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ASCO Boards > ASCO Review > Flashcards

ASCO Review Flashcards

1
Q

Anal cancer staging T1 vs T2 and treatment

A

T1 <2, T2 2-5 cm

Treat T1 with local excision unless high risk features like poorly differentiated

otherwise chemo/rads with 5-FU mitomycin

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2
Q

After definitive treatment recheck with DRE and anoscopy when

if residual disease then

A

8-12 weeks DRE and anoscopy

if residual disease, salvage surgery with APR (abominoperineal resection) removes anus, rectum and necesitates ostomy

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3
Q

Treatment lines metastatic anal cancer

A

carbo/taxol preferred first line

Then nivo or pembro

then 5-FU/cis, FOLFOX, DCF

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4
Q

incidentally found gallbladder adenocarcinoma on cholecystectomy, T size at which surgical oncologic staging is needed.

A

T1b or higher (muscle layer not lamina propria should have

CT CAP to r/o mets
then go back to surgery for hepatic resection, lymph nodes, bile duct excision

treat with adjuvant capecitabine especially if positive nodes

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5
Q

First line treatment for biliary tract malignancies

check for which targetable mutations

other lines

A

cis/gem + durvalumab (ABC-02 trial showed sig survival benefit in all comers), if immotherapy CI, then still give cis/gem

check for NTRK, MSI-H, RET (selpercatinib), BRAF V600E (dabrafenib/trametinib), FGFR2 fusions or rearrangements (pemigatinib/futibatinib), IDH1 (ivosidenib), HER2 (trastuzumab+pertuzumab_

other chemo
FOLFOX
gem/abraxane

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6
Q

which patient with cholangio is a candidate for liver transplantation as a curative option

A

unresectable perihilar or hilar cholangio, <3 cm, no mets, no nodes

PSC or other underlying liver disorders are ok

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7
Q

Pemigatinib moa, use and risks

A

FGFR2 fusion or rearrangement

cholangio and others

GI toxicity, hyperphosphatemia, occular toxicity (must see eye doctor regularly corneal and retinal issues)

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8
Q

Futibatinib moa, use risks
compare to pemigatinib

A

FGFR2 gene fusion or rearrangement
irreversible FGFR1-4 inhibitor

resistance to acquired resistance mutations to other inhibitors, maybe less occular SE

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9
Q

BRAF mutation in colon ca significance

A

poor prognosis, they will be KRAS wt

FOLFIRI Bev is an option

encorafenib+cetuximab or panitumumab can be tried after oxali therapy

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10
Q

Adjuvant treatment for colon cancer by stage and other factors

A

Stage III disease favor FOLFOX/CAPEOX over 5-FU alone

for low risk stage III (<T4, <N2): 3 months of CAPEOX or 3-6 mo FOLFOX (reduced neuropathy)

For high risk group stage III (T4 N1 or N2): 6 months FOLFOX

However, Age >70 (stage II or III), no added benefit of FOLFOX vs 5-FU. 6 mo of 5-FU.

In stage II, survival benefit not demonstrated for FOLFOX over 5-FU
- therefore unless high risk factors present, would do 5-FU alone

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11
Q

Colon cancer oligometastatic disease treatment

A

resect primary and resect or radiate oligomets, treat with adjuvant FOLFOX for 6 mo

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12
Q

stage II colon cancer (T,N) indications for chemo

A

T3-4 N0
T3 invades through muscularis (but not into visceral peritoneum or other
adj organs T4)

Adj chemo if:
not MSI-H and
T4
or
T3 with high risk: poorly differentiated, LVI, PNI, bowel obstruction or perforation, <12 LN evaluated, positive margin, tumor budding

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13
Q

anti-EGFR therapy in colon cancer, who gets it

A

left sided tumors that are KRAS/NRAS/BRAF WT

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14
Q

First line treatment for metastatic colon cancer by molecular markers

A

FOLFOX bevacizumab
FOLFOX cetuximab for (KRAS/NRAS/BRAF WT and Left)
MSI-H: pembro or dostarlimab or nivo or ipi/nivo

FOLFIRINOX bev if visceral disease and young

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15
Q

subsequent lines of therapy in colon metastatic disease

A

if progressed on cetuximab regimen switch to bevacizumab regimen

FOLFOX–>FOLFIRI

HER2- Trastuzumab+ pertuzumab/lapatinib/tucatinib or ENHER2

KRASG12C: sotorasib or adagrasib + cetuximab

Lonsurf +/- bev

regorafenib 80 mg start with uptitration to 160 days 1-21

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16
Q

lonsurf MOA and use

A

trifluridine and tipiracil (thymidine phosphorylase inhibitor which prevents degredation)

2 mo OS benefit

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17
Q

suveillance by stage colon

A

Stage I–> colonoscopy only

Stage II-III

colo in 1 year

then CEA Q3-6 for 2 years then every 6 for 5 years

CT CAP every 6-12 mo for 5 years

IV oligo mets- CT every 3-6 mo for 2 years then every 6-12 for 5

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18
Q

significance of subserosal tumor deposits in colon cancer staging

A

upstages to stage III even in the absence of node positivity

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19
Q

pseudomyxoma peritonei

A

low-grade mucinous carcinoma with diffuse peritoneal involvement

observe vs resect and HIPEC

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20
Q

GEJ tumors are treated like what

A

esophageal adenocarcinoma

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21
Q

esophageal staging, define T 4a vs T4b and why important

A

T4a- involves the pericardium, pleura, diaphragm, peritonieum, azygous vein

T4b- involves trachea, great vessels, vertebral body or heart

T4b are unresectable but if not metastatic could be treated with definitive chemo/rads (5-FU and oxaliplatin)

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22
Q

barretts esophagus predisposes to what. Treat with RFA at what level of barretts.

A

esophageal adenocarcinoma

treat high grade dysplasia with RFA

low grade dysplasia can be treated with PPI/repeat EGDs

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23
Q

esophageal adenocarcinoma localized treatment by stage

difference for esophageal squamous

MSI-H

A

Tis (high grade dysplasia, T1a= endoscopic resection/ablation

T1b= submucosal invasion
T2= muscularis

T1b- T2 low risk <3 cm well differentiated: surgery

cT2 with high risk (>3 cm mass, LVI, poorly differentiated) or nodes or T3-T4a; preop chemo/rads (carbo/taxol weekly for 5 weeks or FOLFOX 3 cycles every 2 weeks with radiation)

PET before surgery!

cT4b: definitive chemo-rads

PET before surveillance, if persistent, then surgery if possible

Squamous: same as above up for Tis and T1a

cT2N0 high risk, nodes, cT3-4: pre-operative chemo/rads (carbo/taxol) or definitive chemo/rads

cT4b= definitive chemo/rads

MSI-H:
- neoadjuvant or perioperative checkpoint inhibitor therapy

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24
Q

cervical esophageal cancers treatment and definition

A

<5c from cricopharyngeous muscle should be treated with definitive chemo/rads due to difficulty with surgery in that area

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25
Q

indication for bronchoscopy as a part of the work up in esophageal cancer

A

cancer at or above carinoa, bronchoscopy performed to rule out a fistula

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26
Q

GEJ cancer, could consider what for staging

A

laparoscopy as these tumors are more high risk for occult metastatic disease

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27
Q

adjuvant therapy in eosphageal cancer with surgery upfront (no chemo or rads)

A

R0 node negative or positive: surveillance

R1 or R2 resection: chemo/rads 5-FU/oxaliplatin

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28
Q

adjuvant therapy in esophageal cancer with upfront chemo or rads

A

R0 with CR: observation

R0 without CR: nivolumab

R1 or R2: chemo/rads with FOLFOX preferred (only if RT not given upfront)

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29
Q

lymph nodes during surgery considered adequate

colon versus esophageal versus gastric

A

12 vs 15 vs 15

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30
Q

metastatic esophageal adenocarcinoma treatment

what actionable mutations to check to decide first line

how does this change for squamous

A

HER2
- FOLFOX+ trastuzumab +/- pembro

MSI-H
- pembro
- dostarlimab
- ipi/nivo
- FOLFOX with nivo or pembro

PD-L1 CPS <5
FOLFOX

PD-L1 CPS>5
- FOLFOX and nivo

PD-l1 CPS>10
- FOLFOX and pembro

Squamous
- FOLFOX + nivo regardless of CPS
- FOLFOX pembro (still CPS>10)
- FOLFOX alone
- ipi/nivo

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31
Q

second line for esophageal adeno

special order for GEJ

HER2 next lines

squamous

A

docetaxel
paclitaxel
irinotecan

FOLFIRI

ramucirumab/paclitaxel or ramucirumab alone for EGJ only (cat 1)
lonsurf in 3rd line EGJ only (cat 1)

ENHER2 if HER2 overexpressing

Squamous:
- if no immunotherapy before then give nivo
then the same as above

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32
Q

esophageal follow up plan after definitive treatment

A

visits 3-6 mo for 2 years
imaging or EGD is not recommended without symptoms

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33
Q

who gets adjuvant therapy in gastric cancer after surgery without and what do you give

A

pT3, pT4, or N+

5-FU x1, 5-FU chemo/rads, then 5-FU x3 if not a complete D2 dissection

if complete D2 dissection then 6 mo XELOX

R1 or R2 resection: FOLFOX chemo/radiation

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34
Q

metastatic gastric adeno treatments and targets to test

A

No targets:
- FOLFOX

PD-L1 CPS>5
- FOLFOX with nivolumab

HER 2
- FOLFOX and trastuzumab +/- pembro

MSI-H
- pembro
- dostarlimab
- ipi/nivo
- FOLFOX with nivo or pembro

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35
Q

metastatic gastric adenocarcinoma second and subsequent lines

A

2nd line all cat 1
Ramucirumab +/- paclitaxel
Docetaxel
Paclitaxel
Irinotecan

FOLFIRI

3rd line
Lonsurf (cat 1)

HER 2
- Enhertu

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36
Q

Hereditary diffuse gastric cancer presentation and mutation/inheritance, treatment

A

AD mutation in CDH1

young gastric cancer with lifetime risk of 70-80%

women risk of lobular breast cancer, also prostate cancer

prophylactic total gastrectomy versus intense screening

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36
Q

Localized gastric cancer treatment by stage

A

cT1 surgery or ER

T2= invades into muscularis propria

resectable cT2 or higher perioperative chemotherapy (FLOT sandwich)

Restage with PET prior to surgery

unresectible cT2 or higher: chemorads or neoadj chemo

restage with PET and surgery if possible or surveillance

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37
Q

ramicirumab moa

A

VEGFR2 antagonist (receptor blocker)

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38
Q

bevacizumab MOA

A

VEGF-A antibody

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39
Q

diffuse seborrheic keratoses aka leser-trelat sign

A

paraneoplastic development of seborrheic keratoses in GI malignancies also breast and lymphomas

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40
Q

milan transplant criteria for HCC

A

single tumor 2-5 cm or <3 measuring <3 cm in size
no macrovascular involvement
no extrahepatic extension
AFP <1000

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41
Q

Child pugh C treatment options

A

tremelimumab+ durva does not restrict by child-pugh

no other options indicated

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42
Q

LI-RADS criteria apply only to patients with cirrhosis or chronic hepatitis

A

CT or MRI multiphasic with arterial phase hyperenhancement and delayed phase washout or enhancing capsule appearance

<1 cm lesions should be monitored on repeat US

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43
Q

sorafenib child pugh

A

B7

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44
Q

HCC treatment by line in metastatic disease

A

1st: atezo bev (child pugh A)
tremelimumab+durva
or sofafenib, lenvatinib, durva pembro

2nd line
regorafenib (A)
cabozantinib (A)
Ramucirumab (AFP>400 and A)
lenvatinib (A)
sorafenib (B7)
nivo (B)
ipi/nivo (A)
pembro (A)

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45
Q

which HCC drug has a AFP cut off and what is it

A

RAMUCIRUMAB APF >400

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46
Q

local therapy for HCC, use and criteria

A

use if liver-only disease, not a resection or transplant candidate

ablation for <3 can be curative, 3-5 is for prolongation of survival

> 5 cm should be considered for arterial-directed therapy such as chemoembolization or radioembolization (Y90)
- contraindicated if bili >3

radiation is also option

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47
Q

adjuvant treatment for pancreatic adeno s/p resection

A

mFOLFIRINOX or gem+ cape

elderly: gem or 5-FU bolus with lecovorin

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48
Q

blood antigen associated with no production of CA19.9

A

lewis antigen

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48
Q

resectability of a pancreatic adeno by vessel involvement, which ones are bad

A

resectable
- no contact with celiac, common hepatic artery or AMA
<180 contact with SMV or portal

unresectable with >180 of
- SMA
- celiac
- contact with aortic
- tumor thrombus in SMV/PV

borderline
- contact with common hepatic
- SMA <180
- celiac <180
- SMV or PV >180
- IVC contact

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49
Q

treatment for metastatic pancreatic adeno

A

first line
- gem
- gem erlotinib
- FOLFIRINOX
- gem/abraxane

2nd line (NOT FOLFIRINOX in 2nd line technically)
- gem/abraxane
- capcitabine
- gemcitabine

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50
Q

confusing drug used in pancreatic adeno treatment different between adjuvant and metastatic

A

gem cape important in adjuvant but gem abraxane is favored in metastatic

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51
Q

olaparib for pancreatic adeno

A

germline BRCA1 or 2

first-line platinum-based chemo

stable disease for 16 weeks

olaparib maintenance

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52
Q

germline genetic testing in pancreatic adeno when

A

anyone with the diagnosis

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53
Q

immunotherapy for MSI-H pancreatic adeno

A

pembro, dostarlimab

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54
Q

rectal cancer local therapy by stage

A

T1- transanal local excision
T1-2- transabdominal resection
T3 N0 low risk high- TAR
T3-4 or N any–> check MMR status
if pMMR: total neoadjuvant therapy with chemo/RT then chemo or vise versa then restage then surgery

Or now if eligible for sphincter sparing surgery do FOLFOX, restage, surgery or chemo/rads if poor response then surgery

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55
Q

for rectal, After TAR, what is adjuvant therapy for:
T1
T2
T3
N1

A

T1-2 observe
T3 or N1 chemo RT then chemo or vice versa

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56
Q

bevacizumab and surgery

bevacizumab avoid in

A

6-8 weeks
Stroke, MI, TIA, bleeding

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57
Q

rectal cancer local and metastatic MSI-H

treatment of metastatic disease that is MSS

A

local dMMR checkpoint inhibitor therapy for up to 6 months with restaging every 2-3 months

surveillance or if persistent chemo/RT and TAR

checkpoint inhibitor if dMMR and metastatic

normal MSS:
- treat like colon cancer
- test same markers
- EGFR therapy indicated if KRAS wt as these are left sided

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58
Q

head and neck cancers of the lip localized treatment

A

surgical resection
no neck dissection if T1-3, dissect if N2c bilateral

adj radiation if high-risk features like close margin, LVI/PNA, N2/3 nodes, T3/4 primary

consider chemo/rads if pos margins, extra nodal extension

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59
Q

WHO nasopharyngeal SCC subtypes (3) and treatment if local or metastatic

A

type 1 keratinizing EBV (USA #1)
type 2 non-keratinizing differentiated
type 3 (bad) undifferentiated non-keratinizing most common and EBV +

T1- RT to nose and neck
T2- RT +/- chemo with high risk
N1 or N3 chemo/rads or induction
T3-4 N1-3 induction then chemo/rads preferred (cat 1) gem/cis or 5-fu/cis/doce if induction and EBV

metastatic cis/gem +/- pembro or nivo

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60
Q

head and neck PET restage after radiation timeline

A

12 weeks or 4 months

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61
Q

hypopharyngeal SCC (glottic larynx) treatment differs how

A

T4a is invasion of the thyroid cartilage

T4a is treated with surgery and neck dissection and thyroidectomy

T4b is treated with chemo/rads and invades the prevertebral fascia, encases the carotid, involves the mediastinal structures

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62
Q

head and neck metastatic disease first-line
testing for actionable mutations

A

PD-L1 testing and foundation one

all comers: pembro/cis or carbo/5-FU

PD-L1 CPS>1 can give pembro alone

other options if not immunotherapy candidate includes cetuximab/cis or carbo/5-FU

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63
Q

head and neck chemo RT options
induction options

A

cisplatin
carbo
carbo/5-FU
cetuximab

induction: 5-FU/cisplatin/docetaxel (no survival benefit)

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64
Q

Second-line options head and neck metastatic

A

if no prior immunotherapy: nivo or pembro

otherwise:
carbo/docetaxel or paclitaxel/cetux

docetaxel
cetuximab
paclitaxel

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65
Q

IVA thymoma chemo option

A

cisplatin, doxorubicin, cytoxan induction then surgery, adjuvant chemo and radiation

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65
Q

oral cavity local treatment by stage

A

T1-2: surgery or definitive RT
- resect primary and neck direction or SLN biopsy
- no nodes or high risk observe
- node without other high risk–>RT
- high risk features like close margin, T3-4, N2-3, PNI/LVI: RT
-very high risk features extranodal extension or positive margin: chemo/RT

T3-T4a N1-3: surgery still preferred with neck dissection
- high risk features guide adjuvant as above

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66
Q

head and neck oropharynx local treatment by stage

A

T1-2 N0-1 surgery and high risk feature adjuvant assessment or RT alone

T3-4 N0-1 chemo/RT or surgery with neck dissection with adj RT or chemo/RT by risk factors

N2-3 chemo/RT or surgery with adj RT or chemo/RT by risk factors

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67
Q

define oropharynx

A

base of tongue, tonsil, posterior pharyngeal wall, soft palate

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68
Q

HPV+ staging difference versus HPV-

A

N3 disease (large node >6) is still stage III versus IVB

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69
Q

treatment of localized NUT midline carcinoma

A

surgery + adjuvant chemorads

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70
Q

thymic carcinoma treatment unresectable or metastatic

A

unresectable- chemo/rads with carbo/taxol

met carbo/taxol

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70
Q

define hypopharynx and treatment by stage

A

pyriform sinus, posterior pharyngeal wall, post-cricoid area

T1-2 low risk RT or surgery
T2-3 N0-3 induction chemo or surgery or chemo/rads

T4a–> surgery!!!

T4b–> chemo/rads

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70
Q

PD-L1 level for single agent pembro in head and neck

A

PD-L1 CPS> or equal to 1

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71
Q

gardasil version for HPV head and neck prevention

A

gardasil 9, 9 HPV types, 9 valent

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71
Q

adenoid cystic carcinomas local and metastatic treatment

A

local- surgery, adjuvant radiation with high-risk features including intermediate grade or T3-4 disease (pretty much all get adjuvant RT)

combination chemo with cisplatin, vinorelbine, gem, doxorubicin, cyclophosphamide (avoid paclitaxel alone)

lenvatinib

test for NGS and HER2

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72
Q

Lung adenocarcinoma IHC typically

A

TTF-1 napsin A+

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72
Q

WT-1 is found on which tumors

A

mesothelioma, ovarian serous, wilms tumors, desmoplastic small round cell tumors

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72
Q

ovarian serous carcinoma IHC

A

CK7+/CD20-, PAX8+ WT1+ mesothelin+

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73
Q

mesothelioma IHC

A

CK7+, calretinin, WT1, CK5/6, mesothelin, D2-40

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73
Q

TTF-1 is found on what tumors

A

thyroid and lung

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74
Q

markers to to distinguish HCC from intrahepatic cholangio

A

albumin in situ hybridization and MOC3 negative in HCC

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75
Q

upper vs lower GI tumors IHC

A

Lower GI CK20+ CK7-
Upper usually CK7+ and CK20-

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76
Q

IHC for GIST tumor

A

CD117+ KIT+ CD99

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77
Q

IHC CDX2 location

A

GI tract

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78
Q

melanoma markers IHC

A

S-100, HMB-45, SOX11

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79
Q

TMPRSS2:ETS rearrangement is found in which tumor and gene mutation

A

prostate and PTEN

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80
Q

CUP with SCC in neck node should:

A
  • test HPV, EBV, thyroid markers (PAX8, TTF-1, thyroglobulin)
  • get full exam and pet and if primary is not found, then they undergo tonsillectomy bilaterally as this is the most likely primary source.

if negative, then neck dissection

if positive then treat per algorithm for oropharynx by stage

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81
Q

carcinoma markers IHC

A

pan-keratin (AE1/AE3), CAM5.2

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82
Q

squamous cell markers IHC

A

CK 5/6, p63, p40

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83
Q

germ cell tumors IHC

A

negative for CK7/CK20, OCT3/4, SALL4, CD30, Glypican-3, PLAP

gain of ch12p

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84
Q

mediastinal CUP treatment by age

A

<45 treat as high stage Germ cell tumor (VIP or BEP), >50 treat as NSCLC lung adeno

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85
Q

BRAF drug combos matched correctly

which combo can be used in adjuvant melanoma treatment

what should you check before starting

A

Vemurafenif/cobimetinib (skin issues and SCC of skin)
encorafenib/binimetinib
dabrafenib/trametinib (DT, pyrexia, CHF)

only DT can be used as adjuvant treatment in melanoma stage III only

EKG for QTc

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86
Q

c-kit mutations can be found in which solid tumors commonly

treatment option

A

mucosal melanoma

imatinib for kit exon 11 and 13

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87
Q

melanoma indications for SLNB

positive node next steps

A

stage IB T1b <0.8 ulcerated or 0.8-1

complete LN dissection or surveillance of the lymph node basin

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88
Q

melanoma staging and adjuvant treatment

A

Stage I-IIA

Stage IIb or higher treat with adjuvant pembro
- T3bN0 (>2 mm with ulceration or unspecified or >4mm without)

Stage III or higher treat with adjuvant pembro or braf therapy
- nodes made you III
- microsatellosis or intransit mets make you N1 or stage III

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89
Q

margin goals for melanoma

A

based on depth
1 cm margin for <1-2
2 cm margin for >2

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89
Q

merkel vs small cell lung cancer IHC

A

CK20 is positive in merkle cell
TTF-1 is negative in merkel cell and positive in small cell LC

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90
Q

vismodegib moa and use

A

SHH hedgehog pathway inhibitor used in basal cell carcinoma

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91
Q

virus associated with merkel cell

A

polyomavirus

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92
Q

adjuvant radiation option in melanoma when

A

head and neck location, neurotropism, pure desmoplastic subtype, close margins, local recurrence, extra capuslar extension, parotid node involved, >2 cervical or axillary nodes involved, >3 inguinalfemoral nodes,

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93
Q

PD-1 vs PD-L1 which immunotherapy is which and what is ipi and what is relatlimab

A

Nivo is PD-1
Pembro is PD-L1
ipi is CTLA-4
relatlimab is LAG-3

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94
Q

treat metastatic cutaneous SCC

A

pembro and cemiplimab (PD-1)

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95
Q

second line for metastatic Basal cell

A

cemiplimab (PD-1) but only after SHH therapy

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96
Q

MGMT mutation is what

A

good prognostic sign and a good likelihood of temodar response

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97
Q

grade 2 oligodendroglioma treatment

A

resection of tumor

low risk features age <40, observe

high risk features if >40 or subtotal resection, offer RT and adjuvant PCV x6 os and pfs benefit

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98
Q

WHO grade 3 oligodendromas treatment

A

resect and then treat with RT and then PCV x 6

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99
Q

HER2 FISH analysis

A

HER2 ratio <2 and copy number less than 4 is negative

HER2 ratio >2 and copy number >4 is positive

more complex in the middle with positivity definite as:

HER2 ratio <2 is positive if copy number is >6 and IHC 2+ or higher

HER2 <2 and copy number 4-6 with IHC repeated as 3+

Her2 >2 and copy number <4 if repeat IHC 3+

HER2 ratio <2 but copy number 4-6 equivocal, other testing ordered

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100
Q

generally when to recommend AI+ ovarian suppression

A

pre-menopausal, node positive or higher risk women

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100
Q

What is the oncotype cut-off for chemo for pre-menopausal and post-menopausal for node-positive and negative disease?

A

pre-menopausal:
- node-negative 16
- node-positive should get chemo regardless of oncotype score

post-menopausal
- 26 node negative
- 26 1-3 nodes positive
- always offer chemo >4 nodes

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101
Q

criteria for the addition of pertuzumab to TCHP per trial

A

tumor >2 cm in size

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102
Q

adjuvant her2 therapy if surgery first

A

tumor >1cm give adjuvant chemo with trastuzumab

if N+ given adj chemo with HP

if <1 cm can consider chemo with trastuzumab especially if HR-

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103
Q

management of pagets disease of the breast

A

> 90% of cases have occult malignancy, treat with mastectomy

104
Q

sarcoma after breast radiation and treatment

A

angiosarcoma, treated with mastectomy or metastatic paclitaxel or AIM

105
Q

antidepressants contraindicated in tamoxifen use

A

paroxetine or fluoxetine

106
Q

role of bisphosphonate therapy in adjuvant setting

A

improved survival in post-menopausal patients (natural or induced)

zometa use if high risk of recurrence

107
Q

oncotype less than what auto stages you to IA

A

11 or less

108
Q

margetuximab-cmkb moa and use

A

4th line option for HER2+ metastatic BC, given with chemotherapy, it is a Fc engineered HER2 monoclonal antibody

109
Q

Elacestrant moa nd use

A

ESR1 mutated metastatic breast cancer via guardant 360 testing, given as monotherapy after progression on one line of endocrine therapy

oral SERD

109
Q

lynch syndrome cancers, genes, screening start

A

colon/gi, endometrial, ovarian

msh2, mlh1, msh6, pms2

age 20-25, 30s for MSH6

110
Q

lifraumenti gene and cancers

A

p53 gene

sarcoma (esp osteosarcoma), breast, chroid pluexus, brain tumors, adrenocortical cancers

111
Q

cowden syndrome, gene and cancer types

A

PTEN

breast, endometrial, colon, rcc, follicular thyroid

harmartomas, harmatoumatous polyps, skin tumors, macrocephaly, autism

112
Q

Gardners FAP gene and issues, treatment

A

APC gene mutation

GI cancers, papillary thyroid

CHRPE congenital hypertrophy of the retinal pigment epithelium, benign bone tumors, desmoid tumors, hepatoblastoma, cysts, medulloblastoma (turcot syndrome)

treat with proctocolectomy, thyroid US, colo afed 10

113
Q

peutz- jeghers gene and issues

A

STK11 cancer of breast, colon/GI, pancreas and sex cord stromal ovarian or sertoli testicular

harmartomatous polyps and hyperpigmented macules in the mouth, nose, eyes, genitals and fingers

113
Q

BRCA 1gene, chromosome, risks

A

ch17, DNA repair, breast cancer exp triple negative, ovarian, melanoma, pancreas

MRI at 25, mammogram at 30

BSO by 35-40

114
Q

BRCA 2, chromosome, risks

A

ch13, breast, ovarian, prostate, pancreas, melanoma

115
Q

carney-stratakis syndrome triad, mutation

A

GIST, paragangliomas, pulmonary chondromas

SDH mutation

116
Q

Gorlin syndrome mutation and issues

A

PTCH1 or SUFU tumor suppressors

basal cell carcinomas
mandibular tumors, jaw problems, prominent skull
meduloblastomas

117
Q

MUTYH associated polyposis

A

germline MUTYH
test if >10 adenomas
older age than FAP and fewer polyps
recessive

118
Q

juvenile polyposis syndrome mutation and presentation/screening

A

BMPR1A and SMAD4
colon polyps- harmatomatous
surveillance at age 12

SMAD 4 causes telangiectasias of the skin and nasal mucosa (epistaxis and rectal bleeding)

119
Q

hereditary diffuse gastric cancer gene, inheritance, treatment

whats the other cancer risk and when does screening start

A

CDH1 e-cadherin

gastrectomy

lobular breast cancer, age 30

120
Q

werner syndrome, gene and risk

A

WRN
premature aging
osteosarcoma and soft tissue sarcomas

121
Q

CHEK2 mutations risk and screening

A

mammogram at 40
colonoscopy screening at 40

122
Q

PALB2 mutation riskB and screening

A

breast cancer risk, screening at 30
slight ovarian cancer risk
pancreatic cancer

123
Q

muir-torre syndrome is what and what risk

A

lynch syndrome + skin stuff (sebaceous gland adenomas and keratoacanthomas)

MLH and MSH2 with AD pattern

124
Q

Turcot syndrome mutation and risk

A

lynch/FAP overlap

MLH PMS2 genes or APC!

colon cancer and brain tumors

125
Q

emberger syndrome is what and what gene

A

GATA2 gene

deafness, lymphedema, leukemia syndrome

also cirrhosis, pancytopenia, cerebellar atropy

126
Q

BAP-1 tumor syndrome

A

spitz tumors, uveal melanoma, mesothelioma, RCC, melanoma, basal cell

127
Q

CDKN2 mutation carriers have what types of cancer and what else and what syndrome name

A

pancreatic cancer and melanoma

FAMMM syndrome familial atypical multiple mole melanoma syndrome

128
Q

neurofibromatosis type 2 tumors

A

vestibular schwannomas or acoustic neuromas

129
Q

MEN 1 which mutation and which cancers

A

menin mutation
parathyroid
pancreatic islet tumor
pituitary

130
Q

MEN IIA mutation and cancers

A

RET mutation
medullary thyroid
pheochromocytoma
parathyroid

131
Q

MEN IIB

A

RET
marfanoid
medullary thyroid
pheo

132
Q

Men 4

A

CDNK1B
parathyroid adenoma
pituitary tumors
adrenal tumors
kidney cancer
testicular or reproductive cancers

133
Q

RAD51c mutations risks and treatment

A

breast cancer screening at 40

~20% risk of ovarian cancer, BSO recommended 45

134
Q

CMMRD presentation and gene

A

MMR gene mutation biallelic

early childhood cancers including brain tumors, leukemias and lynch spectrum cancers with many polyps

cafe au lait and hyperpigmented skin lesions,

135
Q

DICER1 sydnrome

A

childhood tumors
pleuropulmonary blastomas
cystic nephromas
sertoli leydig tumors
mutlinodal goiter

136
Q

ATM mutation

A

breast cancer risk screening at 40, MRI 35

small ovarian risk
moderate pancreatic risk

137
Q

what is CHRPE and what is it associated with

A

congenital hypertrophy of the retinal pigment epithelium

FAP

138
Q

BRIP1 mutation association and treatment

A

ovarian cancer risk (BRCA1 interaction protein gene 1)

  • BSO at age 45

breast cancer risk

139
Q

NF1

A

cafe au lait/pigmented skin
neurofibromas of the skin
lisch nodules of the eyes, optic gliomas
malignant peripheral nerve sheath tumor
GIST
pheochromocytoma
macrocephaly, short stature

breast cancer risk, screen at 30

140
Q

VHL tumors

A

hemangioblastomas, retinal angiomas, clear cell RCC, pheochromocytoma, pancreatic neuroendocrine tumors

141
Q

Dermatofibrosarcoma protuberans, translocation and gene result and treatment

A

t(17;22) fuses COL1A1 to PDGF which leads to PDGFRB

treat with imatinib, resection

141
Q

Desmoid tumor treatment, mutation, associated syndrome

A

observe for spontaneous regression, sorafenib (cat 1), NSAIDS, imatinib, pazopanib, MTX and vinblastine

CTNBB1
gardners syndrome FAP

142
Q

GIST mutations and drug sensitivity

A

Imatinib- KIT and PDGFRA except resistant exon 18 (D842V)

Avapritinib- for exon 18 resistance mutations (D842V)

NTRK, BRAF- associated target therapies

SDH deficient- sunitinib

143
Q

GIST IHC

A

SDHB, CD117, DOG1, CD34 also look for mutations in KIT and PDGFRA

144
Q

Adjuvant therapy GIST what determines this

A

location, size and mitotic rate

low risk resected- observe
gastric: <2 cm (regardless of high or low mitoses) is low
size up to 10 cm with low mitoses are still low risk

non-gastric:
- generally 0-5 cm with <5 mitoses=low
- >5 mitoses and <2 is high

int or high

145
Q

GIST imatinib duration and dose per mutation

A

KIT 11 normal dose 400 daily
KIT 9 double the dose helps with better response

36 months for high risk post-op

146
Q

second line, third line, fourth line GIST metastatic

A

sunitinib, regorafenib, ripretinib (switch control kinase)

then pazopanib, dasatinib (D842V mutation), sorafenib, nilotinib, ponatinib, everolimus +TKI, cabozantinib

147
Q

ewing sarcoma treatment and translocation

A

t(11;22) CD99+, FISH EWS gene

neoadjuvant chemo VAC/IE for 9 weeks, then surgery and then adjuvant chemo or chemo/rt with + margins

148
Q

chondrosarcomas and types treatment

A

normal chondrosarcoma treat with surgery and observe

if undifferentiated treat like osteosarcoma if mesenchymal treat like ewings

149
Q

osteosarcoma treatment

A

low grade or parosteal: resect and ajuvant chemo if high risk features

int-high grade or undifferentiated: neoadjuvant chemo with cisplatin/doxorubicin or high dose MTX, cisplatin and doxorubcin followed by surgery and adjuvant chemo

metastatectomy

150
Q

Giant cell tumor of the bone treatment

A

express RANK ligand, therefore can be treated with denosumab which blocks RANK ligand

151
Q

good response to neoadjuvant chemo in bone tumors

A

<10% viable tumor is a good response to chemo

152
Q

treat kaposis sarcoma if visceral disease, virus associated

A

doxil or paclitaxel, second line is pomalidomide, can also use immunotherapy; hhv-8

153
Q

Inflammatory myeofibroblastic tumors mutation and drug

A

ALK gene rearrangements and crizotinib and related drugs

154
Q

epithelioid hemagioendothelioma mutation

A

WWTR1 protein TAZ-CAMTA1 fusion gene t(1;13)

155
Q

breast cancer with lymphedema chronically at risk for which sarcoma and treatment

A

angiosarcoma, surgical resection

156
Q

tenosynovial giant cell tumors aka pigmented villonodular synovitis aka diffuse type giant cell tumor treated with and mutation

A

CSR1, treatment with pexidartinib (cat 1 liver tox), imatinib, nilotinib,

157
Q

metastatic liposarcoma or leiomyosarcoma treatment

1st and 2nd line

A

AIM or single agents of this like doxorubicin
trabectedin or eribulin (liposarcoma)

157
Q

KIT exon 17 mutation in GIST means what for treatment

A

resistance to imatinib and sunitinib so try regorafenib

158
Q

which sarcomas respond to immunotherapy

A

myxofibrosarcoma, UPS, dediff liposarcs, cut angiosarcs, undiff sarcs

159
Q

rhabdomyosarcoma treatment

A

pleomorphic vs non-pleomorphic

non: VAC (vincristine dactinomycin and cyclophosphamide

pleo: doxo/ifos. mesna or ifos epi mesna

160
Q

epithelioid sarcoma mutation and treatment

A

INI1, SMARCB-1 which allows EZH2 to drive tumor growth

tazemetostat is a EZH2 inhibitor

161
Q

PEComa treatment and mutation

A

TSC1/2 mTOR complex overexpression treated with sirolimus

162
Q

alveolar soft part sarcoma treatment

A

surgically resect or surveillance

atezolizumab or pembro

pazopanib or sunitinib

163
Q

adjuvant NSCLC lung cancer treatment by stage

what chemo/immuno

A

stage II (generally nodes involved or >5 cm) or higher are offered treatment with chemo followed by immunotherapy or osimertinib if EGFR mut

IB (3-5 cm in size T2, N0) with high-risk features also considered (poor diff, vascular inv, only a wedge resection, visceral pleural inv or no node dissection)

re-resection or RT if positive margins

Stage III consider adjuvant RT after chemo

adjuvant chemo/immuno
adeno: cis/pemetrexed x4 with atezo pd-l1 >1%
squam: cis/gem or cis/doce or cis etop x4 with atezo pd-la >1%

163
Q

treatment options by stage for NSCLC

A

I surgery (up to T3N1)
II surgery (up to T3N1)
III generally chemo/rads if N2 or T4 or T3 with invasion

164
Q

ROS + metastatic disease treatment

1st, 2nd lines
brain

A

crizotinib, entrectinib

lorlatinib, ceritinib, or chemo

entrectinib, lorlatinib for brain

165
Q

ALK metastatic treatment

A

1st line alectinib, brigatinib (pneumonitis), lorlatinib, ceritinib

2nd line: lorlatinib
if used crizotibib then alectinib, brigatinib, lorlatinib, certinib

3rd line lorlatinib

brain: alect, brig or lorlat, cert?

all cause brady cardia
ceritinib and crizotinib cause qtc

166
Q

metastatic squamous NSCLC no targetable mutations

1st line
2nd line

A

carbo/taxol or nabpaclitaxel pembro (all comers

ramicirumab/docetaxel
gem
nab/paclitaxel

167
Q

metastatic adenocarcinoma no targetable mutations

A

carbo/pem/pem

ramicirumab/docetaxel
gem
nab/paclitaxel

pembro pdl1>1 if not given upfront

168
Q

multiple nodules in the same node for lung cancer staging

A

stage T3

169
Q

N3 disease NSCLC, what stages does this correspond to and what does that mean for treatment

A

contralateral hilar or mediastinal lymphadenopathy or any supraclavicular or scalene, upstages to IIIB, chemo/rads +durva not surgery

170
Q

N2 definition, stage and treatment

A

metastasis in ipsilateral mediastinal or subcarinal nodes,

upstages to stage III which means chemo/rads +durva

171
Q

EGFR-mutated metastatic treatment lines

mutations

A

exon 19del or 21 L858R
- osimertinib (ILD, Qtc, CHF)
(afat, gefit, dacomit, erlot+/- ramucirumab or bev)

if started not osi:
- then if T790M+ switch to osimertinib
- if negative continue treatment or switch to chemo based treatments

S768I, L861Q and G719X
- afat or osi
- if afat is started check T790M and switch if + on progression

20 insertion
- amivantamab
- mobocertinib (oral)

172
Q

pancoast tumor NSCLC treatment differs how

A

neoadj chemo followed by surgery

172
Q

extensive stage SCLC 1st line and subsequent

A

carbo/etop x6 + atezo

<6 mo relapse
- lurbinectedin
- topotecan
- paclitaxel, docetaxel

> 6 mo relapse could retrial as above

173
Q

EGFR mechanisms of resistance to therapy

A

EGFR 790M mutation or MET amplification

174
Q

immunotherapy in EGFR or ALK

A

generally not helpful

some benefit with atezo+ bev+ carbo+paclitaxel in the mutated groups

175
Q

sotorasib use and moa and electrolyte issue

A

2nd line KRAS g12c mutated NSCLC, causes hypocalcemia , hepatotoxicity, ILD

176
Q

RET mutation treatments

A

Selpercatinib (hepatotox, HTN, QTc, bleeding)
Pralsetinib
Cabozantinib

177
Q

METex14 skipping mutation

A

capmatinib
tepotinib
(crizotinib)

178
Q

lorlatinib side effect

A

hyperlipidemia

start rosuvastatin as it is low CTP450

179
Q

lung nodule plan

A

solid nodule 6-8 mm repeat CT scan

> 8 mm CT or PET in 3 or biopsy

180
Q

crizotinib side effect

A

visual disturbances like flashing lights or floaters, liver enzyme elevation and diarrhea

180
Q

T3 invasion of the chest wall, proximal airway or T4 resectable mediastinum if resectable (IIIA T3 N0-1)

A

treat with neoadj chemo then surgery

181
Q

checkpoint 816 lung ca trial

A

stage IB-IIIA resectable NSCLC given neoadjuvant chemo+nivo or placebo then surgery

improves EFS
improves PCR

182
Q

manage siadh in sclc

A

tolvaptan vasopressin antagonist

183
Q

erlotinib things

A

take on empty stomach
smokers need to increase dose to 300 mg
causes rash

184
Q

chemo/rads treatment is given with what in local NSCLC curative intent

A

DURVALUMAB always pdl1 does not matter

185
Q

indications to forgo adjuvant RAI thyroid

A

papillary tumor <2 cm, all foci less than 1 cm if multifoal, no Tg antibodies, unstimulated ttg post op low <1, neg post-op US

186
Q

std work up in medullary thyroid cancer and treatment of local disease

A

calcitonin level, cea, screening for RET germline mutations, screen for pheochromocytoma

surgery with b/l neck dissection if >1 cm

no RAI

187
Q

MEN 2 mutations in RET thyroid plan

A

total thyroidectomy by 1 year if high risk mutation and by age 5 if lower risk mutation

188
Q

treat metastatic medullary thyroid cancer

A

observe if asymptomatic or cabozantinib or vandetanib both are RET and VEGF inhibitors

189
Q

metastatic papillary thyroid cancer treat

A

radioactive iodine scan (2 months apart from CT scan which interferes

if uptake treat with RAI (100-200)

if no uptake check RET mutation status (selpercatinib, pralsetinib), BRAF status (DT)

1st line: lenvatinib, sorafenib
2nd line: cabozantinib

metastatectomy

190
Q

Post-operative TSH suppression goals

A

high risk <0.1
low risk <0.5
liberalize after few years to 2

191
Q

tumor markers in thyroid cancer

A

thyroglobulin in papillary
calcitonin in medullary
(>150 prompts imaging post-local therapy)

192
Q

carcinoid of the appendix surgical plan

A

<2 cm appendectomy ok
>2 needs r hemi colectomy/ if neg SSTR-PET

193
Q

treat metastatic NET of pancreas or other well-differentiated areas

A

octreotide, everolimus, sunitinib, capecitabine and temozolomide

193
Q

alpha blocker drug prior to pheo surgery

A

terazosin, doxazosin, prazossin and phenoxybenamine

194
Q

carcinoid causes what heart thing

A

serotonin thickens the R cardiac valves, causes R heart failure, tricuspid regurg or pulmonary stenosis

195
Q

moa and use of telotristat ethyl

A

tryptophan hydrolyase inhibitor for diarrhea due to serotonin from carcinoid tumors

196
Q

papillary thyroid staging

A

age <55 with distant met is stage II disease
- treat with thyroidectomy then RAI

age >55 with lung mets is IVB with poor prognosis

196
Q

HPV co-testing is indicated for women of what age

A

> 30

197
Q

chemoradiation + brachy for which stages of cervical cancer

A

IB3, and then IIB, III, IVA

aka huge tumor or invades things

IB3= >4 cm tumor
parametrial invasion or invasion into
nodes

cisplatin or carbo weekly

198
Q

cervical treatment stage IB1, IB2 and IIA1

A

tumors <4 cm!
IIA1 is tumor with extention beyond uterus but not to wall or lower vagina

surgical resection with hysterectomy with cervix removed and lymph node dissection

fertility-sparing is a radical trachelectomy and pelvic lymph node direction

199
Q

adjuvant treatment after surgery with high-risk factors for cervical

A

positive nodes, positive margins, parametrium involvement, LVI

staging imaging

chemo/rads and brachytherapy (cat 1)

200
Q

treatment for metastatic cervical cancer

A

carbo/cis + taxol + bev
carbo/cis +taxol bev + pembro (pdl1>1)
topotecan/taxol/bev (allergy)

2nd line
pembro if not previously received (>1)
tisotumab vedotin (ADC)
cemiplimab

201
Q

gardasil 9 HPV types

which one is adenocarcinoma

A

6, 11,16,18, 31, 33, 45, 52, 58

18 is adenocarcinoma

202
Q

salvage cervical ca surgery after definitive treatment

A

pelvic exenteration

or chemo/rads +brachy

203
Q

vulvar cancer treatment local

A

<2 cm with <1 mm invasion simple vuvlectomy

> 2 cm with more than 1mm invasion radical partial vulvectomy and lymph nodes

204
Q

Endometrial cancer adjuvant treatment

A

stage I
IA endometrium only or less than half myometrium: observe or brachy if grade 3

IB invades more than half the myometrium then

stage II brachy and EBRT if high grade

Stage III (invading things) or high risk histology (serous, clear cell, carcinosarcoma, undifferentiated) chemo/rads then carbo/taxol x6

III or IVA after surgery, add brachytherapy

205
Q

gestational trophoblastic disease metastatic treatment

A

risk stratify
low risk methotrexate
second line in slight increase is dactinomycin or hysterectomy

poor response etoposide methotrexate actinomycin cyclophosphamide vincristine

206
Q

endometrial metastatic disease treatment lines

test for what

A

HER 2, MMR

low grade or endometrioid
- AI therapy, megase/tamoxifen

carbo/taxol/pembro (except carcinosarcoma)

carbo/taxol dostarlimab

next line is len pembro in pMMR

carcinosarcoma:
- carbo/taxol +/- dostarlimab
- ifosfamide +/- paclitaxel or cis

MSI H
- pembro
- dostarlimab
- nivo or avelumab

207
Q

tisanlizumab vedotin moa and use and risk

A

metastatic cervical cancer seond line

corneal and conjunctival issues, need to see eye doctor prior to each dose, eye drop steroids pre-med

pneumonitits

208
Q

adjuvant treatment for endometrial stromal sarcoma or adenosarcoma that are low-grade

A

AI or other hormone treatments

208
Q

management of localized RCC

A

T1= <7 cm cm stage I= partial nephrectomy, ablation or surveillance

T1a <4 cm partial nephrectomy is preferred

stage II >7 cm only kidney partial or radical nephrectomy

stage III (extends into veins or perinephric tissues or N+)radical nephrectomy: radical or partial if clinically needed

209
Q

adjuvant therapy for RCC

A

surveillance for stage I

Stage II adjuvant pembro if grade 4 or sarcomatoid or surveillance

Stage III adjuvant pembro or surveillance

210
Q

pazopanib moa use and risks

A

RCC front line favorable risk not immunotherapy candidates, in later lines metastatic, multi TKI to VEGF, c-KIT and PDGFR

LFT elevation

211
Q

metastatic RCC treatment lines

A

favorable first
axi-pemb
cabo-nivo
len-pem
(surveillance, axi, IL-2)

poor first
ipi/nivo
axi-pem
cabo-nivo
len-pem
cabo alone
(pazopanib, sunitinb, temsirolimus)

subsequent lines
- len evero
- axi
- cabo

if no IO then axi-pem, ipi/nivo, len-pem, nivo

3rd line
- tivozantinib

212
Q

papillary renal cell driven by what mutation and what syndrome

A

MET mutations

hereditary papillary RCC

213
Q

chromophobe RCC what syndrome and what other symptoms

A

birt-hogg-dube FLCN gene folliculin

oncocytomas, angiomyolipomas

clear cell and papillary rcc

cysts/blebs, spontaneous ptx

tumors of the follicles

214
Q

hereditary leiomyomatous and RCC syndrome gene

A

fumerase hydratase

adrenal adenomas, uterine lyomyatat, cutaneous leiomyata

215
Q

tuberous sclerosis tumors and gene

A

TSC CNS tubers, renal cysts and clear cell rcc, angiomyolipomas, subependymal giant cell astrocytoma, retinal hamartomas

skin facial tumors, skin patches, thickened skin, shagreen patch

216
Q

treat angiomyolipomas associated with tuberous sclerosis

A

everolimus

217
Q

RCC IHC

A

CK7 and 20 are negative

PAX2 and PAX8 positive
carbonic anhydrase, CD10

218
Q

medullary RCC treatment

who gets this

A

carbo/gem is first line

sickle cell trait

219
Q

treatment of non-clear cell rcc

A

cabozantinib preferred

then len/evero, nivo, cabo/nivo, pembro, sunitinib

220
Q

treatment of ovarian cancer by stage

A

IA-IV: hysterectomy/BSO, comprehensive staging and debulking

IA or IB (tumor in one or both ovaries with capsule intact no malignant washings) (not HG serous or grade 3 endometrioid): observe

Otherwise: stage II-IV IV platinum chemo

stage II- anything out of the ovary itself)

carbo/taxol +/- bev (+ maint bev)

221
Q

treatment difference for mucinous carcinoma

A

FOLFOX bev for mucinous

222
Q

germ cell tumor adjuvant

A

BEP x4

unless stage ia grade1 immature terratoma or dysgerminoma observe

223
Q

granulosa verus sertoli-leydig ovarian cancers

A

granulosa secretes estrogen–> endometrial cancer risk

also secretes inhibin which can be measured and help with diagnosis

sertoli-leydig–> testosterone

224
Q

low-grade serous carcinomas treatment

A

adjuvant treat with chemo (Carno/taxol) if stage II or higher, consider maint letrozole

metastatic disease:
- MEK inhibitors (trametinib)
- check BRAF
- mormone therapy
- chemo

225
Q

role of olaparib in ovarian cancer

A

maintenance only (not single agent) in BRCA mutated disease

or in second remission after platinum if not used in first line in all comers

Niraparib or rucaparib can be used in all comers if bev was not used upfront but not in second remission if unmutated

if bev used upfront and BRCA mutated or HR deficiency give bev and olaparib maintenance

226
Q

mirvetuximab sorvtansine-gynx moa and use

A

folate receptor alpha directed antibody for use in metastatic disease platinum resistant ovarian cancer with one prior lineof therapy including bev

side effect keratopathy/occular toxicity

227
Q

platinum resistant ovarian lines

A

cycolophos bev
docetaxel
etoposide oral
gem
doxil
taxol +/-bev
topotecan +/- bev
bev
mirvetuximab soratvansine (after bev)

228
Q

endometriosis and ovarian ca type

A

clear cell

229
Q

low risk observe after TURBT

A

papillary urethelial of low malig potential
low grade Ta, <3, solitary lesion

230
Q

sqamous bladder tumor management

urachal management

A

resect

adenocarcinoma or urachal if needs chemo think about FOLFOX, resect the urachal ligament with umbilicus and nodal dissection

231
Q

plasmacytoid urolothelial or micropapillary mutation

A

CDH1, aggressive

232
Q

EV target and conjugate and SE

A

nectin-4, platinum, rashes and occular toxicity

232
Q

testicular staging

A

stage I is no nodes regardless of T
stage II is nodes regardless of T
stage III is metastatic disease and/or Nodes with very high tumor markers

232
Q

erdafitinib target and toxicity

A

FGFR2 or 2 second line

hyperphosphatemia

occular disorders, must have upfront and constant eye exams

233
Q

seminoma stage I treatment

A

surveillance

Carbo AUC7 x1
radiation

233
Q

seminoma must have

A

pure seminoma features on pathology, normal AFP (b-hcg can be elevated)

233
Q

Stage I non-seminoma treatment

A

surveillance

RPLND

BEP x1

234
Q

minor b-hcg elevations cause

A

hypogonadism, hyperthyroidism, marijuana

235
Q

treat stage IIA/B seminoma

A

Node +

BEP x3 or EP x4
or
Radiation

236
Q

treat stage IIC (N3 aka node >5cm) or III seminoma

A

risk stratify
good - BEPx3 or EPx4
int risk (mets other than lung)- BEPx4 or VIP x4

237
Q

treat stage II non-seminoma also IIIA (only lung mets)

A

BEPx3 or EP x4

RPLND

238
Q

IIIB and IIIC non-seminoma

A

non-pulmonary mets or very high post op tumor markers or mediastinal primary

BEPx4, VIP x4

239
Q

testicular residual masses by type and size

A

seminoma 3 cm, markers, PET eval or watch, then surgically resect, if seminoma give 2 cycles of adjuvant chemo EP or TIP or VIP

non-seminoma 1 cm, surgically resect, if residual non-seminoma then chemo x2 cycles (EP, VIP or TIP)

240
Q

tumor markers in testicular, half lives

A

AFP 5-7 days
b-hcg 1-2 days

IS- stage is residual tumor marker elevation after surgery (BEPx3 or EPx4)

240
Q

who gets a brain MRI in testicular staging

A

post-op b-hcg >5000, AFP >10,000
extensive lung mets or visceral mets
choriocarcinoma dominant pathology
neuro sx

241
Q

second line chemo regimens in testicular

A

TIP or VeIP (vinblastine)

third line high dose chemo with stem cell rescue

242
Q

treatment of penile SCC

A

stage I wide local excision, or if high grade partial penectomy
Stage II partial penectomy with LND
Stage III nodes neoadj TIP

243
Q

paclitaxel infusion reaction vs allergy which part of the formula

A

cremophor in paclitaxel can cause flushing and a rash, rune more slowly

can switch to docetaxel if still bad

244
Q

moa methotrexate

A

dihydrofolate reductase antimetabolite

245
Q

DPD vs UGA1A1

A

5-FU (cytopenias and other se) vs irinotecan (diarrheaO)

246
Q

moa fulvestrant

A

estrogen receptor antagonist

246
Q

letermovir

A

prevents CMV reactivation

247
Q

opioid conversion help

A

oral morphine, IV divide by 3
oral morphine x10 for tramadol
oral morphine oxycodone divided by 1.5-2

oxy 10= dilaudid 4= morphine 15=traadol 150

247
Q

AST ALT elevation grading in immunotherapy toxicity and manage

A

x2 ULN is grade 1 continue and monitor/work up

x3-5 is grade 2 hold and monitor q3-5d and consider steroid if not improved on first recheck

> 5 grade 3
hold and start steroids

> 20 grade 4 permanent stop

no infliximab

248
Q

bullous rash with immunotherapy grade and manage

A

> 30% BSA= grade 3 permanent d/c due to c/f SJS

249
Q

vincristine vs paclitaxel moa

A

vincristine is a microtubule destablizing agent

paclitaxel is a microtubule stablizing agent

250
Q

pancreatitis as immunotherapy se

A

grade 2 is CT or lab findings (consider hold)

grade 3 is symptomatic with pain and vomiting and elevation/CT findings (hold and give steroids)

grade 4 is life threatening (perm d/c)

251
Q

grapefruit juice and imatinib

A

increase drug levels

252
Q

sunitinib side effects and moa

A

VEGF 2, 3, PDGFR, C-KIT

HTN, CHF, hypothyroidism, adrenal insufficiency

253
Q

TDM-1 is what drug and what is the linker

A

ado-trastuzumab emtansine

maytansinoid is a tubule polymerization inhibitor

254
Q

treat neuropathy

A

duloxetine

255
Q

what does CTLA4 bind with that is interrupted by ipilimumab

A

CD28 and CD80, CD86 (B7)

256
Q

nausea meds moa

NK1
5-HT3

name the components of a high emetogenic cocktail (name a few drugs or combos)

A

aprepitant
ondansetron

two above plus dex and olanzapine

AC
cisplatin
ifosfamide
carbo AUC 4
Enhertu
sacituzumab govitecan

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