therapy

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30
Q

When is Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection] Treatment Modality preferred in Prostate Cancer patients?

A

Life Expectancy 10 years and NO serious comorbid conditions

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31
Q

PSA should be UNDETECTABLE after Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection], if a persistent PSA is present, what does that indicate?

A

Inadequate Surgery or Metastases

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32
Q

Radiation +/-Adjuvant ADT is used when in Prostate Cancer?

A
  1. Early Stage HIGH RISK
  2. Early Stage Intermediate RISK
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33
Q

What is the Goal of Hormonal Therapy [Androgen Deprivation Therapy (ADT)]?

A

To achieve castrate levels of serum testosterone <50 ng/dL

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34
Q

What are the methods of ADT?

A
  1. Surgical Castration
  2. Chemical Castration
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35
Q

How is Chemical Castration ADT done?

A
  1. LNRH/GnRH Agonist +/-
  2. First Generation Antiandrogen (-tamide)
  3. LNRH Antagonist
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36
Q

What drugs are classified as LHRH Agonists?

A
  1. Goserelin – SubQ implant
  2. Leuprolide – IM
  3. Triptorelin
  4. Eligard – SubQ
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37
Q

What is the MOA of LHRH Agonists?

A

Paradoxical depletion of luteinizing hormone LH. Decreased LH release and testosterone production.

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38
Q

Synthetic LHRH Agonists have a ____ affinity to the receptor and _____ susceptibility.

A

Higher; Lower

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39
Q

How long does it take for LHRH Agonists to cause down regulation and castrate levels of testosterone?

A

3-4 weeks

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40
Q

What are AEs of LHRH Agonists?

A
  1. Hot Flashes
  2. Lethargy
  3. ED
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41
Q

What are the Latent Effects of LHRH Agonists?

A
  1. Bone Loss
  2. Fractures
  3. Metabolic Syndrome
  4. CV Disease
  5. Diabetes
  6. VTE
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42
Q

What drugs are classified as LHRH Antagonists?

A
  1. Degarelix – SubQ
  2. Relugolix – PO
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43
Q

What is the MOA of LHRH Antagonists?

A

Antagonists irreversibly bind to LHRH receptors on pituitary gland and reduce production of testosterone to castrate levels

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44
Q

Which LHRH class is associated with Tumor Flare?

A

Agonists

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45
Q

What are the AEs associated with LHRH Antagonists?

A
  1. Injection Site Problems
  2. MAJOR CV for Relugolix
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46
Q

What drugs are classified as Antiandrogens?

A
  1. Bicalutamide
  2. Flutamide
  3. Nilutamide
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47
Q

What is the FDA indication of Antiandrogens?

A

Used in conjunction with ADT

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48
Q

What is the place of therapy for Antiandrogens?

A

Prevent Flare Phenomenon in LHRH Agonists

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49
Q

For a patient with Unfavorable, Intermediate Risk in Prostate Cancer what is the recommended therapy regimen?

A

EBRT + ADT

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50
Q

For a patient with High Risk in Prostate Cancer what is the recommended therapy regimen?

A

EBRT + Neoadjuvant/Adjuvant/Concurrent ADT After Radiation

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51
Q

For a patient with Regional Disease N1,MO in Prostate Cancer what is the recommended therapy regimen?

A
  1. EBRT
  2. Abiraterone
  3. ADT
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52
Q

Define Castrate Sensitive

A
  1. Patients who have not been treated with ADT and those who are not an ADT at the time or progression.
  2. Patients have been neoadjuvent, adjuvant, or concurrent ADT as part of RT provided they have RECOVERED TESTICULAR FUNCTION.
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53
Q

Define Castration Resistant

A

Progression of disease despite castrate levels of testosterone <50 ng/mL

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54
Q

For Non-Metastatic Castration Sensitive Disease M0SPC what is recommended therapy for a patient with a shorter PSADT <10 months/Rapid PSA Velocity?

A

Consider ADT earlier rather than later

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55
Q

For Non-Metastatic Castration Sensitive Disease M0SPC what is recommended therapy for a patient with a longer PSADT >12 months/Older Age?

A

Candidate for observation

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56
Q

For Non-Metastatic Castrate Resistant Disease M0CRPC what is the recommended therapy for PSADT >10 months?

A

Continue ADT to maintain castrate level testosterone <50 ng/mL

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57
Q

For Non-Metastatic Castrate Resistant Disease M0CRPC what is the recommended therapy for PSADT <10 months?

A

Continue ADT + Aplatutamide or Enzalutamide or Darolutamide

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58
Q

What is the Dose of Enzalutamide?

A

160 mg PO QD without regard to food

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59
Q

What are the AEs of Enzalutamide?

A
  1. Falls
  2. Dizziness
  3. Insomnia
  4. Seizures
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60
Q

T/F: You can initiate Enzalutamide therapy in a patient with a history of seizures?

A

False

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61
Q

What are the DDIs of Enzalutamide?

A

CYP3A4 Inducer, interacts with DOACs

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62
Q

What is the dose for Apalutamide?

A

240 mg QD without regard to food

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63
Q

What are the AEs of Apalutamide?

A
  1. Maculopapular Rash
  2. Hypothyroidism
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64
Q

What are the DDIs of Apalutamide?

A

Strong CYP3A4 and CYP2C19 Inducer

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65
Q

What is the dose of Darolutamide?

A

600 mg BID to be taken WITH FOOD

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66
Q

Does Darolutamide need renal dose adjustment? If so, what is the CrCl cutoffs?

A

YES, Needed for CrCl <30 mL/min

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67
Q

Which “tamide” is associated with the least amount of DDIs and CNS side effects?

A

Darolutamide

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68
Q

What is the backbone therapy for Metastatic Hormone Sensitive Disease Prostate Cancer?

A

ADT

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69
Q

What therapy regimens are recommended in High Volume Metastatic Prostate Cancer?

A
  1. ADT + Docetaxel + Abiraterone + Prednisone OR
  2. ADT + Docetaxel + Darolutamide
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70
Q

Which High Volume Metastatic therapy regimen is better according to the STAMPEDE Trial?

A

ADT + Docetaxel + Abiraterone + Prednisone

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71
Q

What is the MOA of Abiraterone?

A

Blockade of CYP17 enzyme = reduction in serum cortisol = increase in ACTH

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72
Q

T/F: Abiraterone has to be given with a glucocorticoid agent: Prednisone.

A

True

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73
Q

What is the administration of Abiraterone?

A

Must be taken on an empty stomach

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74
Q

What are the AEs of Abiraterone?

A
  1. HTN
  2. Hypokalemia
  3. Fluid Retention – monitor monthly
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75
Q

When is use of Aniraterone cautioned?

A

Patients with a history of cardiovascular disease

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76
Q

If patients demonstrate progression of disease after ADT + Docetaxel therapy, what should be given based on the ENZAMET Trial?

A

Enzalutamide + ADT

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77
Q

What is the Standard of Care in Metastatic Prostate Cancer?

A

Triplet Therapy
1. ADT + Docetaxel + Abiraterone (+Prednisone)
2. ADT + Docetaxel + Darolutamide

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78
Q

T/F: In Metastatic Castrate Resistant Prostate Cancer CRPC, ADT is NOT continued.

A

FALSE - ADT is continued in the castrate resistant setting

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79
Q

What is approved for the pre-/post- Docetaxel setting for CRPC?

A
  1. Abiraterone
  2. Enzalutamide
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80
Q

Abiraterone + Predisone CANNOT be used in what patient population for CRPC?

A

Patients with VISCERAL Metastases

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81
Q

What is the MOA of Taxanes?

A

Anti-Microtubular

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82
Q

What 2 Taxanes have FDA indications for CRPC use?

A
  1. Docetaxel
  2. Cabaxitaxel
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83
Q

How should Docetaxel be given in CRPC?

A

Give with Prednisone

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84
Q

What are the AEs of Docetaxel?

A
  1. Peripheral Edema
  2. Myelosuppression
  3. Alopecia
  4. Peripheral Neuropathy
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85
Q

T/F: Docetaxel does NOT contain Cremphor and therefore, has a lower risk of hypersensitivity.

A

True

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86
Q

What is co-administered with Docetaxel to decrease Peripheral Edema?

A

Dexamethasone

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87
Q

What is the Contraindication of Docetaxel?

A

Severe Hepatic Impairment

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88
Q

If a patient does not respond to Docetaxel due to multi-drug resistance mechanisms, what should be used?

A

Cabaxitaxel

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89
Q

What is the specific indication of Cabazitaxel?

A

Metastatic hormone refractory prostate cancer only in patients who previously progressed on Docetaxel

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90
Q

How should Cabazitaxel be adminstered?

A
  1. Given with Prednisone
  2. Premedicate with H1 and H2 block and IV Corticosteroid 30 minutes prior to admin
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91
Q

Why do you have to premeditate with Cabazitaxel?

A

Polysorbate 80

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92
Q

What are the AEs of Cabazitaxel?

A
  1. Myelosuppresion
  2. Fatigue
  3. Hypersensitivity Rxns
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93
Q

What is the Indication of Sipuleucel-T?

A

Only indicated for asymptomatic or minimally symptomatic patients with no liver metastases, life expectancy > 6 months, and good performance status

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94
Q

What are the AEs of Sipuleucel-T?

A
  1. Chills
  2. Pyrexia
  3. Headaches
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95
Q

What is the premedication routine for Sipuleucel-T?

A

APAP 650 mg
Diphenhydramine 50 mg

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96
Q

What is the Indication for Radium 223 Xofigo?

A

Patients with metastatic CRPC with symptomatic bone only metastases, NO KNOWN Visceral metates before or after Docetaxel

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97
Q

Radium-223 Xofigo is not recommended to be used with any chemotherapy except what:

A
  1. ADT
  2. Denosumab
  3. Bisphosphonate
98
Q

What are the AEs of Radium-223 Xofigo?

A
  1. Myelosuppression
  2. N/V
  3. Diarrhea
  4. Peripheral Edema
99
Q

When is Germline Testing Recommended?

A

For patients with family history for cancer, or gremlin mutations

100
Q

In Metastatic CRPC Second Line Options what are 2 agents recommended?

A
  1. Pembrolizumab
  2. Olaparib
101
Q

When would Pembolizumab be recommended in CRPC Second Line?

A

After progression on prior treatment

102
Q

When would Olaparib be recommended in CRPC Second Line?

A

After progression on prior novel hormonal therapy

103
Q

ADT is known to cause Osteoporosis, what is recommended daily supplementation?

A

Vitamin D and Calcium

104
Q

Which drug is superior in preventing skeletal-related events: Denosumab or Zolendronic Acid?

105
Q

What are the 4 most common types of Epithelial Ovarian Cancer?

A
  1. Serous
  2. Mucinous
  3. Endometrioid
  4. Clear Cell
106
Q

What are the Negative Risk Factors of Ovarian Cancer?

A
  1. Increasing Age
  2. Obesity
  3. Infertility/Nulliparity
  4. Hormone Therapy after menopause
  5. Endometriosis
  6. PCOS
  7. Use of IUD
  8. Cigarette Smoking
  9. Genetics
107
Q

What are the Protective/Positive Risk Factors of Ovarian Cancer?

A
  1. Previous Pregnancy
  2. Hx of Breastfeeding
  3. Oral Contraceptives
  4. Tubal ligation
108
Q

What is a screening used in high risk patients for Ovarian Cancer?

A

CA-125 = NORMAL 0-46 IU/mL

109
Q

What is CA-125?

A

Biomarkers that may be elevated in ovarian cancer but also with pelvic inflammatory disease, uterine fibroids, menstruation

110
Q

T/F: No effective screening test currently recommended for ovarian cancer.

111
Q

What are forms of prevention of Ovarian Cancer?

A
  1. Decreasing Lifetime Ovulation: multiple pregnancies, breastfeeding, contraceptive use
  2. Tubal Ligation
  3. Prophylatic Oophorectomy
112
Q

What is used in the Diagnosis of Ovarian Cancer?

A
  1. Ultrasound
  2. CT/MRI
  3. Chest CT or X Ray
  4. Labs
  5. CA-125
113
Q

What is the difference between Stage I and II Ovarian Cancer?

A

Stage I: limited to one or both ovaries/Fallopian tubes
Stage II: extends to other pelvic structures

114
Q

What are the 2 most common metastatic sites associated with Ovarian Cancer?

A
  1. Lung
  2. Liver
115
Q

What is Primary Therapy in Ovarian Cancer?

116
Q

T/F: Neoadjuvant therapy is given in Ovarian Cancer with the sole purpose to shrink the tumor to surgical removal.

117
Q

Ovarian Cancer Adjuvant Chemotherapy is _____ -based.

118
Q

When would Fertility Sparking: Unilateral Salpingo Oophorectomy USO be an option in Ovarian Cancer?

119
Q

Is Radiation recommended in Ovarian Cancer?

120
Q

What is the Goal and Treatment option for Grade 1-IA/IB Ovarian Cancer?

A

Goal: Cure
Surgery followed by observation

121
Q

What is the Goal and Treatment option for Grade 2-1A/1B Ovarian Cancer?

A

Goal: Cure
Surgery with observation or IV chemotherapy

122
Q

What is the Goal and Treatment option for Grade 3-1A/1B Ovarian Cancer?

A

Goal: Cure
Surgery + Platinum Based Chemotherapy

123
Q

What is the Goal and Treatment option for Stage II, III, IV Ovarian Cancer?

A

Goal II, III, IVA = Cure
Goal IVB = Prolong Life
Surgery + Platinum Based Chemo

124
Q

How long is platinum-based chemotherapy usually in Ovarian Cancer?

A

3-6 cycles

125
Q

What is the preferred regimen for Stage I Ovarian Cancer?

A

Paclitaxel/Carboplatin = platinum doublet

126
Q

What is the preferred regimen for Stage II-IV Ovarian Cancer?

A

Platinum Doublet Backbone +/- Bevacizumab 6-8 cycles

127
Q

What are the indications for Intraperitoneal Therapy in Ovarian Cancer?

A
  1. Stage II/III
  2. Optimally Debulked < 1 cm of disease
  3. No prior history of bowel surgey
  4. Age <65 yrs
128
Q

What drugs are used in Intraperitoneal Therapy of Ovarian Cancer?

A
  1. Paclitaxel
  2. CISPLATIN
129
Q

Intraperitoneal Therapy is known to have higher grades of AEs/Complications, would you start this in patient even thought they are not willing to finish the entire cycle?

A

YES, 1 cycle is better than none, finish the rest of the cycles via IV

130
Q

What is the first-line Maintenance Therapy for Stage I Ovarian Cancer?

A

Observation

131
Q

What is the first-line Maintenance Therapy for Stage II-IV Ovarian Cancer?

A
  1. Bevacizumab = ONLY if it was used in primary regimen
  2. Olaparib = ONLY for BRCA1/2
  3. Niraparib
132
Q

Define Platinum Sensitive Disease in Ovarian Cancer

A

> 6 months from the time of last chemotherapy

133
Q

Define Platinum Resistance Disease in Ovarian Cancer

A

<6 months from the time of last chemotherapy

134
Q

Define Platinum Refractory Disease in Ovarian Cancer

A

Progression or NO Response on platinum-based therapy

135
Q

What is given in Recurrence of Platinum Resistant Disease?

A
  1. AVOID Platinum = NON Platinum-Based CHemo
  2. Supportive Care
136
Q

What is given in Recurrence of Platinum Sensitive Disease?

A
  1. Platinum Based Chemo
  2. 2nd Line Chemo
137
Q

What are AEs of Bevacizumab?

A
  1. HTN = DLT
  2. Hemorrhage
  3. Myalgia
  4. Impaired wound healing
  5. GI perforation/fistula
138
Q

What are the AEs of IP Chemotherapy?

A
  1. Painful
  2. Port Malfunction
139
Q

What are the AEs of Platinums?

A
  1. Myelosuppresion = DLT
  2. Peripheral Neuropathy
  3. Nephrotoxicity
140
Q

What are the AEs of Taxanes?

A
  1. Myelosuppression
  2. Peripheral Neuropathy
  3. Fluid Retention
141
Q

Cisplatin vs Carboplatin: Which has the worse N/V?

142
Q

Cisplatin vs Carboplatin: Which needs a dose reduction for patients with bone marrow fibrosis?

A

Carboplatin

143
Q

Cisplatin vs Carboplatin: Which has increased hypersensitivity reactions with cycles 6-8?

144
Q

PARP Inhibitors are used FIRST LINE for what type of Ovarian Cancer?

A

BRCA Mutation related

145
Q

List the factors that lead to INCREASED Cervical/Endometrial Cancer

A
  1. Persistent HPV Infection
  2. Smoking
  3. Parity (increase # of births)
  4. Oral Contraceptive Use
  5. Early age onset of sexual activity
  6. Increased number of sexual partners
  7. Certain autoimmune diseases/long term immunosuppresion
146
Q

What is the number 1 contributing factor that increases the risk of Cervical/Endometrial Cancer?

A

HPV Infection

147
Q

What 5 factors decreases the risk of Cervical/Endometrial Cancer?

A
  1. HPV Vaccination
  2. Reduce exposure to HPV
  3. Practice safe sex
  4. Reduce number of sexual partners
  5. Smoking cessation
148
Q

What is the HPV Vaccine called?

A

Gardasil 9 Papillomavirus 9-Valent Vaccine

149
Q

What is the recommended HPV Vaccination schedule for Children 9-14 yrs?

A

2 Dose Series: IM 0.5 mL at 0 and 6-12 months
3 Dose Series: IM 0.5 mL at 0, 2, and 6 months

150
Q

What is the recommended HPV Vaccination schedule or Adults 15-45 yrs?

A

3 Dose Series: IM 0.5 mL at 0, 2, 6 months

151
Q

What are 2 screening tools used in Cervical/Endometrial Cancer?

A
  1. PAP Test
  2. HPV Test
152
Q

What is the Primary Treatment for Early Stage Disease of Cervical/Endometrial Cancer?

A

Surgery or RT

153
Q

What is the Primary Treatment for Advanced Disease IB3-IVA Cervical/Endometrial Cancer?

A

Chemoradiation

154
Q

What is the Primary Treatment for Metastatic Disease IVB Cervical/Endometrial Cancer?

A

Systemic Chemotherapy

155
Q

What are the 2 Radiation Options for Cervical/Endometrial Cancer?

A
  1. External Beam Radiation EBRT
  2. Brachytherapy Internal Radiation
156
Q

What is the Primary Systemic Chemotherapy for Cervical/Endometrial Cancer?

A
  1. CISPLATIN = given with RT
  2. Carboplatin = given with RT ONLY if patient is Cisplatin Intolerant
157
Q

What is the Treatment for Localized Recurrence after initial treatment in Cervical/Endometrial Cancer?

A
  1. RT and/or Chemotherapy or Pembrolizumab
  2. Surgery
  3. Clinical Trial
158
Q

What is the Treatment for Recurrence after 2nd Line Therapy (POOR Prognosis) in Cervical/Endometrial Cancer?

A
  1. Systemic Chemotherapy
  2. Clinical Trial
  3. Best supportive care
159
Q

What is the Therapy for Recurrent Disease in Cervical Cancer if PD-L1+?

A
  1. Cisplatin + Paclitaxel +/- Bevacizumab +/- Pembrolizumab
  2. or sub Cisplatin with Carboplatin
160
Q

What are the other Therapy options for Recurrent Disease Cervical Cancer?

A
  1. Tisotumab Vedoin
  2. Single Agent: Cisplatin/Carboplatin/Paclitaxel
161
Q

What is the Therapy for Recurrent Disease if PDL1+ or MSI-H/dMMR Uterine tumors?

A

Pemrbolizumab or Nivolumab single agent

162
Q

What is considered most effective therapy for Metastatic Disease of Cervical/Endometrial Cancer?

A

Cisplatin + Paclitaxel +/- Bevacizumab

163
Q

When would Pembrolizumab be added to therapy regimen for Metastatic Cervical/Endometrial Cancer?

A

CPS Score >1 PDL1+

164
Q

What are the 6 Risk Factors of Uterine Cancer?

A
  1. Increased levels of estrogen (obesity, diabetes)
  2. Reproductive history of infertility
  3. Age >55 yrs
  4. Genetics, FH (Lynch Syndrome)
  5. Hormone replacement therapy
  6. Tamoxifen
165
Q

What would quantify Delineation of Treatment?

A
  1. Disease limited to uterus
  2. Cervical involvement
  3. Suspected extrauterine disease
166
Q

What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage I Uterine Cancer?

A
  1. Observation OR
  2. RT +/- Systemic Therapy
167
Q

What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage II Uterine Cancer?

A

EBRT and/or Brachytherapy

168
Q

What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage III-IV Uterine Cancer?

A

Systemic Therapy +/- EBRT +/- Vaginal Brachytherapy

169
Q

What are the agents used in Continuous Progestin Therapy for Fertility Sparing Options of Disease Limited to Uterus?

A
  1. Megestrol
  2. Medroxyprogesterone
  3. Levonorgestrel IUD
170
Q

What is used for Adjuvant Treatment in Primary Systemic Chemotherapy of Uterine Cancer?

A

Carboplatin + Paclitaxel

171
Q

What is used for Recurrent/Metastatic HER2+ Therapy Regimens for Uterine Cancer?

A

Carboplatin + Paclitaxel +/- Trastuzumab

172
Q

What is used for Recurrent/Metastatic MSI-High/TMB-H Therapy Regimens for Uterine Cancer?

A

Pembrolizumab

173
Q

What is used for Recurrent/Metastatic NOT MSI-H or dMMR Therapy Regimens for Uterine Cancer?

A

Pembrolizumab + Lenvatinib

174
Q

What is used for Recurrent/Metastatic dMMR Therapy Regimens for Uterine Cancer?

175
Q

What is used for Recurrent/Metastatic NTRK Gene Fusion Therapy Regimens for Uterine Cancer?

A

Larotrectinib or Entrectinib

176
Q

What is used for Hormonal Therapy in Uterine Cancer?

A
  1. Megestrol Acetate AND
  2. Tamoxifen
177
Q

What are the Supportive Care Medications for Infusion of Carboplatin?

A
  1. NK1 Antagonist
  2. 5HT3 Antagonist
  3. Dexamethasone +/- Olanzapine
178
Q

What are the Supportive Care Medications for Infusion of Cisplatin?

A
  1. Hydration + Electrolytes
  2. NK1 Antagonist
  3. 5HT3 Antagonist
  4. Dexamethasone +/- Olanzapine
179
Q

What is the main AE of Paclitaxel?

A

Neuropathy

180
Q

There are allergic reactions with Paclitaxel due to Cremphor, what are the 3 medications that must be used?

A
  1. Diphenhydramine
  2. Famotidine
  3. Dexamethasone
181
Q

What are the AEs of Bevacixumab (VEGF Inhibitor)?

A
  1. HTN –> BIGGEST CONCERN
  2. Proteinuria
  3. Wound Healing Complications
  4. GI Perforation
  5. Thromboembolism
182
Q

What are the AEs of Doxorubicin?

A
  1. Myelosuppression
  2. Hand Foot Syndrome
183
Q

What is used for the prevention of Hand Foot Syndrome?

A
  1. Avoid excessive friction
  2. Moisturize BID
  3. Cold Packs
  4. Avoid hot showers
184
Q

What are the AEs of Pembrolizumab?

A
  1. Diarrhea/Colitis
  2. Skin Rash
  3. Endocrinopathies
185
Q

What is the toxicity connected to Tisotumab?

A

Ocular Toxicity

186
Q

What is required to be administered when using Tisotumab?

A
  1. Steroid
  2. Vasoconstrictor
  3. Lubricating Eye Drops
  4. Cold Packs during Infusion
187
Q

T/F: For Uterine Carincoma, Tamoxifen must be used with Megestrol, not monotherapy.

188
Q

What are the Modifiable Risk Factors for Colon Cancer?

A
  1. High Fat, Low Fiber
  2. Red or Processed Meats
  3. Alcohol
  4. Smoking
  5. Obesity
  6. Metabolic Syndrome
  7. Vitamin D Deficiency
189
Q

What are the Non-Modifiable Risk Factors for Colon Cancer?

A
  1. Age >50
  2. Inflammatory Bowel Disease
  3. Polyps
  4. FH
  5. Genetic Predisposition
190
Q

What are the 2 types of genetic predisposition that are risk factors of Colon Cancer?

A
  1. Lynch Syndrome
  2. Familial Adenomatous Polyposis FAP
191
Q

List the 4 things that can be used as Prevention of Colon Cancer

A
  1. Vitamin D + Calcium
  2. Healthy Lifestyle
  3. High Fiber Diet
  4. ASA/NSAIDs
192
Q

T/F: Carcinoembyroinic Antigen CEA is NOT useful in detecting recurrence or metastatic disease.

193
Q

T/F: CEA is NOT a diagnostic value for colon cancer.

194
Q

What 4 sites is Metastatic Colon Cancer common?

A
  1. Liver
  2. Lungs
  3. Bone
  4. Peritoneum
195
Q

What is recommended therapy for Stage I-Low Risk II Colon Cancer?

A

Surgery + Observation

196
Q

What is recommended therapy for Stage II-III Colon Cancer?

A
  1. Surgery
  2. FOLFLOX 3-6 months OR
  3. CapeOx
197
Q

T/F: Stage III patients with Colon Cancer, demonstrated a benefit in survival outcome compared to Stage II patients when Oxaliplatin was added.

198
Q

Addition of ______ to a Fluoropyridine improves survival and should be added for Stage III patients with NO contraindications.

A

Oxaliplatin

199
Q

What drugs are NOT recommended in Stage I-III Colon Cancer?

A
  1. Irinotecan
  2. Bevacixumab
  3. Cetuximab
  4. Panitumumab
200
Q

FOLFOX ____ FOLFIRI

201
Q

FOLFOX ____ CAPEOX

202
Q

FOLFIRI ___ CAPEIRI

203
Q

In Stage IV Colon Cancer what are the Chemotherapy Regimens?

A
  1. FOLFLOX
  2. CapeOx
  3. FOLFIRI
  4. FOLFIRINOX
    +/- Targeted Therapy
204
Q

What is the benefit in adding on Bevacizumab?

A

Addition of Bevacizumab improves response rates and survival when added to 5-FU and Capecitabine based regimens in the metastatic setting

205
Q

Define Right Side Colon Cancer

A

Cecum – Transverse Colon

206
Q

Define Left Side Colon Cancer

A

Splenic Flexure – Rectum

207
Q

Which side of Colon Cancer is known to have a worse prognosis?

A

Right Side

208
Q

Which side of Colon Cancer is known to have KRAS/BRAF Mutations aka NOT wild type?

A

Right Side

209
Q

In Stage IV Colon Cancer when would you add on an EGFR Inhibitor?

A

Wild Type AND Left Sided Tumor

210
Q

T/F: In Stage IV Colon Cancer all patients should add on Bevacizumab.

A

False: Contraindications are HTN recent surgery, otherwise add on Bevacizumab

211
Q

If the patient demonstrates Progression of Stage IV Colon Cancer, should Bevacizumab be discontinued?

212
Q

If the patient demonstrates Progression of Stage IV Colon Cancer, and was prescribed an EGFR inhibitor, what would be done next?

A

DC EGFR Inhibitor
Do NOT add on Bevacizumab

213
Q

If the patient demonstrates Progression of Stage IV Colon Cancer and prescribed Oxaliplatin Therapy, what would be done next?

A

Switch to Regimen with Irinotecan

214
Q

If the patient demonstrates Progression of Stage IV Colon Cancer and prescribed Irinotecan Therapy, what would be done next?

A

Switch to Regimen with Oxaliplatin

215
Q

What drugs are NOT recommended and should be avoided in Stage IV Colon Cancer?

A
  1. CapeIRI Regimen
  2. VEGF Inhibitor + EGFR Inhibitor Combo
216
Q

What is the MOA of 5-FU?

A
  1. FUTP inhibits RNA synthesis
  2. FdUMP inhibits DNA synthesis through inhibition of thymidylate synthetase
217
Q

What is the difference between Bolus and Continuous administration of 5-FU?

A

Bolus = RNA false base pair
Continuous = TS inhibition

218
Q

What is the DLT of Bolus 5-FU?

A
  1. Myelosuppression
  2. Neutropenia
  3. Thrombocytopenia
219
Q

What is the DLT of Continuous 5-FU?

A
  1. Diarrhea
  2. Hand Foot Syndrome
220
Q

What is the MAJOR DDI of 5-FU?

221
Q

What is the MOA of Leucovorin?

A
  1. Stabilize the complex between FdUMP and Thymidylate Synthetase
  2. Help increase cytotoxicity of 5-FU
222
Q

T/F: You can give Leucovorin with Capecitabine.

A

False, avoid combination due to toxicity

223
Q

When is Capecitabine Contraindicated?

224
Q

What is the DLT of Capecitabine?

A
  1. Diarrhea
  2. Hand Foot Syndrome
225
Q

What is used for the treatment of Hand Food Syndrome?

A
  1. Urea - Keratolytic Cream
  2. Steroid Cream
  3. Oral Analgesics
226
Q

What is the DLT of Oxaliplatin?

A

Cumulative Peripheral Neuroapthy

227
Q

Define Acute DLT of Oxaliplatin

A
  1. REVERSIBLE
  2. Resolves within 14 days
  3. Exacerbated by cold
228
Q

Define Chronic DLT of Oxaliplatin

A
  1. PERSISTENT
  2. > 14 days
229
Q

What is more common in Oxaliplatin, Thrombocytopenia/Anemia or Neutropenia?

A

Thrombocytopenia/Anemia > Neutropenia

230
Q

What is the DLT of Irinotecan?

231
Q

What should be given for EARLY diarrhea in Irinotecan?

A

Atropine, max dose 1.2 mg

232
Q

What should be given for LATE diarrhea in Irinotecan?

A

Loperamide

233
Q

What is the dosing of Loperamide in treatment of diarrhea of Irinotecan?

A

4 mg at onset then 2 mg Q2 hrs until diarrhea free for 12 hours

234
Q

T/F: There is NO Max Dose for Loperamide when concerned with Irinotecan induced Diarrhea.

235
Q

Patients with Homozygous ________ allele have increased Neutropenia and Diarrhea with Irinotecan.

236
Q

If patients demonstrate with deficient enzymatic activity due to UGT1A1*28, what can be done with Irinotecan therapy?

A
  1. Dose Reduction
  2. Use alternative regimen
  3. Accept greater toxicity levels
237
Q

What are the class AEs of VEGF Inhibitors (Bevacizumab/Regorafenib)?

A
  1. HTN
  2. Impaired Wound Healing
238
Q

What are the specific AEs of Regorafenib (VEGF Inhibitor)?

A
  1. Hepatotoxicity
  2. Hand Foot Syndrome
  3. Diarrhea
239
Q

What is the most common AE of EGFR Inhibitors?

A

Papulopustular Acneiform Rash

240
Q

T/F: You can treat Acneiform Rash with acne products.

241
Q

What is used in the Prevention of Acneiform Rash?

A
  1. Hydrocortisone 1%
  2. Moisturizer
  3. Sunscreen
  4. Doxycycline 100 mg BID
    x6 weeks
242
Q

What is used in the Treatment of Acneiform Rash?

A
  1. Topical Steroids
  2. Clindamycin 1% Gel
  3. Doxycycline or Minocycline
  4. Oral Steroids = ONLY for severe rash

Hem/Onc Module (5 decks)

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