Principles of Systemic Therapy Flashcards
What are the preferred regimens for perioperative chemotherapy (neoadjuvant or adjuvant)
DDMVAC and GC
How many cycles is DDMVAC given?
3 to 4 cycles
What is given WITH DDMVAC?
Growth factor support
How many cycles is Gemcitabine and Cisplatin given?
4 cycles
What are other recommended regimens for perioperative chemo?
CMV x 3 cycles
What can you offer patients who are not candidates for cisplatin?
Surgery
Is there an overall survival benefit with adjuvant cisplatin based chemo for pT3, T4 and N+ patients at cystectomy who were not given neoadjuvant chemo?
Yes
Which is preferred: neoadjuvant or adjuvant?
Neoadjuvant
How many days per cycle is preferred for GC?
21 day cycle
Why is neoadjuvant chemo preferred in e patients with high stage and grade UTUC as opposed to adjuvant chemo?
Renal function will decline after nephroureterctomy and may preclude adjuvant chemo
Can carboplatin be substituted for cisplatin in the perioperative setting?
No
What is an option for borderline renal function/minimal dysfunction?
Split dose administration of cisplatin
For cisplatin eligible patients, what are the preferred regimens? (locally advanced or metastatic disease)
“Gemcitiabine and Cisplatin followed by Avelumab maintenance therapy
DDMVAC with Growth Factor Support followed by Avelumab maintenance therapy”
For cisplatin ineligible patients, what are the 2 drugs will you give patients whose tumors express PD-L1 or who are not eligible for any platinum containing chemotherapy regardless of PD-L1 expression?For cisplatin ineligible patients, give 3 preferred regimens. (locally advanced or metastatic disease)
“Gemcitabine and Carboplatin
Atezolizumab
Pembrolizumab”
What is the condition in doing maintenance therapy after the preferred regimens in cisplatin eligible patients?
If there is no progression on first line platinum containing chemo
