Onc - dis Flashcards
Prostate Cancer - types & differentiation
95% adenoCa
1) Castration-sensitive
- Give ADT (T suppression via GnRH agonists (Goserelin, Leuprolide)
+ Docetaxel if high vol of dis (>4 boney mets, pain, risk urinary retention)
- Consider GnRH antagonists (degarelix) + anti-androgen cover- Bicalutamide)
2) Castration-resistant
- progresses while on ADT
- Docetaxel - first line
- Androgen receptor targeted Rx: Abiraterone/Enzalutamide - 2nd line
- Consider PARP in BRCA, vaccine (Sipuleucel), & labelling PSMA (prostate specific mmb antigen) for Lutetium-PSA
Renal cell Rx
1) TKIs: VEGF
- Sunitinib, Sorafenib
S/E: LFT derangements, HTN, PRES etc
2) Immune checkpt inhibitors: Nivolumab + Ipilimumab
3) mTOR-inh
Don’t do nephrectomy
Rx in CRC (not genetic)
1) RAS/BRAF wildtype LEFT - EGFR (cetuximab/panitumumab) + chemo (5-FU/capecitabine + Oxaliplatin/Irinotecan)
2) RAS/RAF mutant + RIGHT - VEGF (Bevacizumab) + chemo (5-FU/capecitabine + Oxaliplatin/Irinotecan)
3) MSI high - Pembro, Niv, Nivo + Ipi
Abiraterone - MOA & S/E
Blocks T synthesis in adrenal gland
Through inhibition CYP17 (therefore DHEA - androgens - T)
= Increase other steroid precursors
- LFTs - transaminitis
- Adrenal insufficiency - need to give w/ Pred (C/I in DM)
- Mineralocorticoid sx - HTN, HypoK (C/I CVD)
Enzalutamide - MOA & S/E
Inhibition of AR testosterone binding
- C/I in seizures / cog impairment
- Cog decline, hallucinations
- ADT s/e: Gynaecomastia, fatigue
- HTN
Melanoma - Stage III/IV
BRAF mutant (50%): Dabraf + Trametinib
BRAF wildtype; Pembrolizumab or Nivolumumab
(Vemurafenib + Cobimetinib)
Breast Ca - HER2+
1st line: Transtuzumab (neoadjacent prior to surg) ?PCR
- Identifies non responders change to T-DM1)
Surgery (SLNB) if >2 SN - Axillary dissection, if tumour >4cm then masectomy
Adj RadioRx
Adj Chemo in high risk (eg ER/PR low)
- Anthracycline (doxirub, epirub) + Taxane (pacli, docetax)
Adj Transtuzumab 12m (+ Pertuzumab if mets, inc LN)
- in low risk pts coudl deescalate after 12wks (only paclitaxel)
T-DM1: 2nd line metastatic
T-DM1?
Transtuzumab - emtansine
DM1 is internalised & acts as cytotoxic
Less toxic than std chemo
2nd line metastatic HER2+
