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BPT Oncology > Medical Oncology > Flashcards

Medical Oncology Flashcards

1
Q

What are poor prognostic factors in lung cancer?

A

stage of disease, performance status, substantial weight loss, male

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2
Q

What is the screening for patients with lynch syndrome?

A

annually or 2 yearly colonoscopy at age 25 or 5 years before youngest family member diagnosed with cancer

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3
Q

What immunotherapy is used for mismatch repair associated tumours?

A

pembrolizumab, nivolumab and combination (ipilimumab and nivolumab)

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4
Q

What is the treatment for stage 1 colorectal cancer?

A

surgery

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5
Q

What is the treatment for stage 2 colorectal cancer?

A

surgery alone in most, consider single agent chemotherapy for high risk patients

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6
Q

What is the treatment for stage 3 colon cancer?

A

surgery with chemotherapy (single or doublet chemotherapy - 5FU, capecitabine +/- oxaliplatin)

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7
Q

What is the treatment for stage 3 rectal cancer?

A

neoadjuvant chemoraditherapy then wait 10 weeks then surgery

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8
Q

What is the treatment for resectable oligometastatic colorectal cancer?

A

surgery sometimes followed by adjuvant chemotherapy

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9
Q

What factors need to be considered in unresectable metastatic colon cancer?

A

KRAS, NRAS, BRAF mutations, microsatellite instability, performacne status, organ function, right vs left

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10
Q

What is the mainstay of streatment for stage IV colon cancer?

A

chemotherapy

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11
Q

What biologics are available to treat metastatic colon cancer?

A

bevacizumab (VEGF inhibitor), cetuximab/panitumumab (EGFR antibodies)

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12
Q

What are the toxicities of bevacizumab?

A

HTN, proteinuria, arterial thrombosis, poor wound healing, bleeding

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13
Q

What are the side effect for EGFR antibodies?

A

acneform rash, hypomagnesaemia

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14
Q

Which patients can you use EGFR antibodies for?

A

KRAS, NRAS and BRAF wild type

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15
Q

Can you use EGFR antibodies in patients with right sided tumours?

A

no

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16
Q

What is the treatment to prevent acneform rash?

A

moisturised, doxycycline, topical steroid

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17
Q

What is the side effect of oxaliplatin?

A

dose dependent neurotoxicity

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18
Q

What is the side effect of irinotecan?

A

cholinergic side effects and diarrhoea

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19
Q

What is the side effect of 5FU/capecitabine?

A

hand-foot syndrome, diarrhoea, coronary spasm

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20
Q

What is TAS 102 (lonsurf)

A

a last line treatment for metastatic colorectal cancer

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21
Q

How is prostate cancer risk stratified?

A

gleason score, PSA doubling time, PSA after ADT

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22
Q

What ist he PSMA scan?

A

a PET scan with prostate specific membrane antigen enabling earlier and better identification of metastases

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23
Q

What is the first line treatment for prostate cancer?

A

androgen deprivation therapy

24
Q

What are the two different androgen deprivation therapies and why would you choose each?

A

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

25
Q

What are the side effects of ADT?

A

CV risk, osteoporosis, decreased libido, fatigue, hot flushes

26
Q

How do you treat high risk metastatic prostate cancer?

A

Give upfront aggressive treatment (chemotherapy/abiraterone) rather than waiting to become castrate resistant

27
Q

How are denosumab and zoledronic acid used in prostate cancer?

A

to reduce skeletal related events in castrate resistant prostate cancer with bony metastases

28
Q

How do you treat metastatic castrate resistant prostate cancer?

A

if fit and chemo naive give docetaxel, if unfit or prior chemo give abiraterone or enzalutamide

29
Q

Which patients can PARP inhibitors be used in?

A

patients with DNA repair anomalies (e.g. BRCA)

30
Q

What is the mechanism of action of abiraterone?

A

inhibits CYP17 in adrenals and possibly intratumoral

31
Q

What is the mechanism of action of enzalutamide?

A

androgen receptor antagonist and also causes intranuclear inhibition of androgen receptor dependent DNA transcription

32
Q

Which patients is enzalutamide contraindicated in?

A

patients with past history of seizures

33
Q

What is the AR-V7 mutation a marker of?

A

poor response to abiraterone or enzalutamide

34
Q

What things should be assessed in melanoma?

A

whether there is surgical resectability (do a PET scan), presence of BRAF mutation, CNS involvement (do MRI B), check LDH (prognostic marker)

35
Q

How do you treat BRAF mutation positive advanced melanoma?

A

with BRAF and MEK kinase inhibitor (either dabrafenib and trametinib OR vemurafenib and cobimetinib)

36
Q

What are the side effects of BRAF and MEK kinase inhibitors?

A

fever, photosensitivity, rash, fatigue, GI toxicity, cutaneous SCC

37
Q

How do you treat BRAF negative advanced melanoma in fit patients?

A

combined ipilimumab and nivolumab (need to be fit because high toxicity - colitis, pneumonitis)

38
Q

How do you treat BRAF negative advanced melanoma in unfit patients?

A

either nivolumab or pembrolizumab

39
Q

How do you treat melanoma CNS metastases?

A

if isolated can do targeted radiotherapy or surgery

if symptomatic multiple do whole brain radiotherapy

40
Q

Does chemotherapy work in RCC?

A

no

41
Q

What is the preferred treatment for early stage breast cancer?

A

breast conservation surgery (wide local excision) plus radiotherapy

42
Q

Which patients need mastectomy?

A

patients with tumour >4cm, multifocal, previous chest radiotherapy or central tumour

43
Q

Which patients need axillary clearance?

A

positive sentinel node biopsy

44
Q

What types of chemotherapy are used for breast cancer?

A

anthracyclines and/or taxanes

45
Q

What are the common toxicites of anthracyclines?

A

cardiomyopathy, secondary leukaemia

46
Q

What are the common toxicities of taxanes?

A

peripheral neuropathy

47
Q

What are the indications for chemotherapy in breast cancer?

A

node +ve cancer,

node negative but high risk features (grade 3, extensive LVI, size >4cm, weak ER/PR expression)

48
Q

Which patients get tamoxifen?

A

pre menopausal

49
Q

What are the side effects of tamoxifen?

A

joint aches, hot flushes, VTE, secondary uterine cancer

50
Q

Which patients get aromatase inhibitors/

A

post menopausal

51
Q

What are the side effects of aromatase inhibitors?

A

osteoporosis, joint aches, hot flushes

52
Q

How do you treat HER 2 positive breast cancer?

A

trastuzumab with chemotherapy

53
Q

What is the side effect of trastuzumab?

A

cardiotoxicity (reversible)

54
Q

What is the treatment for metastatic HER 2 positive breast cancer?

A

trastuzumab and pertuzumab with chemotherapy

55
Q

How do you treat triple negative breast cancer?

A

consider neoadjuvant chemoterhapy, add carboplatin to chemotherapy regimen, consider PARP inhibitors

56
Q

What is the strongest predictor of long term prognosis in breast cancer?

A

+ve axillary lymph node

BPT Oncology (10 decks)

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