Medical Oncology Flashcards
What are poor prognostic factors in lung cancer?
stage of disease, performance status, substantial weight loss, male
What is the screening for patients with lynch syndrome?
annually or 2 yearly colonoscopy at age 25 or 5 years before youngest family member diagnosed with cancer
What immunotherapy is used for mismatch repair associated tumours?
pembrolizumab, nivolumab and combination (ipilimumab and nivolumab)
What is the treatment for stage 1 colorectal cancer?
surgery
What is the treatment for stage 2 colorectal cancer?
surgery alone in most, consider single agent chemotherapy for high risk patients
What is the treatment for stage 3 colon cancer?
surgery with chemotherapy (single or doublet chemotherapy - 5FU, capecitabine +/- oxaliplatin)
What is the treatment for stage 3 rectal cancer?
neoadjuvant chemoraditherapy then wait 10 weeks then surgery
What is the treatment for resectable oligometastatic colorectal cancer?
surgery sometimes followed by adjuvant chemotherapy
What factors need to be considered in unresectable metastatic colon cancer?
KRAS, NRAS, BRAF mutations, microsatellite instability, performacne status, organ function, right vs left
What is the mainstay of streatment for stage IV colon cancer?
chemotherapy
What biologics are available to treat metastatic colon cancer?
bevacizumab (VEGF inhibitor), cetuximab/panitumumab (EGFR antibodies)
What are the toxicities of bevacizumab?
HTN, proteinuria, arterial thrombosis, poor wound healing, bleeding
What are the side effect for EGFR antibodies?
acneform rash, hypomagnesaemia
Which patients can you use EGFR antibodies for?
KRAS, NRAS and BRAF wild type
Can you use EGFR antibodies in patients with right sided tumours?
no
What is the treatment to prevent acneform rash?
moisturised, doxycycline, topical steroid
What is the side effect of oxaliplatin?
dose dependent neurotoxicity
What is the side effect of irinotecan?
cholinergic side effects and diarrhoea
What is the side effect of 5FU/capecitabine?
hand-foot syndrome, diarrhoea, coronary spasm
What is TAS 102 (lonsurf)
a last line treatment for metastatic colorectal cancer
How is prostate cancer risk stratified?
gleason score, PSA doubling time, PSA after ADT
What ist he PSMA scan?
a PET scan with prostate specific membrane antigen enabling earlier and better identification of metastases
What is the first line treatment for prostate cancer?
androgen deprivation therapy
What are the two different androgen deprivation therapies and why would you choose each?
goserelin which is an agonist - give most often
firmagon (degaralix) which is an antagonist - give if need rapid onset of action or need to make sure doesn’t have flare response
What are the side effects of ADT?
CV risk, osteoporosis, decreased libido, fatigue, hot flushes
How do you treat high risk metastatic prostate cancer?
Give upfront aggressive treatment (chemotherapy/abiraterone) rather than waiting to become castrate resistant
How are denosumab and zoledronic acid used in prostate cancer?
to reduce skeletal related events in castrate resistant prostate cancer with bony metastases
How do you treat metastatic castrate resistant prostate cancer?
if fit and chemo naive give docetaxel, if unfit or prior chemo give abiraterone or enzalutamide
Which patients can PARP inhibitors be used in?
patients with DNA repair anomalies (e.g. BRCA)
What is the mechanism of action of abiraterone?
inhibits CYP17 in adrenals and possibly intratumoral
What is the mechanism of action of enzalutamide?
androgen receptor antagonist and also causes intranuclear inhibition of androgen receptor dependent DNA transcription
Which patients is enzalutamide contraindicated in?
patients with past history of seizures
What is the AR-V7 mutation a marker of?
poor response to abiraterone or enzalutamide
What things should be assessed in melanoma?
whether there is surgical resectability (do a PET scan), presence of BRAF mutation, CNS involvement (do MRI B), check LDH (prognostic marker)
How do you treat BRAF mutation positive advanced melanoma?
with BRAF and MEK kinase inhibitor (either dabrafenib and trametinib OR vemurafenib and cobimetinib)
What are the side effects of BRAF and MEK kinase inhibitors?
fever, photosensitivity, rash, fatigue, GI toxicity, cutaneous SCC
How do you treat BRAF negative advanced melanoma in fit patients?
combined ipilimumab and nivolumab (need to be fit because high toxicity - colitis, pneumonitis)
How do you treat BRAF negative advanced melanoma in unfit patients?
either nivolumab or pembrolizumab
How do you treat melanoma CNS metastases?
if isolated can do targeted radiotherapy or surgery
if symptomatic multiple do whole brain radiotherapy
Does chemotherapy work in RCC?
no
What is the preferred treatment for early stage breast cancer?
breast conservation surgery (wide local excision) plus radiotherapy
Which patients need mastectomy?
patients with tumour >4cm, multifocal, previous chest radiotherapy or central tumour
Which patients need axillary clearance?
positive sentinel node biopsy
What types of chemotherapy are used for breast cancer?
anthracyclines and/or taxanes
What are the common toxicites of anthracyclines?
cardiomyopathy, secondary leukaemia
What are the common toxicities of taxanes?
peripheral neuropathy
What are the indications for chemotherapy in breast cancer?
node +ve cancer,
node negative but high risk features (grade 3, extensive LVI, size >4cm, weak ER/PR expression)
Which patients get tamoxifen?
pre menopausal
What are the side effects of tamoxifen?
joint aches, hot flushes, VTE, secondary uterine cancer
Which patients get aromatase inhibitors/
post menopausal
What are the side effects of aromatase inhibitors?
osteoporosis, joint aches, hot flushes
How do you treat HER 2 positive breast cancer?
trastuzumab with chemotherapy
What is the side effect of trastuzumab?
cardiotoxicity (reversible)
What is the treatment for metastatic HER 2 positive breast cancer?
trastuzumab and pertuzumab with chemotherapy
How do you treat triple negative breast cancer?
consider neoadjuvant chemoterhapy, add carboplatin to chemotherapy regimen, consider PARP inhibitors
What is the strongest predictor of long term prognosis in breast cancer?
+ve axillary lymph node
