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General Gynaeoncology > Systemic therapy > Flashcards

Systemic therapy Flashcards

1
Q

At what level of potential recurrence would you consider adjuvant therapy? When would you not?

A

Over 20% yes

Under 10% no

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2
Q

What is the benefit of chemoradiation?

A

The chemotherapy sensitizes the tumour to the effects of radiation

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3
Q

Main side effects of ..

Carboplatin

A

Myelosupression (especially thrombocytopaenia)

Hypersensitivity reaction

Sterility/ovarian failure

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4
Q

Main side effects of…

Doxorubicin

A

Cardiotoxicity

Radation recall

Photosensitivity

Red/orange urine

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5
Q

Main side effects of…

Gemcitabine

A

Myelosupression (often dose limiting)

GI - diarrhoea, stomatitis, mucositis

Fever/flu-like

Pnuemonitis

Mac/pap rash

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6
Q

Main side effects of…

Paclitaxel

A

Myelosupression

Hypersensitivity reaction

Sensory neuropathy

transient sinus brady

GI: mucositis, diarrhoea

Onycholysis

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7
Q

Who is HIPEC best for and why?

A

Those who have minimal residual disease because the passive diffusion in to peritoneal tumour nodules is limited.

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8
Q

What is bevacizumab?

A

humanised anti-VEGF

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9
Q

What is pembrolizumab?

A

anti-PD-1 antibody

PD-1 blockade has been shown to activate antitumour immunity via T cells - tumour infiltrating lymphocytes (TILs)

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10
Q

What drugs have failed to show improvements in PFS or OS with increased dose intensity?

A

taxanes and platinum

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11
Q

What is the most common dose-limiting side effect associated with cytotoxic drugs?

A

Bone marrow suppression with neutropenia being the most common

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12
Q

When does bone marrow suppression typically occur?

A

7-14 days after the initial drug treatment

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13
Q

How long does the bone marrow suppression persist for?

A

3-10 days

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14
Q

What can be used to combat the SE bone marrow suppression and when?

A

G-CSF
(used if risk of febrile neutropenia is more than 20% or if previously had a neutropenic complication in a prior cycle but where dose reduction or treatment delay not an option)

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15
Q

What are the most common SE to systemic therapy

A 
bone marrow supression
GI side effects (N/V/D)
Alopecia
Skin toxicity
neurotoxicity
GU toxicity
Hypersensitivity
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16
Q

What can be used to treat nausea

A

anti-histamines
5-HT3 antagonists
Steroids
anticipatory nausea - benzos

17
Q

What can be used to treat oral or oesophageal symptoms and what do you have to consider?

A

2% lidocaine

Candidiasis and herpes simplex

18
Q

What can be used to treat Alopecia

A

preventative measures:
scalp tourniquets
ice caps

19
Q

What skin complications can occur:

A

hyperpigmentation

hypersensitivity

radiation recall reactions

nail abnormalities

folliculitis

palmar-plantar erythrodysesthesia

Local extravasation necrosis (requires debridement often)

20
Q

What is a radiation recall reaction?

A

Radiation recall is an acute inflammatory reaction confined to previously irradiated areas that can be triggered when chemotherapy agents are administered after radiotherapy

21
Q

How does neurotoxicity present?

A

Usually peripheral neuropathy

sometimes: ototoxicity

22
Q

Who is more susceptible to neurotoxicity

A

those who have:

underlying neurological problems - diabetes, alcoholism, carpal tunnel syndrome

23
Q

Most common toxicities of PARPi?

A

fatigue and haematological toxicity (low Hb, neutrophils and PLT)

24
Q

Toxicity of VEGFi?

A 
HTN
proteinuria
bleeding
VTE
GI - bowel perf and fistula
25
Q

Toxicity of immune mediated therapy?

A 
Enterocolitis
Dermatitis
Hepatitis
Neuropathies 
Endocrinopathies
Hypophysitis
26
Q

Definitive chemoradiotherapy and brachytherapy

What should the overall treatment time be

A

should not exceed 7-8 weeks

27
Q

EBRT

What should the overall treatment time be

A

should not exceed 5-6 weeks

28
Q

what is the total dose of pelvic ERBT that should be used and in what fractions

A

45-50 Gy with 1.8-2 Gy per fraction (daily)

Often 45 Gy in 25 fractions

General Gynaeoncology (8 decks)

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