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IPT: Hem/Onc/Transplant > More Block 2 > Flashcards

More Block 2 Flashcards

1
Q

Who is more likely to get lung/bronchus cancer?

A

Males

White, blacks (the most)

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2
Q

What are some screening options for lung cancer?

A

US preventive services task force aims at 55-80 yr olds ≥30 pack-year history

They perform annual low dose CT scans

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3
Q

NSCLC vs SCLC

Which one is sometimes curable?

A

NSCLC

SCLC is NOT curable

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4
Q

NSCLC vs SCLC

Which one is faster growing?

A

SCLC

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5
Q

NSCLC vs SCLC

Which one has no role for surgery?

A

SCLC

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6
Q

NSCLC vs SCLC

Which one makes up 15% of lung cancers?

A

SCLC

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7
Q

NSCLC vs SCLC

Which one has variable histologies?

A

NSCLC

SCLC has neuroendocrine

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8
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one is found on the periphery of lungs?

A

Large cell

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9
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one is the most common type?

A

Adenocarcinoma

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10
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one has a chance of activating mutations?

A

Adenocarcinoma

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11
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one is related to smoking?

A

SCC

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12
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one is most common in non-smokers?

A

Adenocarcinoma

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13
Q

NSCLCs

Adenocarcinoma vs SCC vs large cell carcinoma

Which one occurs centrally?

A

SCC

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14
Q

What is the most common mutation in lung cancer?

A
  1. EGFR

2. ALK

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15
Q

NSCLC staging

A 
I = 1-4cm
II = 5-7cm or invades chest wall, diaphragm, or lungs

III = invades local tissue
IV = metastases present

Stage I - IIIA = resectable

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16
Q

NSCLC treatment?

A

Cisplatin + ______
(or carboplatin if intolerant to cisplatin)

Pemetrexed for non SCC
Gemzar or Docetaxel if SCC

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17
Q

NSCLC Tx if EGFR+?

A

Osimertinib PO for 3 yrs

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18
Q

ECOG status?

A 
0 = active, no symptoms
1 = symptoms, but ambulatory

2 = <50% of time in bed/chair
3 = >50% of time in bed/chair

4 = bed bound
5 = death
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19
Q

Goal of stage IIIB NSCLC?

A

Downstage it for chance of resection

CT scan every 2 cycles

Drugs the same as resectable disease

Maintenance = durvalumab x 12 months

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20
Q

Goal of stage IV NSCLC?

A

Either target mutation

or do that standard chemo doublet

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21
Q

Osimertinib AE?

A

Diarrhea, rash

QTc prolongation and cardiomyopathy

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22
Q

Alectinib AE?

A

Gotta take 8 capsules a day WITH FOOD

Liver and anemia issues

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23
Q

Dabrafenib + Trametinib AE?

A

Both taken on an EMPTY stomach

Dabrafenib - hyperkeratosis

Trametinib - Diarrhea

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24
Q

Limited (one-sided) SCLC treatment?

A

Cisplatin + Etoposide + radiation

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25
Extensive SCLC treatment?
Carboplatin + Etoposide + (atezolizumab/durvalumab) for 4 cycles then just the last drug ***Cisplatin make take over with durvalumab only instead of carboplatin
26
Subsequent treatment of SCLC and relapsed ≤6 months from end of treatment?
Topotecan Lurbinectedin
27
Subsequent treatment of SCLC and relapsed >6 months from end of treatment?
Original treatment
28
How do you screen for melanoma?
ABCDE ``` Asymmetric irregular Borders Color Diameter (>6mm) Evolving characteristics ``` x monthly
29
Where does melanoma arise from?
Melanocytes
30
Superficial spreading melanoma Nodular melanoma Lentigo Maligna melanoma Acral Lentiginous melanoma Which one is the most invasive?
Nodular melanoma
31
Superficial spreading melanoma Nodular melanoma Lentigo Maligna melanoma Acral Lentiginous melanoma Which one is the most common type?
Superficial spreading melanoma
32
Superficial spreading melanoma Nodular melanoma Lentigo Maligna melanoma Acral Lentiginous melanoma Which one is most common in the elderly?
Lentigo Maligna melanoma
33
Superficial spreading melanoma Nodular melanoma Lentigo Maligna melanoma Acral Lentiginous melanoma Which one is most common in blacks, asians, and hispanics?
Acral Lentiginous melanoma
34
Interferon for melanoma use, AE, and dosage forms?
Use = adjunct after surgery AE = granulocytopenia, increased LFTs, flu-like symptoms, anorexia, fatigue, depression Dosage forms = non-PG + PG Peg is much longer duration, but pt doesnt need to show up as often in a week
35
How do you manage interferon toxicity?
Anorexia = smaller, more frequent meals Fatigue = hydration, physical work, nutrition Depression = find cause, test thyroid, maybe add antidepressant Flu-like symptoms = APAP, hydration, anti-emetic, change admin time to bedtime, rule out infections
36
IL-2 toxicities? Contraindication?
Capillary leak syndrome constitutional symptoms Infection N/V NO CORTICOSTEROIDS
37
Which targeted therapies are used for melaonma?
BRAF/MEK inhibitors Cobimetinib and Vemurafenib Dabrafenib and Trametinib
38
BRAF/MEK inhibitor AE? What are some other issues associated with these drugs?
BRAF = skin toxicities, pyrexia, diarrhea MEK = elevated CK and LFTs, pyrexia, diarrhea Innate/Acquired resistance, acquired being more common where initially drug works and then it doesnt
39
What are the immunotherapy options for melanoma?
CTLA-4 inhibitors - Ipilimumab PD-1 inhibitors - Pembrolizumab + Nivolumab **Nivolumab can be used with Ipilimumab
40
Ipilimumab AE?
Rash, diarrhea, liver issues, hypophysitis
41
Dosing of Nivolumab + Ipilimumab for melanoma?
Nivolumab 1mg/kg over 30min followed by ipilimumab 3mg/kg over 90 mins x 4 doses, then nivolumab 240mg q2weeks or 480mg q4weeks over 30 min until disease goes away or toxicity occurs
42
Nivolumab AE? Management?
Lung, liver issues, colitis, TYPE 1 diabetes! Typically give corticosteroids
43
How is early RCC presented?
Typically no symptoms at all in the beginning But can get side/back pain, fatigue, weight loss, loss of appetite
44
1st line therapy to RCC
Sunitinib Pazopanib Axitinib + Pembrolizumab Cabozantinib + nivolumab Favorable risk^ Poor risk v Cabozantinib w/ or w/o nivolumab Ipilimumab w/ nivolumab Axitinib + Pembrolizumab
45
What are the VEGF inhibitors used for RCC?
Avastin Sunitinib Sorafenib Pazopanib
46
Avastin Sunitinib Sorafenib Pazopanib Which one doesnt cause QTc prolongation?
Avastin
47
Avastin Sunitinib Sorafenib Pazopanib Which one causes TLS?
Pazopanib
48
Avastin Sunitinib Sorafenib Pazopanib Which one oral pain?
Sunitinib
49
Avastin Sunitinib Sorafenib Pazopanib Which one causes more liver damage?
Pazopanib
50
General side effects of VEGF inhibitors?
Hypothyroidism, HFSR, HTN, thromboembolism
51
What are some other VEGF inhibitors that are typically "better" with some AE?
Axitinib; less HFSR Tivozanib; generally less AE
52
How do you treat HFSR?
Give urea or salicylic cream/lotion
53
How do you treat the diarrhea associated w/ VEGF inhibitors?
BRAT diet
54
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 3 weeks before surgery?
Cabozantinib + Sunitinib
55
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 1 week before surgery?
Lenvatinib + Pazopanib
56
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 2 days before surgery?
Axintinib
57
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 10 days before surgery?
Sorafenib
58
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 28 days before surgery?
Avastin
59
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one is held 2 weeks AFTER surgery?
All of them except Avastin Avastin is 28 days AFTER too
60
``` Avastin Sunitinib Sorafenib Pazopanib Axitinib Cabozantinib Tivozanib Lenvatinib ``` Which one has no data on surgery?
Tivozanib
61
What are the 2nd line drugs for RCC?
mTOR inhibitors (STE) Sirolimus Temsirolimus (prodrug of sirolimus) Everolimus
62
mTOR AE?
Hyperglycemia, hypercholesterolemia, and hyperlipidemia Pneumonitis
63
BSA equation?
Square root of ((cm*kg)/3600)
64
Where does BSA NOT work?
<1yo <15kg Therefore use 1m^2 = 30kg
65
What is the Calvert Equation?
Carboplatin dose (mg) = Target AUC * (GFR+25) GFR max = 125
66
How do you figure out the max dose of carboplatin?
Find out what the target AUC is and multiply by 150
67
How do you calculate a absolute neutrophil count?
WBC * (%segmented + bands)

IPT: Hem/Onc/Transplant (7 decks)

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