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FRACP NOSH 2020 > Medical Oncology > Flashcards

Medical Oncology Flashcards

1
Q

What is the incidence of breast cancer among Australian women?

A

1/8

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2
Q

What percentage of breast cancer is gene-related?

A

5-10%

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3
Q

Which gene is most common one to be associated with hereditary breast cancer?

A

BRCA1 (20-40%)

BRCA2 (10-30%)

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4
Q

Which BRCA gene is associated with prostate cancer in men?

A

BRCA2

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5
Q

What is the mode of transmission of BRCA genes?

A

Autosomal dominant

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6
Q

For breast cancer, which imaging modality is most sensitive in pre-menopausal women?

A

MRI breast

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7
Q

What is the best chemoprevention option for breast cancer in BRCA positive premenopausal women?

A

Tamoxifen

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8
Q

What age group receive screening mammography?

A

Age 50-74

Still free for women over 40

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9
Q

Which palpable breast masses need to be biopsied?

A

All of them!

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10
Q

What is the general purpose of adjuvant chemotherapy?

A

To eliminate micro-metastatic disease, to prevent relapse

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11
Q

What effect does HER2 positivity status have on breast cancer prognosis?

A

Confers poorer prognosis

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12
Q

In early stage breast cancer, what type of adjuvant chemotherapy is generally used?

A

Anthracycline and/or taxane based

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13
Q

In early stage breast cancer, what is the indication for axillary node dissection?

A

A clinically positive node pre-op

Consider if sentinel node biopsy positive

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14
Q

As adjuvant therapy in breast cancer, how long should Tamoxifen be given?

A

5 years for lower risk

10 years for high risk

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15
Q

What is the most effective adjuvant chemotherapy for breast cancer in postmenopausal women?

A

Aromatase inhibitors.

Block conversion of DHEA to oestrogen

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16
Q

What are the indications for adjuvant radiotherapy in early stage breast cancer? (2)

A

After breast conserving surgery

Post mastectomy in breast cancer >5cm per lymph node positive

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17
Q

What is the treatment of choice for metastatic breast cancer which is ER+/HER2- ?

A

Endocrine therapy =

Aromatase inhibitors
Tamoxifen
Fulvestrant

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18
Q

What is the treatment of choice for metastatic breast cancer that is HER2+ ?

A

Trastuzumab + pertuzumab + taxane chemo

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19
Q

What is the treatment of choice for metastatic breast cancer that is triple negative?

A

Chemotherapy =

Sequential single agent, many different options

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20
Q

What are the 4 main histological subtypes of lung cancer, in order of frequency?

A

Adenocarcinoma -40%
SCC - 20%
Small cell - 13%
Large cell - 7%

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21
Q

What defines ‘limited stage’ in small cell lung cancer?

A

All disease is within one radiation field

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22
Q

What size do lung tumours have to be to be classed as stage 1 NSCLC?

A

Less than 5cm

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23
Q

At what stage NSCLC are contralateral hilar nodes present?

A

Stage IIIb (N3)

24
Q

What form of chemotherapy is favoured in metastatic NSCLC that is driver mutation negative?

A

Platinum containing doublet - cisplatin or carboplatin plus another

25
Q

What is the classic phenotype of those with EGFR mutation negative NSCLC?

A

Non-smokers
Female
Asian
Adenocarcinoma

26
Q

Which lung cancer type is most closely associated with smoking?

A

Small cell

27
Q

For patients with unresectable, stage III NSCLC whose disease has not progressed following concurrent platinum-based chemotherapy and RT, what agent may improve survival?

A

PD-L1 antibody Durvalumab, irrespective of PD-L1 expression

As per PACIFIC trial

28
Q

Which lung cancer type is most associated with hypercalcaemia?

What is the common mechanism?

A

Squamous cell carcinoma

PTHrP release by cancer

29
Q

Which paraneoplastic syndromes are most common with SCLC?

A

SIADH

Neurological e.g. Lambert-Eaton, peripheral neuropathy

30
Q

Which type of cancer is most common in Australia (aside from non-melanomatous skin cancers)?

A

Breast cancer

31
Q

What is the strongest prognostic factor in breast cancer?

A

Lymph node involvement

32
Q

What does “grade” refer to in cancer?

A

The degree of cellular atypia

33
Q

What is the prognostic relevance of age in breast cancer?

A

Younger age confers poorer prognosis

34
Q

What is the risk factor most associated with chemotherapy-induced amenorrhea?

A

Increasing age

35
Q

Which form of metastatic breast cancer has the worst prognosis?

A

Triple negative

36
Q

In what kind of cancers are CDK4/6 inhibitors used?

A

Hormone receptor positive, HER2 negative metastatic breast cancers

37
Q

Which BRCA gene is more associated with pancreatic cancer?

A

BRCA 2

38
Q

Which BRCA gene is more associated with prostate cancer?

A

BRCA 2

39
Q

What is the deal with tamoxifen and CYP2D6?

A

Requires the enzyme to be converted to active form

Thus antidepressants that inhibit enzyme result in less efficacy of tamoxifen

40
Q

Which electrolyte is decreased in TLS?

A

Calcium

41
Q

What is the option for adjuvant treatment in Stage 2 CRC with high risk features?

A

Single agent 5FU or capecitabine

42
Q

What is the usual adjuvant Rx for Stage 3 CRC?

A

Single or double agent chemo for 3-6 months depending on risk

  • FOLFOX
  • CAPOX
43
Q

Best option for widely metastatic CRC that is R) sided?

A

Chemo - FOLFOX/FOLFIRI/CAPOX
Can do triplet of FOLFOXIRI if good performance status
+ Bevacizumab

44
Q

When can EGFR inhibitors be used in CRC?

A

Metastatic disease, L) sided primary
KRAS / BRAF wild-type
**If KRAS wild-type, EGFR mutant in advanced disease ->
can consider BRAF/MEK/EGFR blockade

45
Q

When are PD-1 inhibitors used in CRC?

A

Metastatic CRC that is MSI high or MMR deficient, that have progressed on chemotx

46
Q

What is the difference between Goserelin and Degarelix?

A

Goserelin -> GnRH agonist
- can initially stimulate sudden surge in T = “flare response, need to cover with testosterone antagonist for first week e.g. Bicalutamide

Degarelix -> GnRH antagonist (avoids flare response)

47
Q

What is done to the ADT in prostate cancer that has become castrate-resistant?

A

Generally continued, as it may slow progression

48
Q

What is the ideal 1st line treatment for metastatic castrate-sensitive prostate cancer?

A

Aggressive upfront treatment ->

ADT + chemotherapy with docetaxel + abiraterone

49
Q

What is the general treatment for metastatic castrate-resistant prostate cancer?

A

Continue ADT
Many options:
- chemo with taxane if fit enough
- unfit or progressed on chemo -> Abiraterone or Enzalutamide

50
Q

How does abiraterone work?

AEs?

A

Androgen biosynthesis inhibitor -> inhibits CYP17 gene products, including 17-alpha-hydroxylase

AE: HTN + Hypokalaemia (overproduction of aldosterone)
Should be co-administered with prednisolone (as cortisol synthesis also blocked)
LFT derangement

51
Q

How does enzalutamide work?

AEs?

A

AR antagonist. Inhibits binding of androgens to receptor

AEs: HTN, fatigue, may increase risk of seizures (contraindication in hx seizures), cognitive impairment

52
Q

How does tamoxifen work?

A

Selective oestrogen receptor modulator, may act as agonist or antagonist depending on target organ

  • antagonistic in breast cancer and breast tissue, as well as brain
  • agonistic effects in bone, liver, and uterus
  • Improves BMD and cholesterol

AEs: Headache, hot flushes (Rx venlafaxine), fluid retention, genitourinary Sx, small ↑ risk of thromboembolic events
Small ↑ risk endometrial cancer (in postmenopausal women)

53
Q

How do aromatase inhibitors work?

A

Inhibits peripheral conversion of androgens to oestrogens

  • More effective than tamoxifen in post-menopausal women where oestrogen production occurs outside of ovaries in peripheral tissues
  • Can only be used in premenopausal women in combination with ovarian suppression, as it does only works peripherally

AEs: MENOPAUSE -> N&V, headaches, hot flushes, fluid retention, genitourinary Sx, hyperlipidaemia

  • Joint pain and stiffness, vaginal dryness, accelerated BMD loss
  • More CVD / increased chol / DM compared with tamoxifen
54
Q

How do CDK4/6 inhibitors e.g. ribociclib work?

AEs?

A

Prevents progression through the cell cycle, resulting in arrest at the G1 phase. Inhibit progression of cell cycle from G to S phase.

AEs: neutropaenia (managed with cyclical dosing), QT prolongation, LFT derangement

55
Q

Metastatic melanoma Rx - 1st line for..

  • BRAF mutant?
  • BRAF wild-type?
A

BRAF mutant -
- BRAF + MEK inhibition
- dabrafenib + trametinib
AEs: fever, rash, GI upset

BRAF wild-type -

  • FIT -> Ipi (CTLA-4) + Nivo (PD1)
  • not fit for combo ->
    1. Nivolumab
    2. Pembro
    3. Ipi

FRACP NOSH 2020 (18 decks)

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