MONC Flashcards
Which of the following is most commonly associated with severe diarrhea?
A. Cisplatin B. Cladribine C. Doxorubicin D. Capcitabine E. Cyclophosphamide
D - capcetibine; pyrimadine antagonist associated with severe diarrhea
A. Cisplatin - neuropathies, extremely emetogenic
B. Cladribine - mucositis, depression, neurotoxicity
C. Doxorubicine - heart failure
E. Cyclophosphamide - Hemmorhagic cystitis
Name 3 non-malignant factors that can elevate CEA
Smoking Diabetes COPD Pancreatitis, diverticulitis, colitis, gastritis, hepatitis/cirrhosis Any chronic inflammatory condition
In which group of patients is olparib likely to be of most benefit?
A. BRCA mutated, HER2 positive breast cancer
B. BRCA mutated, HER2 negative breast cancer
C. BRCA wild type, triple negative breast cancer
D. BRCA wild type, HER2 positive breast cancer
B. BRCA mutated HER2 negative breast cancer (regardless of HR status)
- can be used after initial surgery+ chemo in high risk (i.e. node +ve, large tumor) disease or second line for recurrence in same groups
Not used in HER2 +ve breast cancer or BRCA wild type (targets BRCA mutated deficient cells)
In which group of patients is sacituzumab-govitecan likely to be of most negative?
A. Triple negative breast cancer
B. HER2+ve/HR-ve breast cancer
C. HER2-ve/HR +ve breast cancer
D. Breast cancer with brain metastases
A. locally advanced unresectable triple negative breast cancer (failed 2 therapies)
Trop-2-directed antibody and topoisomerase inhibitor drug conjugate
Target of ribociclib?
A. PDL1
B. PL3-Ka
C. CD4/6
4. PARP
C. CD4/6, HR+ve/HER2 -ve metastatic breast cancer (+AI/fulvestrant)
PL3-KA = alpelisib
PDL1 = pembolizumab
PARP inhibitor = olparib
Standard chemotherapy regime for colorectal cancer?
With or without radiotherapy?
FOLFOX - oxiplatin + leucovorin + FU
CAPOX (oxi + capcitabine) can be used, more toxic but shorter course
Radiotherapy only for rectal cancer
Cetuximab:
- target
- use
- side effects
Target: EGFR mab
Utility: RAS wild type CRC; head and neck SCC
S/e: rash, diarrhea, infusion related reaction
Other EGFR mab - panitumumab
Erlotinib:
- target
- use
- side effects
Target: EGFR TKI
Utility: NSCLC EGFR mutation +ve
S/.E: rash, dirreah
Other agents: gefitinib, afatinib
Osimertinib
- target
- use
- side effects
Target: EGFR against T790M TKI
Utility: NSLC EGFR T790M+
S/E: maculopapular rash (face and upper body)
Trastuzumab
- target
- use
- side effects
Target: HER2 MAB
Utility: HER2 +ve breast cancer
S/E: cardiotoxicity
Other agents: pertuzumab (associated with diarrhea)
Lapatinib
- target
- use
- side effects
Target: HER2/EGFR TKI
Utility: HER2 +ve breast cancer
S/E: palmar-plantar erythrodysthesia (hand-foot syndrome), rash, diarrheah, cardiotoxicity
TDMI
- target
- use
- side effects
Target: HER2 mab conjugated to chemotherapy DM1 (emtansine)
Utility: HER2 +ve breast cancer
S/E: thrombocytopenia, transaminitis
Alectinib
- target
- use
- side effects
Target: ALK rearrangement
Utility: ALK +ve NSCLC
S/E: N/V/D, visual disturbances, hepatitis, pneumonitis, bradycardia
Other agents: ciritnib and crizotinib (more s/e than alectinib) and brigatinib (superior to crizotinib)
Dabrafenib
- target
- use
- side effects
Target: BRAF TKI
Utility: Melanoma, BRAF V600 +ve
S/E: fever, skin tioxicity, hair changes, arthralgias
Other agents: vemurafenib
Not - skin toxicities improved when given with a MEK inhibitor
Trametinib
- target
- use
- side effects
Target: MEK TKI
Utility: Melanoma, BRAF V600 +ve
S/E: rash, diarhhoea
Bevacizumab
- target
- use
- side effects
Target: VEGF Mab
Utility: metastatic CRC (inc. RAS mutants)
S/E: HTN, thrombosis
Sunitinib
- target
- use
- side effects
Target: VEGFR TKI
Utility: clear cell RCC, HCC, differentiated thyroid, soft tissue sarcoma
S/E
Other agents: pazopanib, axitinib, cabozantinib, lenvatinib, vandetanib, sorafenib
S/E - many, but hand/foot syndrome, HTN, hypothryoidism, hepaitis, cardiotoxicity, diarrhoea
Imatinib
- target
- use
- side effects
Target: cKIT
Utility: GIST
S/E: cramps, maculopapular rash, NV/V/D, fatigue
Ipilumab
- target
- use
- side effects
Target: CTLA-4
Use: melanoma, clear cell RCC
S/E: immune related toxicity
Which group of patients with NSCLC are most likely to have a EGFR mutation?
A. Smokers
B. Caucasians
C. Men
D. Asian populations
Which drug do patients with NSCLC and EGFR mutation benefit from?
D. Asians - also non-smokers, females
Benefit from erlotinib, alatanib and gefitinib
Osimertinib recently shown to have greater survival benefit compared with above
Selpercatinib
- target
- use
- side effects
Target: RET-oncogene (TKI)
Use: NSCLC + thyroid cancer RET fusion +ve; medullar thryoid cancer with RET mutant
S/E: haemmorhage, hepatotoxicity, HTN, hypersensitiviity
Chemotherapies with the highest emotogenic risk
Doxorubicin>=60 mg/m2
Anthracycline + cyclophosphamide combination
Cisplatin, carboplatin + oxiplatin
What 3 syndromes can be associated with cyclophosphamide?
1) Interstitial pneumonitis – if low dose, prolonged duration of Rx.
2) Interstitial pulmonary fibrosis – if used in high dose for prolonged duration.
3) Severe cardiotoxicity- if large dose in short period
Also most common cause of chemo-related haemmorhagic cystitis
Which of the following is a PD-1 inhibitor?
a) Atezolizumab
b) Avelumab
c) Durvalumab
d) Dostarlimab
E - dostarlimab
All the others are PDL1 inhibitors
Mechanism of action of ipilimumab
In which of the following does it NOT have a role?
a) melanoma
b) RCC
c) HCC
d) CRC
e) mesothelioma
f) NSCLC
CTLA4 blockage
Enhanced the ability of APCs to activate T cells –> enhanced T cell activation and proliferation
E) mesothelioma
NB: MSI high/MMR deficient CRC
Which cancers does FDG PET have a role in stage?
Which does it not?
- oesophageal and colorectal cancer
- head and neck cancer
- melanoma
No current role for gastric cancer
Strongest predictive factor of poor outcome in breast cancer
Node +ve disease
4–8 times higher mortality than those without nodal involvement
Risk factors for renal cell carcinoma
Analgesic nephropathy
Leather tanners
Cadmium Thorotrast (used as a contrast medium in X-ray)
Acquired cystic disease
Von Hippel-Lindau (VHL) tumor suppressor gene Smoking
Obesity
Hypertension
Where do the tumor cells of renal cell cancer arise from?
Proximal convoluted tubule
What is the leading cause of death for survivors of testicular tumors following successful chemotherapy?
Secondary cancers
Risk factors for relapse in seminomas (germ cell)?
Risk factors for relapse in non-seminomas?
Seminoma (GCT)
- Tumour size (> 4 cm)
- Invasion of the rete testis
Non-seminoma
- Vascular/lymphatic in or peri-tumoural invasion
- Proliferation rate > 70%
- Percentage of embryonal carcinoma > 50%
Treatment of G1 seminoma
Orchiectomy
Carboplatin based chemotherapy recommended if high risk features (>4cm, invasion of rete testis)
Treatment of GBM
Surgery + Temozolomide + radiotherapy
PARP inhibitors mechanism of action
Single-strand DNA repair inhibition
Chemotherapy agents acting at metaphase
Vinca alkaloids
- M/S phase specific (cell cycle arrest at metaphase)
Chemotherapy agents acting at S phase
Topoisomerase inhibitors (i.e. irinotecan) Antimetabolites
Chemotherapy agents acting at G2 phase
Etoposide
Bleomycin
Taxanes
