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RACP 2022 Written > MONC > Flashcards

MONC Flashcards

1
Q

Which of the following is most commonly associated with severe diarrhea?

A. Cisplatin
B. Cladribine
C. Doxorubicin
D. Capcitabine
E. Cyclophosphamide

A

D - capcetibine; pyrimadine antagonist associated with severe diarrhea

A. Cisplatin - neuropathies, extremely emetogenic
B. Cladribine - mucositis, depression, neurotoxicity
C. Doxorubicine - heart failure
E. Cyclophosphamide - Hemmorhagic cystitis

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2
Q

Name 3 non-malignant factors that can elevate CEA

A

Smoking
Diabetes
COPD
Pancreatitis, diverticulitis, colitis, gastritis, hepatitis/cirrhosis
Any chronic inflammatory condition

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3
Q

In which group of patients is olaparib likely to be of most benefit?

A. BRCA mutated, HER2 positive breast cancer
B. BRCA mutated, HER2 negative breast cancer
C. BRCA wild type, triple negative breast cancer
D. BRCA wild type, HER2 positive breast cancer

A

B. BRCA mutated HER2 negative breast cancer (regardless of HR status)
- can be used after initial surgery+ chemo in high risk (i.e. node +ve, large tumor) disease or second line for recurrence in same groups

Not used in HER2 +ve breast cancer or BRCA wild type (targets BRCA mutated deficient cells)

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4
Q

In which group of patients is sacituzumab-govitecan likely to be of most negative?

A. Triple negative breast cancer
B. HER2+ve/HR-ve breast cancer
C. HER2-ve/HR +ve breast cancer
D. Breast cancer with brain metastases

A

A. locally advanced unresectable triple negative breast cancer (failed 2 therapies)

Trop-2-directed antibody and topoisomerase inhibitor drug conjugate

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5
Q

Target of ribociclib?

A. PDL1
B. PL3-Ka
C. CD4/6
4. PARP

A

C. CD4/6, HR+ve/HER2 -ve metastatic breast cancer (+AI/fulvestrant)

PL3-KA = alpelisib
PDL1 = pembolizumab
PARP inhibitor = olparib

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6
Q

Standard chemotherapy regime for colorectal cancer?

With or without radiotherapy?

A

FOLFOX - oxiplatin + leucovorin + FU

CAPOX (oxi + capcitabine) can be used, more toxic but shorter course

Radiotherapy only for rectal cancer

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7
Q

Cetuximab:
- target
- use
- side effects

A

Target: EGFR mab
Utility: RAS wild type CRC; head and neck SCC
S/e: rash, diarrhea, infusion related reaction

Other EGFR mab - panitumumab

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8
Q

Erlotinib:
- target
- use
- side effects

A

Target: EGFR TKI
Utility: NSCLC EGFR mutation +ve
S/.E: rash, dirreah

Other agents: gefitinib, afatinib

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9
Q

Osimertinib
- target
- use
- side effects

A

Target: EGFR against T790M TKI
Utility: NSLC EGFR T790M+
S/E: maculopapular rash (face and upper body)

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10
Q

Trastuzumab
- target
- use
- side effects

A

Target: HER2 MAB
Utility: HER2 +ve breast cancer
S/E: cardiotoxicity

Other agents: pertuzumab (associated with diarrhea)

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11
Q

Lapatinib
- target
- use
- side effects

A

Target: HER2/EGFR TKI
Utility: HER2 +ve breast cancer
S/E: palmar-plantar erythrodysthesia (hand-foot syndrome), rash, diarrheah, cardiotoxicity

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12
Q

TDMI
- - target
- use
- side effects

A

Target: HER2 mab conjugated to chemotherapy DM1 (emtansine)
Utility: HER2 +ve breast cancer
S/E: thrombocytopenia, transaminitis

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13
Q

Alectinib
- target
- use
- side effects

A

Target: ALK rearrangement
Utility: ALK +ve NSCLC
S/E: N/V/D, visual disturbances, hepatitis, pneumonitis, bradycardia

Other agents: ciritnib and crizotinib (more s/e than alectinib) and brigatinib (superior to crizotinib)

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14
Q

Dabrafenib
- target
- use
- side effects

A

Target: BRAF TKI
Utility: Melanoma, BRAF V600 +ve
S/E: fever, skin tioxicity, hair changes, arthralgias

Other agents: vemurafenib

Not - skin toxicities improved when given with a MEK inhibitor

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15
Q

Trametinib
- target
- use
- side effects

A

Target: MEK TKI
Utility: Melanoma, BRAF V600 +ve
S/E: rash, diarhhoea

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16
Q

Bevacizumab
- target
- use
- side effects

A

Target: VEGF Mab
Utility: metastatic CRC (inc. RAS mutants)
S/E: HTN, thrombosis

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17
Q

Sunitinib
- target
- use
- side effects

A

Target: VEGFR TKI
Utility: clear cell RCC, HCC, differentiated thyroid, soft tissue sarcoma
S/E
Other agents: pazopanib, axitinib, cabozantinib, lenvatinib, vandetanib, sorafenib

S/E - many, but hand/foot syndrome, HTN, hypothryoidism, hepaitis, cardiotoxicity, diarrhoea

18
Q

Imatinib
- target
- use
- side effects

A

Target: cKIT
Utility: GIST
S/E: cramps, maculopapular rash, NV/V/D, fatigue

19
Q

Ipilumab
- target
- use
- side effects

A

Target: CTLA-4
Use: melanoma, clear cell RCC
S/E: immune related toxicity

20
Q

Which group of patients with NSCLC are most likely to have a EGFR mutation?

A. Smokers
B. Caucasians
C. Men
D. Asian populations

Which drug do patients with NSCLC and EGFR mutation benefit from?

A

D. Asians - also non-smokers, females

Benefit from erlotinib, alatanib and gefitinib

Osimertinib recently shown to have greater survival benefit compared with above

21
Q

Selpercatinib
- target
- use
- side effects

A

Target: RET-oncogene (TKI)
Use: NSCLC + thyroid cancer RET fusion +ve; medullar thryoid cancer with RET mutant
S/E: haemmorhage, hepatotoxicity, HTN, hypersensitiviity

22
Q

Chemotherapies with the highest emotogenic risk

A

Doxorubicin>=60 mg/m2
Anthracycline + cyclophosphamide combination
Cisplatin, carboplatin + oxiplatin

23
Q

What 3 syndromes can be associated with cyclophosphamide?

A

1) Interstitial pneumonitis – if low dose, prolonged duration of Rx.
2) Interstitial pulmonary fibrosis – if used in high dose for prolonged duration.
3) Severe cardiotoxicity- if large dose in short period

Also most common cause of chemo-related haemmorhagic cystitis

24
Q

Which of the following is a PD-1 inhibitor?

a) Atezolizumab
b) Avelumab
c) Durvalumab
d) Dostarlimab

A

E - dostarlimab

All the others are PDL1 inhibitors

25
Q

Mechanism of action of ipilimumab

In which of the following does it NOT have a role?
a) melanoma
b) RCC
c) HCC
d) CRC
e) mesothelioma
f) NSCLC

A

CTLA4 blockage

Enhanced the ability of APCs to activate T cells –> enhanced T cell activation and proliferation

E) mesothelioma

NB: MSI high/MMR deficient CRC

26
Q

Which cancers does FDG PET have a role in stage?
Which does it not?

A
  • oesophageal and colorectal cancer
  • head and neck cancer
  • melanoma

No current role for gastric cancer

27
Q

Strongest predictive factor of poor outcome in breast cancer

A

Node +ve disease

4–8 times higher mortality than those without nodal involvement

28
Q

Risk factors for renal cell carcinoma

A

Analgesic nephropathy
Leather tanners
Cadmium Thorotrast (used as a contrast medium in X-ray)
Acquired cystic disease
Von Hippel-Lindau (VHL) tumor suppressor gene Smoking
Obesity
Hypertension

29
Q

Where do the tumor cells of renal cell cancer arise from?

A

Proximal convoluted tubule

30
Q

What is the leading cause of death for survivors of testicular tumors following successful chemotherapy?

A

Secondary cancers

31
Q

Risk factors for relapse in seminomas (germ cell)?

Risk factors for relapse in non-seminomas?

A

Seminoma (GCT)

  • Tumour size (> 4 cm)
  • Invasion of the rete testis

Non-seminoma
- Vascular/lymphatic in or peri-tumoural invasion
- Proliferation rate > 70%
- Percentage of embryonal carcinoma > 50%

32
Q

Treatment of G1 seminoma

A

Orchiectomy

Carboplatin based chemotherapy recommended if high risk features (>4cm, invasion of rete testis)

33
Q

Treatment of GBM

A

Surgery + Temozolomide + radiotherapy

34
Q

PARP inhibitors mechanism of action

A

Single-strand DNA repair inhibition

35
Q

Chemotherapy agents acting at metaphase

A

Vinca alkaloids
- M/S phase specific (cell cycle arrest at metaphase)

36
Q

Chemotherapy agents acting at S phase

A

Topoisomerase inhibitors (i.e. irinotecan)
Antimetabolites

37
Q

Chemotherapy agents acting at G2 phase

A

Etoposide
Bleomycin
Taxanes

38
Q

Large does of chemo as part of BMAT cause pericarditis and pericardial effusion

A

Cuclophosphamide

39
Q

Anti-depressant to avoid when using tamoxifen?

A

Fluoxetine and Paroxetine

40
Q

Memory rash radiotherapy

A

Daunorubicin

41
Q

Most common cancer post successful treatmetn of hodgkins disease with radiotherapy?

A

Breast cancer

42
Q

Analine dye risk of which cancer?

A

Bladder cancer

RACP 2022 Written (21 decks)

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