Rando points Flashcards

Question

Recurrent Disease in Ovarian Ca - ?benefit of Ca125 monitoring - Platinum sensitivity definition and secondary agents

Answer 1

Higher incidence of immunotoxicity with CTLA4 inhibitor (ipilimumab)

Answer 2

Associated cancer - **SCLC,** others Syndrome - **Encephalomyelitis** including cortical, limbic, and brainstem encephalitis; c**erebellar degeneration; myelitis; sensory neuronopathy; and/or autonomic dysfunction**

Answer 3

FOLFIRINOX is preferred but more toxic

Answer 4

Alkalyting agents Other - MTx

Answer 5

Associated Cancer - **Hodgkin lymphoma** Syndrome - **Cerebellar degeneration**

Answer 6

patients have **autosomal dominant germline** mutation in 1 of the following DNA mismatch repeair genes: * MLH1 * MSH2 * MSH5 * PMS2 - lower penetrance than other genes * EPCAM gene Lynch syndrome patients have a germline mutation in one allele of a MMR gene 2nd allele is inactivated somatically by mutation, loss of heterozygosity or epigenetic silencing by promoter hypermethylation * **Muir-Torre syndrome:** variant characterised by **sebaceous tumors** and **cutaneous keratoacanthomas** + normal ca associated with Lynch syndrome. **MSH2** mutations seem to be particularly predisposed

Answer 7

* used therapeutically to reduce the incidence of haemorrhagic cystitis and haematuria * Ifosfamide or cyclophosphamide can be/may be converted to urotoxic metabolites such as acrolein * MESNA assists to neutralise these metabolites by binding through its sulfhydryl-moieties and also increases urinary excretion of cysteine

Answer 8

Associated Cancer - **Gynae, breast** Syndrome **- cerebellar degeneration**

Answer 9

* Most commonly by **bacterial infection** * GPCs are the most common pathogens * Common * Staph epidermitis, by far the most common * Staph aureus * Streptococci * Less common * Corynebacterium, bacillus, leuconostoc, lactobacillus, propionibacterium acnes, rhodococcus * GNBs used to be more common, but now account for only 10-20% of neutropoenic infections * Generally associated with the most severe infections * Increasing trend in multiresistant GNB infections * Empiric broad cover is targeted at the small but significant risk of infection * Fungal * Candida and aspergillus spp account for most invasive fungal infections during neutropoenia * Disseminated candidiasis with hepatosplenic involvement may not have symptoms until neutropoenia resolves * Non albicans spp more common when fluconazole prophylaxis used

Answer 10

**Primary prophylaxis** * Initiation of G-CSF during first cycle of myelosuppressive chemotherapy with the goal of preventing neutropoenic complications through all chemotherapy cycles * May be used to allow for dose dense/intense strategies when reduction in density/intensity is known to be associated with poorer prognosis * *Indicated when anticipated incidence of neutropoenic fever is \>=20%* **Secondary prophylaxis** * Use of G-CSF in subsequent cycles when neutropoenic fever has occurred in a previous cycle * *Reduces incidence of subsequent neutropoenic fever by 50%* **NOT recommended for routine use in those with established fever and neutropoenia** * *Data show no change in overall mortality or infection related mortality* **Filgrastim** * Start 24-72hrs post end of chemo and continuing until count reaches 5000-10000 **Pegfilgrastim** * Start 24hrs post chemo and leave at least 14 days before next cycle

Answer 11

Onset or progression of an inflammatory focus that manifests at time o**f neutrophil recovery** * - Defined clinically or radiologically Need to consider superinfection