Oncology disease modifying therapies

Question 1

What are the goals of disease modifying therapies?

Answer 1

• Curative
• Palliative
  
  • improve QOL
  • stabilize progression
  • prolong survival

Question 2

List advanced cancers that can be cured with chemotherapy

Answer 2

• ALL peds
• AML
• Choriocarcinoma
• Non hodgkins Lymphoma
• Hodkin’s lymphoma

Question 3

List cancers than could be cured with chemotherapy and radiation therapy

Answer 3

• Anal cancer
• Cervical cancer
• Head and neck cancers
• Lymphoma
• NSCLC
• SCLC

Question 4

Role of surgery in cancer treatment

Answer 4

• cure, better disease control
• Metastatic RCC
  
  • regression of lung mets
• Breast cancer
• Colorectal cancer
• Lung mets removed if primary is controlled and stable and not widespread disease
• Liver mets in CRC
• Solitary brain met
• Metastectomy of adrenal mets, bone for palliation.

Question 5

Radiation treatment : role in outcome and survival

Answer 5

• SCLC
  
  • • chemo = better survival and local control
  • prophylactic whole brain rads
• Solitary brain mets
  
  • SRS or WBRT
  • better than surgery alone
• Recurrent head and neck
  
  • re-radiation if possible can be beneficial
• Metastatic thyroid cancer
  
  • radioactive iodine controls metastatic disease
• Carcinoid tumours
• Castration resistant prostate cancer

Question 6

Breast Cancer : Hormonal Treatment

Answer 6

• 70% of breast cancers are ER or PR positive
• Aromatase inhibitors (ER+) OR
• Estrogen blockers
• improve disease free progression
• POST menopausal:
  
  • AI (letrozole, anastrazole, exemestane)
  • block peripheral estrogen production
• PRE menopausal
  
  • Tamoxifen
  • Ovarian suppression

Question 7

Endometrial Cancer Treatment : Hormonal treatments

Answer 7

• Progesterone
• Tamoxifen

Question 8

Prostate Cancer : Hormonal Treatments

Answer 8

• Androgen Deprivation Therapy
  
  • Orchiectomy
  • LHRH agonists / antagonists
• reduces disease progression
• No clear survival benefit
• castration resistant –> effective
• Abiraterone

Question 9

Thyroid Cancer Treatment

Answer 9

• L-thyroxine to suppress TSH

Question 10

Neuroendocrine Cancer treatment

Answer 10

• Somatostatin Analogues (octreotide, lanreotide)
• symptomatic treatment
• progression free survival

Question 11

Cytotoxic chemotherapy

Answer 11

• impacts cell division (mitosis)
• therapeutic index narrow (activity and toxicity)
• often combined with radiation and surgery
• Curative for:
  
  • testicular, germ cell, lymphoma
• Palliative for:
  
  • disease control
  • extended survival
  • QOL
• Common side effects:
  
  • myelosuppression
  • mucositis
  • alopecia
• Paclitaxel, docetaxel, doxrubicin

Question 12

Targeted Agents:

Answer 12

• Monoclonal antibodies against EGFR receptor
  
  • Cetuximab
  • Panitumumab
• Tyrosine Kinase inhibitors
  
  • Gefitinib, erlotinib
• Monoclonal antibodies against HER2 receptors
  
  • Trastuzumab, pertuzumab
  • Epidermal grwoth factor recptor family
• VEGF receptor
  
  • Bevacizumab, sorafinibm sutinib