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Oncology Flashcards

1
Q

2 main NTs involved in the patho of CINV

A

5-HT3
NK-1

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2
Q

risk factors for CINV (6)

A

emesis during pregnancy, age <50, female, anxiety pretreatment, little/no alcohol use, history CINV/prone to motion sickness

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3
Q

CINV treatment
HIGH RISK PARENTERAL

A

day 1- olanzapine, dexamethasone, NK1RA, 5-HT3 RA
day 2-4- olanzapine, dexamethasone +/- aprepitant

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4
Q

CINV treatment
MOD RISK PARENTERAL

A

day 1- dexamethasone, 5-ht3 RA
day 2-3- dexamethasone or 5-ht3 ra

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5
Q

CINV treatment
LOW RISK PARENTERAL

A

dexamethasone > metoclopramide > prochlorperazine > 5-ht3 ra

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6
Q

CINV treatment
MOD/HIGH RISK ORAL

A

5-HT3 RA

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7
Q

CINV treatment
what do you do if breakthrough emesis?

A

add agent from another class

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8
Q

CINV treatment
what do you do if there is anticipatory emesis

A

lorazepam
behavioral therapy

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9
Q

which 5HT3-ra are short acting and best for acute NV

A

ondansetron, granisetron

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10
Q

which 5ht3-ra is long acting and good for acute or delayed

A

palonosetron

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11
Q

which agents are NK1 RAs used for CINV

A

aprepitant, fosaprepitant, rolapitant, etc.

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12
Q

NK1 RA can only be used for ___ of CINV

A

prevention
NOT TREATMENT

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13
Q

2 options for refractory CINV

A

dronabinol
scopolamine

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14
Q

major offender causing chemo diarrhea

A

irinotecan

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15
Q

main 2 options for chemo diarrhea?
alternatives?

A

loperamide, diphenoxylate-atropine

alt- hyoscyamine, atropine, octreotide

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16
Q

patient risk factors for mucositis (6)

A

smoking, poor oral hygiene, oral lesions at baseline, female, younger age, pretreatment nutrition

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17
Q

major offender for mucositis

A

melphalan

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18
Q

treatments for mucositis

A

cryotherapy
mouthwash (bland/oncology/dexamethasone)
etc

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19
Q

patient risk factors for febrile neutropenia

A

prior chemo/radiation, persistent neutropenia, bone marrow involvement, recent surgery/wounds, liver/renal dysfunction, age >65 receiving full chemo intensity

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20
Q

when are growth factors used for primary prevention

A

high risk no matter the risk factors– yes

int risk with 1 risk factor- maybe

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21
Q

when is growth factors needed DURING febrile neutropenia

A

if received prophylactic filgrastim– continue

no prophylaxis— assess risk factors

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22
Q

short acting growth factor given daily until recovery starting up to 3-4 days post chemo

A

filgrastim

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23
Q

long acting growth factor given up to 3-4 days post chemo and there should be 12 DAYS BETWEEN DOSE AND NEXT CHEMO

A

pegfilgrastim

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24
Q

long acting growth factor given 24 hours post chemo
DO NOT ADMIN 14 DAYS BEFORE & 24 HOURS AFTER CHEMO

A

eflapegrastim, efbemalengrastim

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25
Q

3 subtypes of breast cancer

A

hormone receptor pos
HER2 pos
triple negative

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26
Q

patho of breast cancer

A

proliferative abnormality in lobular and ductal epithelium

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27
Q

non modifiable risks for BC

A

female, older, FH/PH, genetics, breast changes, ionizing radiation, breast density, early menarche/late menopause

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28
Q

modifiable risks for BC

A

nulliparity or older age for 1st child, menopausal hormone therapy, post menopause obesity, physical inactivity, alcohol

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29
Q

which type of BC has skin edema, redness, warmth, induration, cancer cells in dermal lymphatics with very quick onset and poor prognosis

A

inflammatory BC

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30
Q

treatment for NONINVASIVE lobular carcinoma in situ? ductal?

A

lobular– monitor
ductal– lumpectomy + radiation or mastectomy +/- endocrine therapy

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31
Q

2 regimens used for HER2+ DIRECTED therapy

A

docetaxel/carboplatin/trastuzumab +/- pertuzumab
or
paclitaxel + trastuzumab

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32
Q

criteria for pertuzumab use in BC

A

> T2 or >N1, HER2 +, high recurrence risk

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33
Q

endocrine therapy options for ER/PR + BC?
when is each class preferred?

A

tamoxifen— premenopause aromatase inhibitor– postmenopause

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34
Q

if an aromatase inhibitor is used premenopause, what is also required

A

ovarian suppression

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35
Q

what treatment is required post-chemo for HER+?

A

continue trastuzumab or pertuzumab/trastuzumab to complete 1 year

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36
Q

what general treatments are started for ER/PR+ and HER2+ BC

A

chemo (HER2 directed) + endocrine therapy

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37
Q

what general treatment is started for ER/PR+ and HER2- BC

A

chemo + endocrine therapy

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38
Q

what are the 2 preferred chemo regimens for ER/PR+ and HER2-

A
  1. doxorubicin/cyclophosphamide –> paclitaxel Q2W
  2. docetaxel and cyclophosphamide
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39
Q

when is oncotype dx used in BC

A

hormone + and HER2 - cancer with small tumor to determine if chemo is needed

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40
Q

general treatment option for ER/PR- and HER2+ BC

A

chemo (HER2 directed)

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41
Q

general treatment option for triple negative BC

A

chemo

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42
Q

neoadjuvant and adjuvant chemo regimen options for TRIPLE NEG BC

A

neo: pembrolizumab + paclitaxel/carboplatin –> pembrolizumab + doxorubiicn/cyclophosphamide

adj: pembrolizumab

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43
Q

endocrine therapy options for HR+ HER2- MBC (4)

which 2 can be added in stage II/III w/ high risk?

A

palbociclib
ribociclib **
abemaciclib **
everolimus

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44
Q

endocrine therapy option for HR + HER2-, PIK3CA/AKT1/PTEN mutated MBC

A

capivasertib

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45
Q

additional adjuvant if needed for HER2+ or ER/PR+

A

neratinib

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46
Q

regimen for HER 2 + MBC

A

pertuzumab + trastuzumab + docetaxel/paclitaxel

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47
Q

what can be added for BC treatment to help with internalization of chemo?

A

antibody drug conjugates

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48
Q

agents that can be added for bone metastases in BC?
which ones need renal adjustment

A

zoledronic acid, pamidronate- renal
denosumab

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49
Q

which drugs for BC treatment causes neuropathy?

A

taxanes- paclitaxel, docetaxel

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50
Q

which 2 agents/classes cause cardiotoxicity for BC treatment

A

doxorubicin
HER2 therapies

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51
Q

important PK/DDI for tamoxifen

A

prodrug w/ hep metabolism
DDI w/ CYP2D6 inhibitors (SSRI/SNRI)

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52
Q

3 aromatase inhibitors

A

anastrazole, letrozole, exemestane

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53
Q

counseling for tamoxifen

A

menopausal sx, menstrual changes, uterine/endometrial cancer, VTE, stroke, avoid during pregnancy

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54
Q

counseling for aromatase inhibitors

A

menopausal sx, musculoskeletal sx, increased bone loss, high cholesterol, CV risk

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55
Q

patho of lung cancer

A

acquire molecular lesions — cell division/death — malignant transformation

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56
Q

2 subtypes of lung cancer

A

non-small cell (most common)
small cell (more aggressive)

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57
Q

common metastatic sites of lung cancer

A

contralateral lung, lymph nodes, CNS

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58
Q

2 common presenting signs of lung cancer

A

pulmonary symptoms, SUperior Vena Cava Syndrome

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59
Q

general 2 neoadjuvant regimens for lung cancer

A

immunotherapy + platinum based chemo

platinum chemo alone (if not candidate for ICI)

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60
Q

3 immunotherapy options for neoadjuvant lung cancer treatment

A

nivolumab, pembrolizumab, durvalumab

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61
Q

lung cancer PLATINUM REGIMENS
non-squamous

A

cisplatin/pemetrexed

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62
Q

lung cancer PLATINUM REGIMENS
squamous

A

cisplatin/gemcitabine

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63
Q

lung cancer PLATINUM REGIMENS
not candidate for cisplatin

A

carboplatin/paclitaxel
carboplatin/gemcitabine
carboplatin/pemetrexed (non-squamous)

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64
Q

which platinum is preferred? which has worse AEs?

A

cisplatin preferred, worse AEs (except thrombocytopenia)

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65
Q

dose calculation for carboplatin (after weight & CrCl)

A

dose (mg) = target AUC x (CrCl + 25)

66
Q

2 common AEs of paclitaxel, docetaxel (taxanes)

A

alopecia, neuropathy

67
Q

pemetrexed can only be used for which lung cancer histology

A

non-squamous

68
Q

when should pemetrexed be avoided?
what can it cause deficiency in?

A

avoid crcl <45
b12 and folate deficiency

69
Q

2 options for advanced NSCLC with EGFR mutation

A

osimertinib, lazertinib

70
Q

common AE of EGFR inhibitors and how to manage if mild/mod/sev?

A

rash
mild- hydrocortisone/clinda topical
mod- hydrocortisone cream + PO doxy/minocycline
sev- hold treatment & dose reduce, use above

71
Q

4 options for advanced NSCLC with ALK mutation

A

alectinib, brigatinib, lorlatinib, ensartinib

72
Q

which ALK inhibitor has the best potency and penetration of the BBB

A

lorlatinib

73
Q

2 options for advanced NSCLC with KRAS mutation AFTER receipt of 1 prior therapy

A

sotorasib, adagrasib

74
Q

avoid coadministartion of sotorasib with

75
Q

which KRAS inhibitor may cause renal impairment and QT prolongation

76
Q

what is started for metastatic NSCLC with negative biomarkers/mutations based on PD-L1 status

A

immunotherapy alone (>50) or with chemo (PDL1 <50)

77
Q

ICI added to platinum chemo regimen for metastatic NSCLC with negative actionable biomarkers

A

pembrolizumab, atezolizumab, cemiplimab

78
Q

common AE of immunotherapy (ICI)
and how to manage

A

induction of autoimmune processes
steroid if grade 3 or higher, hold therapy

79
Q

2 immunotherapy agents that inhibit VEGF receptors (ICI)

A

bevacizumab, ramucirumab

80
Q

aes of VEGF inhibitors

A

bleed, thromboembolic events, acute HTN

81
Q

SCLC treatment
LIMITED stage

A

cisplatin/carboplatin + etoposide + concurrent RT +/- durvalumab

82
Q

SCLC treatment
EXTENSIVE STAGE

A

carboplatin/cisplatin + etoposide + ICI (atezolizumab/durvalumab)

83
Q

additional agents for SCLC treatment

A

etoposide, topotecan, lurbinectedin, tartalamab

84
Q

SCLC treatment
t cell engager that directs t cells to cancer cells expressing DLL3

A

tartalamab

85
Q

BBW for tartalamab

A

cytokine release syndrome, neurologic toxicity

86
Q

3 major risk factors for prostate cancer

A

african american
65-74 y/o
FH (1st deg rel, Lynch, BRCA2)

87
Q

how does localized, invasive, and advanced prostate cancer present?

A

localized- asymptomatic
invasive- urinary sx
advanced- back pain, lower edema, anemia, weight loss, etc

88
Q

glycoprotein produced by the prostate specific for the prostate?
normal range?
range at higher risk for cancer?

A

PSA
normal <= 4 ng/ml
risk >10

89
Q

risk/grade group
gleason score <=6
pattern <= 3+3

A

low, group 1

90
Q

risk/grade group
gleason score 7
pattern 3+4

A

intermed favorable
group 2

91
Q

risk/grade group
gleason score 7
pattern 4+3

A

intermed unfav
group 3

92
Q

risk/grade group
gleason score 8
pattern 4+4, 3+5, 5+3

A

high
group 4

93
Q

risk/grade group
score 9 or 10
pattern 4+5, 5+4, 5+5

A

high
group 5

94
Q

preferred treatment method
very low or low risk grade group 1 PC

A

surv <10 years- observation
surv >10 years- active surveillance

95
Q

preferred treatment method
favorable intermed group 2 PC

A

surv <10 yrs- observation
surv >10 yrs- active surveillance

96
Q

preferred treatment method
unfavorable int grade group 3 PC

A

surv <10 yr- observation > EBRT+ADT
surv >10 yr- RP +/- PLND > EBRT + ADT

97
Q

preferred treatment method
high/very high grade group 4 PC

add what if regional disease (nodal)

A

surv <5 yr asympt- observ or ADT
surv >5 yr or sympt- EBRT + ADT (+abiraterone if regional)

98
Q

preferred treatment method
castrate naive NONMETASTATIC PC

A

monitoring

99
Q

preferred treatment method
castrate naive METASTATIC PC

A

continue ADT + abiraterone or enzalutamide or apalutamide or docetaxel

100
Q

preferred treatment method
castrate resistant RECURRENT (M0) based on PSADT PC

A

continue ADT +
PSADT >10 mos- monitor or other secondary
PSADT <10 mos- apalutamide or darolutamide or enzalutamide or other

101
Q

preferred treatment method
castrate resistant METASTATIC PC
adenocarcinoma vs small cell

A

adeno- continue ADT + abiraeterone, docetaxel, enzalutidmide
(consider cabazitaxel, olaprib, rucaparib)
small cell- chemo with platinum + etop or taxane

102
Q

4 LHRH agonists

A

goserelin, leuprolide, triptorelin, histrelin

103
Q

acute AEs of LHRH agonists
long term

A

acute tumor flare
long osteoporosis, fracture

104
Q

how to mitigate tumor flare with LHRH agonists

A

1st gen antiandrogen

105
Q

2 major counseling points for LHRH agonists

A

tumor flare
supplement Ca and Vit D

106
Q

2 LHRH antagonists

A

degarelix, relugolix

107
Q

2 pros of LHRH antagonists

A

rapid test. decline (7 days)
no tumor flare

108
Q

3 1st gen antiandrogens

A

bicalutamide, flutamide, nilutamide

109
Q

3 2nd gen antiandrogens

A

apalutamide, enzalutamide, darolutamide

110
Q

AEs of antiandrogens

A

inc LFTs, diarrhea, gynecomastia, hot flashes

111
Q

which 2 antiandrogens have a risk for seizures

A

apalutamide
enzalutamide

112
Q

antiandrogen enzalutamide has DDI with

A

CYP2C8 inhibitors
CYP3A4 inducers

113
Q

which antiandrogen has renal dose adjustments & BID dosing

A

darolutamide

114
Q

how is docetaxel admin for PC?
caution in?

A

with BID prednisone
caution hepatic impairment

115
Q

abiraterone is admin with?
key point about the 2 brand names

A

with steroids
not interchangeable brands!!

116
Q

PARP inhibitor for HRR mutated metastatic CR prostate cancer

117
Q

PARP inhibitors have was risk

A

double risk developing secondary cancer

118
Q

alpa-emitting radiopharmaceutical for mCRPC with symptomatic bone metastases and no visceral metastases

A

radium-223

119
Q

dendritic cell vaccine used for mCRPC

A

sipuleucel-t

120
Q

taxane derivate used secondarily in mCRPC in COMBO W/ PREDNISONE

A

cabazitaxel

121
Q

beta-minus emitting radiopharmaceutical used for PSMA+ M1CRPC

122
Q

risk factors for colon cancer )

A

pmh polyps, IBD, FH, smoking, heavy alcohol use, physical inactivity, genetic predisposition, low socioeconomic, increased age, race

123
Q

2 genetic predispositions for COL cancer

A

familial adenomatous polyposis (FAP)
lynch syndrome/HNPCC

124
Q

presentation of COL cancer

A

generally changes in bowel habits
weight loss no reason, fatigue, NV

125
Q

when is screening started for COL cancer if avg risk? what is gold standard

A

45 years
colonoscopy

126
Q

when is screening for COL cancer started if personal history

A

8 years after symptom onset
colonoscopy

127
Q

when is screening for COL cancer started if 1st degree relative
with CRC?
with advanced adenoma?

A

crc- age 40 or 10 yrs before earliest diagnosis
adv adenoma- age 40 or age of onset of adenoma

colonoscopy

128
Q

when is screening for COL cancer started if 2nd degree relative

A

age 45 colonoscopy

129
Q

when is screening for COL cancer started with lynch syndrome

A

age 20-25 or 2-5 years prior to earliest colon cancer if dx <25
colonoscopy

130
Q

when is screening for COL cancer started if FAP

A

colonoscopy age 10-15

131
Q

how is 5FU admin?

A

IV or bolus ususally with leucovorin

132
Q

important metabolism & testing point for 5-FU

A

metabolized by DPD
deficiency –> toxicity potential

133
Q

AEs of 5FU & capecitabine?
bolus 5FU?

A

hand-foot, diarrhea, mucositis
bolus5FU- myelosuppression

134
Q

prodrug of 5FU
requires dose adjustment for ?

A

capecitabine
adjust renal

135
Q

DDI of capecitabine

A

CYP2C9 inhibitor

affects drugs like warfarin & phenytoin

136
Q

contraindications to capecitabine

A

crcl<30
DPD deficiency

137
Q

acute AE of oxaliplatin
chronic ?

A

acute- cold intolerance
chronic- peripheral neuropathy!!!!!

138
Q

2 AEs of irinotecan

A

diarrhea!!!!!!!
alopecia

139
Q

how to manage acute irinotecan diarrhea? delayed?

A

acute- atropine +/- diphenoxylate
delayed- loperamide

140
Q

moab VEGF-a inhibitor used for metastatic COLREC cancer in combo with f-FU regimens

A

bevacizumab

141
Q

AEs of VEGF inhibitors

A

hemorrhage, wound healing, epistaxis, VTE, proteinuria, htn

142
Q

2 major AE points for VEGF inhibitors (bevacizumab or ramuciraumab) to consider when starting and/or d/c

A

htn must be controlled
d/c 4 weeks before surgery & start 4 weeks after

143
Q

VEGF2 inhibitor used in comb with FOLFIRI in pt who progressed on 1st line with bevacizumab COLREC cancer

A

ramucirumab

144
Q

2 EGFR inhibitors for KRAS wildtype metastatic CRC

A

cetuximab, panitumumab

145
Q

major AE of EGFR inhibitors for CRC and how to manage

A

acneiform rash
topical steroid, PO abx, or PO steroid based on severity
may need to hold/dc treatment

146
Q

multikinase inhibitor for mCRC used later in line as single agent salvage

A

regorafenib

147
Q

2 HER2 directed agents used in CRC with overexpression

A

trastuzumab or pertuzumab

148
Q

agent used for mCRC if previously tried F, OX, IRI regimens, anti-VEGF, and EGFR if eligible…. late line

A

trifluridine + tipiracil

149
Q

trifluridine + tipiracil usually given in combo with

A

bevacizumab

150
Q

warning for trifluridine + tipiracil?
AEs?

A

warn-severe myelosuppresion
aes- anemia, neutropenia, fatigue, NV

151
Q

2 immunotherapy options for MSI high stage IV CRC

A

pembrolizumab, nivolumab

152
Q

BRAF inhibitor for CRC in combination with an EGFR inhibitor (cetuximab) in those with BRAF V600E mutation

A

encorafenib

153
Q

general treatment of stage I CRC

A

surgery w/ surveillance

154
Q

general treatment of stage II CRC if no high risk IIA?
high risk IIA, IIB, IIC?

A

usually just surgery + observation

higher risk consider adjuvant chemo

155
Q

adjuvant chemo regimens used in stage II CRC

A

folfox, capeox, capecitabine, 5FU/leucovorin

156
Q

general treatment for stage III CRC

A

surgery + adjuvant chemo

157
Q

what should NOT be used as adjuvant chemo for stage III CRC

A

targeted therapy or irinotecan

158
Q

preferred adjuvant chemo for stage III CRC (2)
alt?

A

Capeox, FOLFOX
alt if no ox- capecitabine, 5FU/leuco

159
Q

general treatment for stage IV CRC if resectable lung or liver

A

surgery + chemo

160
Q

adjuvant chemo regimens for resectable stageIV CRC?
neoadjuvant?

A

adj: capeox, folfox
neoadj- folfiri, capeox, folfox +/- beva/panitumumab/cetuximab

161
Q

general treatment for stage IV CRC if unresectable

162
Q

preferred chemo regimens for unresectable stage IV CRC

A

folfox or capeox or folfiri +/- bevacizumab
folfox or folfiri + cetuximab or panitumumab

Therapeutics (34 decks)

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