Immuno/Chemotherapy and Heme/Onc Facts

Question 1

Traztuzumab
Herceptin
Pertuzumab

Answer 1

Her-2 receptor inhibitor

Breast and Gastro cancers

Question 2

Pembrolizumab (Keytruda)

Nivolumab (Opdivo)

Answer 2

PD-1

standard of care to test ALL metastatic non-small cell lung cancer for PD-1 expression

Question 3

Indications for PD-1 inhibitors

Answer 3

Several indications! NSCLC, RCC

Question 4

Vermurafenib

Dabrafenib

Answer 4

BRAF kinase inhibitor

Question 5

Sorafenib (MOA and indication)

Answer 5

Protein kinase inhibitor

Unresectable hepatocellular carcinoma

Question 6

Ipilumimab (MOA and indication)

Answer 6

CTLA-4 checkpoint inhibitor

Ipilumimab with novilumab for renal cell carcinoma

Question 7

Erlotinib (MOA and indication)

Answer 7

EGFR inhibitor

Metastatic NSCLC

Question 8

Cetuximab
Pantiumumab
(MOA and indication)

Answer 8

EGFR inhibitor

CML, CLL, GIST cancers

Question 9

Bortezomib (MOA and indication)

Answer 9

Proteosome inhibitor

Multiple myeloma

Question 10

Alemtuzumab (MOA and indication)

Answer 10

CD52

T-cell lymphoma/Sezary

Question 11

Treatment of GIST (gastrointestinal stromal tumor)

Answer 11

1. Small with low mitotic indices: surgery alone

2. Large, aggressive: Imatinib

Question 12

Treatment of small cell lung cancer

Answer 12

1. Carboplatin and Etoposide

2. Prophylactic brain irradiation

Question 13

Paraneoplastic syndromes of small cell lung cancer

Answer 13

SIADH

Lambert-Eaton syndrome

Question 14

Treatment of Non-small cell lung cancer

Answer 14

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

Question 15

Treatment of bladder cancer

Answer 15

Superficial: intravesical BCG chemo
Deep but NO muscle involved: surgery (cystectomy)
Muscle involvement: neoadjuvant chemo followed by surgery

Question 16

What is 5q deletion syndrome?

Answer 16

5q genetic deletion in myelodysplastic syndrome that has a favorable prognosis. Responds well to lenalidomide!

Question 17

How many blasts (%) in bone marrow are needed to diagnose AML?

Answer 17

20% blasts in marrow!

If you think someone has MDS but do a BM biopsy and it has 20% blasts –> it is AML!

Question 18

Gene translocation in CML?

Treatment?

Answer 18

BCR-ABL (9;22)

Tx with tyrosine kinase inhibitors: Imatinib, Dasatinib, Nilotinib

Question 19

Big side effects/concerns with tyrosine kinase inhibitors?

Answer 19

Teratogenic; exacerbate LV dysfunction and heart failure; hepatotox; cytopenias

Question 20

Treatment of essential thrombocytosis?

Answer 20

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!

Question 21

Treatment of Hodgkin Lymphoma?

Answer 21

ABVD:
A: adriamycin (doxorubicin)
B: Bleomycin
V: Vinblastine
D: Dacarbazine

Question 22

Therapy for prostate cancer:

1. Low risk
2. Metastases
3. Bone pain or neurologic compromise (spinal cord)

Answer 22

1. 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)
2. Metastases: Androgen deprivation therapy (Leuprolide) + Docetaxel chemotherapy
3. Localized spine pain or neurologic compromsie: XRT

Question 23

Which cancers are the following associated with?
BRAF
RAS
HER-2

Answer 23

BRAF: melanoma
RAS: colorectal cancer
HER-2: breast cancer, upper gastrointestinal stromal tumors

Question 24

Palbociclib (use and MOA)

Answer 24

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

Question 25

What is the treatment for gastroesophageal adenocarcinoma? (be aware, this is different than GIST)

Answer 25

1. Give neoadjuvant (prior to surgery) chemotherapy and radiation, then surgical removal
2. IF metastatic, check HER-2 status, may be able to use Traztuzumab

Question 26

What is the histologic difference between anal and rectal cancer? How are they treated differently?

Answer 26

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

Question 27

What is the management of hairy cell leukemia?

Answer 27

1. If asymptomatic: observation

2. If symptoms: (fatigue, anemia) need a nucleoside analog, cladribine or pentostatin

Question 28

Olaparib (MOA and uses)

Might see it written as [oral poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitor] to confuse you!

Answer 28

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.

Question 29

Treatment for ovarian cancer

Answer 29

1. Surgical BSO and debulking

2. Platinum based chemo (cisplatin and paclitaxel) BOTH IV and intraperitoneal