Med Onc Revision Flashcards
Mx of stage 1 lung Ca?
Surgery if medically fit
Stereotactic surgery if not a surgical candidate
Mx of stage 2 lung Ca
Surgery if medically fit
Conventional Radiotherapy if not surgically fit
Adjuvant chemotherapy
What surgery is preferred?
Lobectomy with draining of LNs
What is the current management of stage IV lung Ca?
If PDL1 status >50%
- Pembrolizumab
If PDL1 status <50%
- Doublet platinum based chemotherapy
What is mx of ALK+ lung Ca?
1st line: Crizotinib traditionally, newer Alectinib - better CNS penetration
2nd line ceritinib
What is the mortality reduction with FOBT in colon Ca?
20-30%
What is the management of stage IV CRC?
Chemotherapy (FOLFOX/XELOX or FOLFIRI) plus;
Bevacizumab (VEGF inhibitor)
or
EGFR antibodies (cetixumab and panitumumab) - only if wildtype for KRAS, NRAS, and BRAF
What is the difference between right and left sided tumour in terms of mab treatment?
Do not benefit from EGFR antibodies (cetixumab/panitumumab)
Which mutation do you look for in met. melanoma?
Presence of BRAF mutation
Mx of non-resectable melanoma?
BRAF+ = BRAF And MEK kinase inhibitor - dabrafenib and trametinib or vemurafenib and cobimetinib
BRAF - and fit patient = Ipilimumab and nivolumab (60% rate of major side effect)
BRAF -ve and unfit for combo = nivolumab or pembrolizumab or ipilimumab
Side effect of BRAF and MEK kinase inhibitor combo?
Fever
Photosensitivity
rash fatigue
GI toxicity
How is CNS mets in melanoma mx?
Isolated met - targeted radiotherapy or surgery
Low volume mets - could be controlled with systemic disease
Symptomatic multiple brain mets - whole brain radiotherapy
What is first line and 2nd line for RCC in Australia?
1st: Sunitinib or pazopanib
2nd: everolimus, Cabozantinib, axitinib, and nivolumab
What are indications for axillary clearance in breast Ca?
Sentinel node biopsy positive
If LNs involved at diagnosis
What are indications for chemo in early stage breast Ca?
Node pos
Node neg with high risk features
New genomic assay to provide risk score
