Immuno/Chemotherapy and Heme/Onc Facts Flashcards
Traztuzumab
Herceptin
Pertuzumab
Her-2 receptor inhibitor
Breast and Gastro cancers
Pembrolizumab (Keytruda)
Nivolumab (Opdivo)
PD-1
standard of care to test ALL metastatic non-small cell lung cancer for PD-1 expression
Indications for PD-1 inhibitors
Several indications! NSCLC, RCC
Vermurafenib
Dabrafenib
BRAF kinase inhibitor
Sorafenib (MOA and indication)
Protein kinase inhibitor
Unresectable hepatocellular carcinoma
Ipilumimab (MOA and indication)
CTLA-4 checkpoint inhibitor
Ipilumimab with novilumab for renal cell carcinoma
Erlotinib (MOA and indication)
EGFR inhibitor
Metastatic NSCLC
Cetuximab
Pantiumumab
(MOA and indication)
EGFR inhibitor
CML, CLL, GIST cancers
Bortezomib (MOA and indication)
Proteosome inhibitor
Multiple myeloma
Alemtuzumab (MOA and indication)
CD52
T-cell lymphoma/Sezary
Treatment of GIST (gastrointestinal stromal tumor)
- Small with low mitotic indices: surgery alone
2. Large, aggressive: Imatinib
Treatment of small cell lung cancer
- Carboplatin and Etoposide
2. Prophylactic brain irradiation
Paraneoplastic syndromes of small cell lung cancer
SIADH
Lambert-Eaton syndrome
Treatment of Non-small cell lung cancer
Stage I: Surgery
Stage II: Surgery +/- chemo
Stage III: Chemo + radiation then immunotherapy
Stage IV: Palliative chemo + immunotherapy
*If metastatic disease with high PDL1: immunotherapy and may avoid chemo
Treatment of bladder cancer
Superficial: intravesical BCG chemo
Deep but NO muscle involved: surgery (cystectomy)
Muscle involvement: neoadjuvant chemo followed by surgery
What is 5q deletion syndrome?
5q genetic deletion in myelodysplastic syndrome that has a favorable prognosis. Responds well to lenalidomide!
How many blasts (%) in bone marrow are needed to diagnose AML?
20% blasts in marrow!
If you think someone has MDS but do a BM biopsy and it has 20% blasts –> it is AML!
Gene translocation in CML?
Treatment?
BCR-ABL (9;22)
Tx with tyrosine kinase inhibitors: Imatinib, Dasatinib, Nilotinib
Big side effects/concerns with tyrosine kinase inhibitors?
Teratogenic; exacerbate LV dysfunction and heart failure; hepatotox; cytopenias
Treatment of essential thrombocytosis?
Significant erythromelalgia: ASA
Pts at high risk for thrombus (>60 YO and/or history of thrombus): Hydroxyurea
If surgery is required you need to get the platelet number down!
Treatment of Hodgkin Lymphoma?
ABVD: A: adriamycin (doxorubicin) B: Bleomycin V: Vinblastine D: Dacarbazine
Therapy for prostate cancer:
- Low risk
- Metastases
- Bone pain or neurologic compromise (spinal cord)
- Low risk: active surveillance in younger men with better performance status, observation in older men with worse performance status (observation is different from active surveillance in that there is no checking PSA with plans to change therapy if necessary)
- Metastases: Androgen deprivation therapy (Leuprolide) + Docetaxel chemotherapy
- Localized spine pain or neurologic compromsie: XRT
Which cancers are the following associated with?
BRAF
RAS
HER-2
BRAF: melanoma
RAS: colorectal cancer
HER-2: breast cancer, upper gastrointestinal stromal tumors
Palbociclib (use and MOA)
Used in conjunction with anti-estrogen therapy in breast cancers that have come back (prev tx witih endocrine tx) or breast cancers that are widely metastatic)
CDK4 and CDK6 inhibitor
What is the treatment for gastroesophageal adenocarcinoma? (be aware, this is different than GIST)
- Give neoadjuvant (prior to surgery) chemotherapy and radiation, then surgical removal
- IF metastatic, check HER-2 status, may be able to use Traztuzumab
What is the histologic difference between anal and rectal cancer? How are they treated differently?
Anal cancer: squamous cell cancer associated with HPV; often cured with chemo and rads WITHOUT surgery (surgery is salvage therapy)
Rectal cancer: is an ADENOcarcinoma; tx below
-stage I: no full thickness penetration –> surgery alone
-stage II (full thickness) or III (lymph nodes) –> chemo, radiation, and surgery
What is the management of hairy cell leukemia?
- If asymptomatic: observation
2. If symptoms: (fatigue, anemia) need a nucleoside analog, cladribine or pentostatin
Olaparib (MOA and uses)
Might see it written as [oral poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor] to confuse you!
Used for BRCA positive ovarian cancer recurrence after platinum based chemo (think in a patient who has failed multiple chemo options). Can also see benefit in recurrent (platinum chemo resistant) breast, prostate, pancreatic BRCA tumors.
Treatment for ovarian cancer
- Surgical BSO and debulking
2. Platinum based chemo (cisplatin and paclitaxel) BOTH IV and intraperitoneal
