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PHM 703- Oncology, Hematology > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Goals of therapy: localized disease

A

control disease and symptoms; decrease morbidity and mortality

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2
Q

Goals of therapy: advanced or metastatic disease

A

palliation- symptom relief; improve QoL, prolong survival

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3
Q

Factors to consider for prostate cancer treatment

A

comorbidities, symptoms, recurrence risk, life expectancy, disease stage (clinically localized and regional disease treatment is based on risk stratification rather than stage)

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4
Q

Generally speaking, if the prostate cancer is localized and hasn’t metastasized yet, what do you do?

A

Observation or active surveillance

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5
Q

Castrate level/goal for serum testosterone

A

Serum testosterone <50ng/dl

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6
Q

Gold standard treatment for advanced prostate cancer

A

ADT

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7
Q

Medical castration for ADT

A

LHRH agonist +/- antiandrogen: combined androgen blockade

LHRH antagonist

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8
Q

Castration-sensitive prostate cancer treatment

A

combined modality approach as initial therapy for castration sensitive or naiïve prostate cancer for select high-risk and metastatic patients

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9
Q

Castration-sensitive prostate cancer regimens

A

ADT + abiraterone OR apalutamide OR enzalutamide
ADT with docetaxel x6 cycles AND abiraterone OR darolutamide

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10
Q

Castration resistant prostate cancer (CRPC) definition

A

Definition: serum testosterone <50ng/dl AND disease progression

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11
Q

How to approach treating CRPC

A

Continue ADT and maintain castrate levels while adding on other therapies
Therapy based on whether patient has nonmetastatic or metastatic disease

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12
Q

CRPC: patient has M0 disease (not metastatic)…treatment is based on what?

A

PSA doubling time within 10 months

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13
Q

If PSA doubling time in M0 CRPC is >10 months, what do you do?

A

Monitor or give secondary hormone therapy

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14
Q

If PSA doubling time in M0 CRPC is ≤10 months, what do you do?

A

Add on apalutamide, enzalutamide, darolutamide, or other secondary hormone therapy

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15
Q

CRPC: patient has M1 disease (metastatic)…what is treatment based on?

A

Histology and prior therapy

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16
Q

CRPC with M1 disease treatment: no prior docetaxel/no prior novel hormone therapy

A

Abiraterone
Docetaxel
Enzalutamide

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17
Q

CRPC with M1 disease treatment: prior novel hormone therapy and no prior docetaxel

A

Docetaxel

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18
Q

CRPC with M1 disease treatment: prior docetaxel and no prior novel hormone therapy

A

abiraterone, cabazitaxel

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19
Q

CRPC with M1 disease treatment: prior docetaxel and hormone therapy

A

Cabazitaxel, docetaxel rechallenge

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20
Q

First-line treatment options: visceral metastases

A

Consider docetaxel if patient hasn’t received and patient is fit for chemo

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21
Q

First-line treatment options: no visceral metastases

A

treat based on prior therapy

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22
Q

First-line treatment options: symptomatic bone metastases

A

Radium-223

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23
Q

First-line treatment options: asymptomatic or minimally symptomatic, no liver metastases, life expectancy >6 months, good ECOG performance status

A

Sipuleucel-T

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24
Q

LHRH agonists

A

Gosrelin, leuprolide, triptorelin, histrelin

25
Q

LHRH agonist place in prostate cancer therapy

A

ADT

26
Q

LHRH agonist acute AEs

A

tumor flare, hot flashes, ED, edema, gynecomastia, injection site reactions

27
Q

LHRH agonist long-term AEs

A

osteoporosis, clinical fracture, obesity, insulin resistance, increased risk of DM, Cv events, HLD

28
Q

Initial tumor flare when using LHRH agonists is caused by what?

A

Surge in LH/FSH release and increases testosterone production (presents as increased bone pain or increased urinary symptoms but resolves in 2 weeks)

29
Q

LHRH agonist monitoring and management

A

Baseline bone mineral density test before starting long-term ADT
calcium and Vitamin D supplementation

30
Q

LHRH antagonists used in prostate cancer

A

Degarelix, relugolix

31
Q

2nd generation antiandrogens used in prostate cancer

A

Apalutamide, darlutamide, enzalutamide

32
Q

Apalutamide AEs

A

Fatigue, HTN, rash, diarrhea, nausea, arthralgias, fracture risk, peripheral edema

SEIZURES!!!!!!!! D/C PERMANENTLY IN PATIENTS WHO DEVELOP A SEIZURE DURING TREATMENT

33
Q

Apalutamide place in therapy

A

Secondary hormonal therapy for M0 and PSADT ≤10 months

34
Q

Darlutamide place in therapy

A

Same as apalutamide

35
Q

Darlutamide AEs

A

Fatigue, HTN, rash

No increase in seizures

36
Q

Darlutamide dose adjustment

A

300mg BID with food if CrCl 15-29ml/min

37
Q

Enzalutamide AEs

A

Diarrhea, fatigue, HA, myalgias, edema

Increased risk of seizures

38
Q

Enzalutamide dose adjustments

A

Strong CYP2C8 inhibitor: 80mg PO QD
Strong CYP3A4 inducers: 240mg PO QD

39
Q

Docetaxel place in prostate cancer therapy

A

CRPC treatment option

40
Q

Docetaxel AEs

A

Myelosuppression
Alopecia
Edema
Peripheral neuropathy
Hypersensitivity reaction

41
Q

Docetaxel and hepatic impairment

A

CAUTION!

Use not recommended with Tbili > ULN, or AST and/or ALT >1.5x ULN concomitant with alk phos >2.5x ULN

42
Q

Abiraterone place in prostate cancer therapy

A

CRPC treatment option

43
Q

Abiraterone AEs

A

Diarrhea
Edema
Hypokalemia
HTN
Hepatotoxicity
Hypertriglyceridemia

44
Q

Abiraterone should be given with what?

A

Steroids (like prednisone) to minimize signs of mineralocorticoid excess

45
Q

Are the 2 formulations of abiraterone interchangeable?

A

No

46
Q

Abiraterone monitoring

A

LFTs, potassium and phosphate levels, BP on monthly basis

47
Q

Radium-223 place in prostate cancer therapy

A

Symptomatic bone metastases and no visceral metastases prior to and after docetaxel therapy

48
Q

Radium-223 AEs

A

Peripheral edema, nausea, myelosuppression

49
Q

Is radium-223 used in combo with chemo?

A

NO

50
Q

Sipuleucel-T place in prostate cancer therapy

A

Asymptomatic or minimally symptomatic, no liver metastases, life expectancy >6 months, ECOG performance status in M1 CRPC

51
Q

Sipuleucel-T AEs

A

Infusion reaction
Chills
Fever
Fatigue
HA

52
Q

Cabazitaxel place in prostate cancer therapy

A

Second-line therapy in CRPC

53
Q

Cabazitaxel AEs

A

Febrile neutropenia
Hypersensitivity reaction
Mucositis
Edema

54
Q

Cabazitaxel clinical pearl

A

Poor affinity for MDR proteins → confers activity in resistant tumors and has activity in docetaxel resistance

55
Q

Lu-177-PSMA-617 place in therapy

A

Second-line therapy in CRPC

PSMA-positive M1 CRPC

56
Q

Lu-177-PSMA-617 AEs

A

Fatigue
Dry mouth
Nausea
Myelosuppression

57
Q

Denosumab place in prostate cancer therapy

A

Androgen deprivation-induced bone loss in prostate cancer (general osteoporosis/bone loss)

58
Q

Denosumab dosing difference

A

Dosing in cancer is different than for osteo

PHM 703- Oncology, Hematology (15 decks)

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