General oncology

Question 1

Immunotherapy toxicity leads to

Answer 1

Autoimmunity

Question 2

Immunotherapy toxicity most commonly occurs in which organs?

Answer 2

Thyroid - 12%

Prednisolone/methylpred

If hypothyroid –> replace with thyroxine
If hyperthyroid –> +/- carbimazole

Question 3

Can you get febrile neutropenia on immunotherapy?

Answer 3

No

Question 4

Immunotherapy toxicity management

Answer 4

Corticosteroids are the primary management

In severe adverse reactions, need to cosnider permanent cessation and immunosuppressants (e.g. infliximab, mycophenolate)

If very serious, cease immunotherapy, can consider changing class of immunotherapy (3% cross reactivity) but this is not commonly done

Question 5

Immunotherapy toxicity

Management of pneumonitis

Answer 5

Rare <1%

Treat only if symptomatic (not on radiology only)

Pred/methylpred
Cease immunotherapy while on >10mg/day
Do not reinitiate if life threatening

If worsening hypoxia after 48h or ICU admission add infliximab or mycophenolate

Question 6

Immunotherapy toxicity

Management of colitis

Answer 6

Relatively common 5-10%

G1: <4 stools more than baseline - loperamide
G2: 4-6 stools more than baseline - WH immunotherapy, add methylpred
G3: >7 stools more than baseline - WH immunotherapy, add methylpred. If refractory over 3-4 days, add infliximab
G4: perforation - permanently cease immunotherapy, add methylpred, consider infliximab, surg review

Question 7

Immunotherapy toxicity

Management of renal dysfunction

Answer 7

G1 - Cr <1.5x baseline (ULN) - continue immunotherapy
G2 - Cr 1.5-6x baseline (or ULN) - WH immunotherapy, ad pred. If it doesn’t improve within 7 days, treat as G4
G4 - Cr >6x baseline (or ULN) - permanently cease immunotherapy and add methylpred

Question 8

Which of the following is not a gene involved in the homologous recombination repair pathway?
A) BRCA 1
B) BRCA 2
C) PTEN
D) RAD 51

Answer 8

PTEN

BRCA 1, 2, RAD51

• Tumour suppressor genes and support DNA repair if damaged
• Mutation impairs ability to repair DNA double strand breaks
• Can be inherited to somatic

Question 9

Which are the highly emetogenic chemotherapy agents?

Answer 9

Cisplatin

Cyclophosphamide

Question 10

Whats the antiemetic regimen for highly emetogenic chemotherapy agents?

Answer 10

NK1 antagonist (day 1) e.g. aprepitant PLUS
5HT3 antagonist (day 1) PLUS 
Dex (day 1-4)