Oncology Flashcards
1
Q
When to cease a cancer drug due to SE
A
If SE impacting function
2
Q
Spindle cells
A
GIST
3
Q
CTLA-4 inhibitor
A
Ipilimumab
4
Q
PD-1 inhibitor
A
Pembrolizumab
Nivolumab
5
Q
Serum marker elevated in testicular Ca
A
b-HCG
AFP in non-seminoma
6
Q
Cancers associated with BRAF mutation
A
Melanoma
CRC less commonly
7
Q
Risk of breast cancer with BRCA
A
70%
8
Q
BRCA screening
A
MRI / ultrasound yearly from 30
Mammogram after 50
9
Q
Breast ca screening
A
2 yearly 50 -74
10
Q
Patients that qualify for axilalry dissection - Early breast cancer
A
> 2 LN
11
Q
High risk breast Ca
A
HER positive
ER negative
12
Q
Tamoxifen
A
Eosteogen receptor blocker
Increased DVT/PE
Uterine Cancer
SSRI reduces active tamoxifen (fluoxetine or parole tube)
Treat for 5 years unless high risk
13
Q
Aromatase inhibitor SE
A
Block conversion if androgen to oestrogen
Post menopausal women
Menopause
Arthralgia
Accelerated osteoporosis
14
Q
Raised AFP
A
Non seminona
15
Q
Chemo for testicular cancer
A
Bleomycin
Etoposide
Cisplatin
16
Q
TTF1 cancer association
A
Adenocarcinoma
17
Q
MEN-1 cancer association
A
parathyroid gland, anterior pituitary, and enteropancreatic
18
Q
C-RET cancer assocaition
A
medullary thyroid cancer
19
Q
FAP screening
A
Annual sigmoidoscopy from age 12 years
Two yearly gastroscopy from 25 years as gastric and duodenal polyposis
20
Q
Risk factors for Trastuzumab cardiac toxicity
A
Previous or concurrent anthracycline use and age greater than 50 years are the strongest risk factors
21
Q
Location of CTLA-4
A
T Cell - interacting with APC
22
Q
Location of PDL-1
A
Tumour cell
23
Q
Drugs that respond well to immunotherapy
A
Microsatellite-repair (MSI) high tumours
High mutation burden
Melanoma, NSCLC, Bladder, Lung small cell, oesophageal
24
Q
Prognostic marker for immunotherapy for melanoma
A
High Baseline LDH has poor prognosis
25
CDK4/6 inhibitor indicates
Metastatic
HER 2 negative
Hormone receptor positive
26
Cheyne stokes breathing
Heart failure
27
Treatment of limited stage 1 Small cell lung cancer
1. Resetion and LN sampling
| 2. Adjuvent chemo with 4 cycles cisplatin based therapy
28
Treatment of extensive disease small cell lung cancer
1. 4 cycles platinum based chemotherapy
| 2. Radiotherapy if good response to chemotherapy
29
Rx stage I or II NSCLC
1. Resection (lobectomy and LN resection) or steroatactic ablative body radiation with curative intent (if not suitable for surgery)
2. Adjuvent cisplatin chemotherapy
30
Rx Stage III NSCLC
1. Surgical resection
2. Chemo
3. RT
4. Immunotherapy with darvalumab if no progression
31
Rx Stage IV NSCLC
Driver mutation absent
Low PD-L1 expression
1. Chemotherapy (platinum-based doublet)
| 2. Supplemental Immunotherapy (Pembrolizumab/bevacizumab)
32
Rx Stage IV NSCLC
Driver mutation absent
High PD-L1 expression (>50%)
Immunotherapy first line with pembrolizumab
33
Rx Stage IV NSCLC
| Driver mutation: EGFR
Osimertinib
34
Osimertinib
| MOA/SE
MOA: EGFR- TKI that selectively inhibits EGFR-TKR-sensitising and EGFR T790M resistant mutations
SE: Aceneiform rash (correlated with treatment response) - steroids
Diarrhoea, ocular, pulomnary, alopecia
35
Rx Stage IV NSCLC
| Driver mutation: ALK gene rearrangement (EML4-ALK fusion oncogene)
1st: Alectinib
other: crizotinib
36
Rx Stage IV NSCLC
| Driver mutation: ROS-1 rearrangement
Crizotinib
MOA: Targets ROS-1 in addition to ALK and MET kinase
37
Rx HCC single lesion and normal portal pressure/bili
Resection
38
Rx HCC up to 3 lesions
Associated comorbidities: Radiofrequency ablation
| Nil comorbidities: Transplant
39
RX HCC Multinodular
1. TACE
| 2. Sorafenib - Oral multi-kinase inhibitor
40
SE Sorafenib
fatigue, fever, diarrhoea, palmar-plantar erythrodysesthesia (hand-foot syndrome)
41
Rx HCC Terminal (Childs Pugh C)
Symptomatic
42
Rx SCC/Adnocarcinoma of oesophagus in T4a or less invasive
Resection
43
Rx SCC of oesophagus in T4b or metastic
Flourouracil plus cisplatin concurrently with RT
44
Rx of Adenocarcinoma of oesophagus
| T4b or metastatic
carboplatin plus paclitaxel concurrently with RT with follow-up resection
45
Treatment of GIST
Resection +/- imitinib
46
Imitinib
tyrosine kinase receptor inhibitor
1. SCF/c-kit receptor tyrosine kinase is activated in gastrointestinal stromal tumor (GIST).
2. BCR/ABLfusion p TK in CML
47
Targeted agent for metastatic CRC if RAS/RAF wild type
EGFR inhibitors
Cetuximab
Panitumimab
48
Targeted agent for metastatic CRC if RAS/RAF mutations
VEGF inhibitors:
| Bevacizumab
49
Rx of stage 1-2 CRC
Resection
50
Rx of Stage 3 CRC (i.e LN positive)
Resection
| Adjuvent FOLFOX or CAPOX (3 to 6 months)
51
Rx Metastatic CRC (4b)
1. Palliative chemo - FOLFOX/CAPOX/FOLFIRI
| 2. Targeted agent (VEGF inhibitor/EGFR inhibitor)
52
CRC screening for category 2 risk
FOBT 2 yearly from 40 - 49
| Colonoscopy 5 yearly 50 -74
53
CRC for category 3 risk
FOBT 2 yearly from 35- 39
| Colonoscopy 5 yearly from 40 - 74
54
Colonoscopy Screening for FAP
1 yearly 10 years
2 yearly 24 + yearly gastroscopy+ thyroid USS _ duodenoscopy
3 yearly 34
5 yearly 44
55
Cancer screening in lynch
1. Yearly colonoscopy from 20/2 years since first diagnosis in family)
2. 3 yearly gastroscopy from 30
Nil other evidence based
Consider endometrial sampling yearly from 30
56
Treatment of advanced RCC
* Tyrosine kinase inhibitors: anti-VEGF, anti-AXL anti-cMET
* Anti-PD1 therapy, eg/ nivolumab, ipilimumab
* mTOR inhibitors
57
Rx Stage III Melanoma (i.e. LN involvement)
Surgical dissection
| Consider RT + Systemic treatment
58
Rx Metastatic melanoma with BRAF mutations
BRAF + MEK inhibitors
o Vemurafenib + cobimetinib
o Dabrafenib + trametinib
59
Rx Metastatic melanoma without BRAF mutations
Ipi/Nivo
60
Type of Thyroid cancer that radioactive iodine does not work against
Medullary (parafollicular cells)
61
BRCA 1/2 related cancers
Breast
Ovary
Prostate
Pancreas
62
Alkylating agents
Cyclophosphamide
Isosfamide
Temosolamide
Melphalen
63
SE cyclophosphamide
```
Haemorrhagic cystitis
Bladder cancer
Infertility
SIADH-like
Lymphopaenia
Cardiotoxicity if given as large dose (BMT)
Fibrosis
Pneumonitis
```
64
Anthracyclines (Topoisomerase II inhibitors)
Doxorubacin
Epirubacin
Mitoxantrone
65
Anthracycline SEs
```
Cardiotoxicity - irreversible and dose dependent, effect can be delayed for decades
Palmar plantar erythema
Blistering
Vasicant rash
Extravasation - Rx: Dexrazoxane
```
66
Azathioprine SE
Rash
Hepatitis
Pancreatitis
67
Bleomycin SE
Pneumonitis
| Renal and skin
68
Calcineurin inhibitors
Tacrolimus
| Cyclosporin
69
Calcineurin Inhibitors SE
```
Nephrotoxicity
Neurotoxicity
Diabetes Tac>cyclo
Electrolytes - K up Mg down
Acne
Dyslipidaemia
Malignancy
Hair loss (tacro)
Hirsuitism (cyclo)
Drug interaction
```
70
Mycophenolate SE
Mucositis
71
Platinum-based chemo(crosslink DNA) examples
Carboplatin
Cisplatin
Oxaliplatin
72
Platinum-based chemo SE
Carbo: Myelosuppressive
Cisplatin: Emetogentic/nephrotoxic, ototoxic
Oxaliplatin: Neurotoxic (PN)
Vesicant rash
73
Pyramidine inhibitors examples
Azacitadine in AML
Capecitabine/5FU in CRC
Cytarabine
Gemcitabine
74
Pyramidine SEs
Azacitadine: myelosupression
5FU: mucositic, diarrhoea, coronary spasm
Cytarabine: Cerebellar toxicity, encephalopathy, keratitis, mucositis
Gemcitabine: Hepatotoxic, flu-like
75
Taxanes examples (inhibit tubulin)
Paclitaxel
| Doxetaxel
76
Taxane SEs
Peripheral neuropathy
Vesicant toxic
infertility
77
Topoisomerase inhibitors (S Phase) examples
Irinotecan
| Etoposide
78
Vinca alkaloids (inhibit microtubules in M phase)
Vincristine in R-CHOP NHL
| Vinblastine in ABVD - HL
79
SEs Vinca alkaloids
Headache
Blistering
Neuropathy
80
MOA, indication and SE of Lapatinib
MOA: Selective inhibitor of the intracellular tyrosine kinase domains of both ErbB1 (EGFR) and HER2 receptors.
Indication: Metastatic HER+ breast Ca if have progressed on trastuzumab
Brain mets (crosses BBB > trastuz)
SE: Skin reactions
81
Absolute contraindications to breast conserving surgery
1) Persistently positive resection margins after reasonable reexcision attempts.
2) Two or more primary tumors in separate breast quadrants.
3) Diffuse malignant appearing mammographic microcalcifications.
4) A history of prior radiotherapy to the breast or chest wall.This precludes further radiotherapy.
5) Pregnancy, although possible to perform BCT in 3rd trimester, deferring breast radiotherapy until after delivery.
82
FU stage 1 testicular Ca
```
1st year monthly.
2nd year 2 monthly
3rd year 3 monthly
4th year 6 monthly
Then yearly.
```
83
Testicular cancer not responsive to radiotherapy
Non seminoma
84
ECOG
```
0 = fully active
1 = limited activity but ambulatory.
2 = In bed <50% of waking hours.
3 = In bed >50% of waking hours.
4 = completely disabled.
5 = dead
```
85
most common metastatic melanoma
superficial spreading
