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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
Q

Extensive SCLC treatment?

A

Carboplatin + Etoposide + (atezolizumab/durvalumab) for 4 cycles then just the last drug

***Cisplatin make take over with durvalumab only instead of carboplatin

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26
Q

Subsequent treatment of SCLC and relapsed ≤6 months from end of treatment?

A

Topotecan

Lurbinectedin

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27
Q

Subsequent treatment of SCLC and relapsed >6 months from end of treatment?

A

Original treatment

28
Q

How do you screen for melanoma?

A

ABCDE

Asymmetric
irregular Borders
Color
Diameter (>6mm)
Evolving characteristics

x monthly

29
Q

Where does melanoma arise from?

A

Melanocytes

30
Q

Superficial spreading melanoma
Nodular melanoma
Lentigo Maligna melanoma
Acral Lentiginous melanoma

Which one is the most invasive?

A

Nodular melanoma

31
Q

Superficial spreading melanoma
Nodular melanoma
Lentigo Maligna melanoma
Acral Lentiginous melanoma

Which one is the most common type?

A

Superficial spreading melanoma

32
Q

Superficial spreading melanoma
Nodular melanoma
Lentigo Maligna melanoma
Acral Lentiginous melanoma

Which one is most common in the elderly?

A

Lentigo Maligna melanoma

33
Q

Superficial spreading melanoma
Nodular melanoma
Lentigo Maligna melanoma
Acral Lentiginous melanoma

Which one is most common in blacks, asians, and hispanics?

A

Acral Lentiginous melanoma

34
Q

Interferon for melanoma use, AE, and dosage forms?

A

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
Q

How do you manage interferon toxicity?

A

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
Q

IL-2 toxicities? Contraindication?

A

Capillary leak syndrome

constitutional symptoms

Infection

N/V
NO CORTICOSTEROIDS

37
Q

Which targeted therapies are used for melaonma?

A

BRAF/MEK inhibitors

Cobimetinib and Vemurafenib

Dabrafenib and Trametinib

38
Q

BRAF/MEK inhibitor AE? What are some other issues associated with these drugs?

A

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
Q

What are the immunotherapy options for melanoma?

A

CTLA-4 inhibitors - Ipilimumab

PD-1 inhibitors - Pembrolizumab + Nivolumab

**Nivolumab can be used with Ipilimumab

40
Q

Ipilimumab AE?

A

Rash, diarrhea, liver issues, hypophysitis

41
Q

Dosing of Nivolumab + Ipilimumab for melanoma?

A

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
Q

Nivolumab AE? Management?

A

Lung, liver issues, colitis, TYPE 1 diabetes!

Typically give corticosteroids

43
Q

How is early RCC presented?

A

Typically no symptoms at all in the beginning

But can get side/back pain, fatigue, weight loss, loss of appetite

44
Q

1st line therapy to RCC

A

Sunitinib
Pazopanib
Axitinib + Pembrolizumab
Cabozantinib + nivolumab

Favorable risk^

Poor risk v

Cabozantinib w/ or w/o nivolumab
Ipilimumab w/ nivolumab
Axitinib + Pembrolizumab

45
Q

What are the VEGF inhibitors used for RCC?

A

Avastin
Sunitinib
Sorafenib
Pazopanib

46
Q

Avastin
Sunitinib
Sorafenib
Pazopanib

Which one doesnt cause QTc prolongation?

A

Avastin

47
Q

Avastin
Sunitinib
Sorafenib
Pazopanib

Which one causes TLS?

A

Pazopanib

48
Q

Avastin
Sunitinib
Sorafenib
Pazopanib

Which one oral pain?

A

Sunitinib

49
Q

Avastin
Sunitinib
Sorafenib
Pazopanib

Which one causes more liver damage?

A

Pazopanib

50
Q

General side effects of VEGF inhibitors?

A

Hypothyroidism, HFSR, HTN, thromboembolism

51
Q

What are some other VEGF inhibitors that are typically “better” with some AE?

A

Axitinib; less HFSR

Tivozanib; generally less AE

52
Q

How do you treat HFSR?

A

Give urea or salicylic cream/lotion

53
Q

How do you treat the diarrhea associated w/ VEGF inhibitors?

A

BRAT diet

54
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 3 weeks before surgery?

A

Cabozantinib + Sunitinib

55
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 1 week before surgery?

A

Lenvatinib + Pazopanib

56
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 2 days before surgery?

A

Axintinib

57
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 10 days before surgery?

A

Sorafenib

58
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 28 days before surgery?

A

Avastin

59
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one is held 2 weeks AFTER surgery?

A

All of them except Avastin

Avastin is 28 days AFTER too

60
Q 
Avastin
Sunitinib
Sorafenib
Pazopanib
Axitinib
Cabozantinib
Tivozanib
Lenvatinib

Which one has no data on surgery?

A

Tivozanib

61
Q

What are the 2nd line drugs for RCC?

A

mTOR inhibitors (STE)

Sirolimus
Temsirolimus (prodrug of sirolimus)
Everolimus

62
Q

mTOR AE?

A

Hyperglycemia, hypercholesterolemia, and hyperlipidemia

Pneumonitis

63
Q

BSA equation?

A

Square root of ((cm*kg)/3600)

64
Q

Where does BSA NOT work?

A

<1yo
<15kg

Therefore use 1m^2 = 30kg

65
Q

What is the Calvert Equation?

A

Carboplatin dose (mg) = Target AUC * (GFR+25)

GFR max = 125

66
Q

How do you figure out the max dose of carboplatin?

A

Find out what the target AUC is and multiply by 150

67
Q

How do you calculate a absolute neutrophil count?

A

WBC * (%segmented + bands)

IPT: Hem/Onc/Transplant (7 decks)

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