Lecture 7 - Colon cancer Flashcards by Patryk Lasiuk

Colon cancer risk factors

Age
Diet = fiber, fat, red meat
Polyps
IBS
Genetics
Personal h/x of colorectal cancer
smoking
Diabetes

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Stuff that is associated with dec risk colon cancer

ASA/NSAID use
Hormones
High Fiber Diet
Calcium rich diet

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Stuff that is associated with inc risk colon cancer

Obesity
Alcohol n smoking

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When to start screening Average risk colon cancer

age 45, continue until 75 and after 85 should probs stop screening

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When to start screening high risk colon cancer groups

40 or earlier
FAP annual screening @ 10-12
HNPCC (Lynch syndrome) annual screening @ 20-25

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What makes someone high risk group for colon cancer

H/x IBS
H/x adenomas, colon cancer
FH cancer/polyps

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Are digital rectal exams used often for colon cancer

not really

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fecal occult blood test info

paper that you poop on

restrict vitamin C
avoid NSAIDs
restrict ASA
avoid red meat

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Fecal immunochemical test info

no restrictions

more sensitive than guaiac

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stool DNA test info

repeat every 3 years
if positive, follow up with colonoscopy

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Sigmoidoscopy info

limited field (distal bowel, left side only)
if positive, follow up with colonoscopy
every 5 years

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Colonoscopy info

gold standard
requires prep
expensive, burdensome, no one really wants stuff up their butt
every 10 yrs (5yrs for virtual)

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most common site for colon cancer to metastasize to is….

liver

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Tumor marker Colon cancer

CEA

Normal < 2.5 non smoker, < 5 smoker

used for detecting recurrences

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Colon cancer biomarkers

EGFR
KRAS/NRAS/BRAF

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KRAS mutation predicts….

lack of efficacy with anti-EGFR drugs, won’t respond

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KRAS/NRAS mutation pts should not receive…..

anti-EGFR agents

When is adjuvant therapy used in colon cancer

usually start thinking about it stage 2

Locally advanced disease (stage 3) therapy

do tend to give adjuvant chemo

Stage 3 Low risk = FOLFOX q2w X 3-6M, CapeOX q3w X 3 month
Stage 3 high risk = FOLFOX q2w X 6M, CapeOX q3w X 3-6M

1st line colon cancer therapy

FOLFOX
CapeOX
FOLFIRI
FOLFOXIRI

FOLFOX made up of…

5FU + Leucovorin (LV) + Oxaliplatin

CapeOX made up of…

Capecitabine + Oxaliplatin

FOLFIRI made up of…

5FU + LV + Irinotecan

FOLFOXIRI made up of….

5FU + LV + Oxaliplatin + Irinotecan

key oxaliplatin toxicity

cold-induced neuropathy dont drink or touch cold stuff

most common 5FU toxicity

myelosuppresion and diarrhea

can you hold Oxaliplatin for few cycles?

yea and overall survivability isn't really effected, helps reduce neuropathy

Using FOLFOX or FOLFIRI first?

doesnt really matter FOLFOX = more neuropathy FOLFIRI = More diarrhea

Capecitabine info

Toxicity = HandFoot syndorme, diarrhea Weight based dosing, 14 days on, 7 days off

VEGF inhibitors Colon cancer

Bevacizumab Ramucirumab

EGFR inhibitors Colon cancer

Cetuximab Panitumumab

BRAF inhibitor Colon cancer

Encorafenib

Immunotherapy Colon cancer

Nivolumab Ipilimumab pembrolizumab

Bevacizumab info

Toxicity: bleeding, HTN, bowel perforation, thromboembolic events VEGF inhibitor if disease progresses, you can continue if switch backbone therapy

Cetuximab (Erbitux) info

Used for KRAS wild-type EGFR expressing metastatic colorectal cancer EGFR inhibitor Dosed based on surface area, weekly

Cetuximab (Erbitux) adverse events

Infusion Rxn most common, start slow n pre-medicate with antihistamine **Dont admin w/ bevacizumab**

Cetuximab (Erbitux) adverse events

Infusion Rxn most common, start slow n pre-medicate with antihistamine **Dont admin w/ bevacizumab** skin rash can occur

Panitumumab (Vectibix) info

Used for KRAS wild-type EGFR expressing metastatic colorectal cancer usually used based on institutional preference

Panitumumab (Vectibix) ADE

infusion rxn Derm toxicity ** dont admin with Bevacizumab**

Nivolumab indication

pts > 12 yrs old with MSI-H or dMMR metastatic colon cancer that have progressed following txm with other therapies