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Question 1

What cancers are Pembrolizumab funded for on PBS?

Answer 1

NSCLC
Melanoma
Bladder
GOJ/gastric
Head and neck

Question 2

Why are the ADRs of ipilimumab more severe than those of Pembrolizumab?

Answer 2

Ipilimumab is less specific for cancer cells

• ipilimumab binds the CTLA4 on the activated T cells to prevent CTLA4-B7 binding to the antigen presenting cell
• Pembrolizumab binds the PD1 on the activated T cell to prevent PD1-PDL1 binding to the tumour cell

Thus Pembrolizumab targets cancer cells specifically, vs ipilimumab non-specifically targeting APCs

Question 3

What percentage of melanoma are BRAF positive?

Answer 3

40-60% melanoma are BRAF positive
- 80-90% of these are V600E (glutamic acid substituted for valine)

Treat with Dabrafabib/Vemurafenib (BRAF inh) with Trametinib (MEK inh)

Question 4

What are the side effects of Dabrafenib?

Answer 4

Fatigue
Arthrarlgia
Alopecia
Skin SCC

Question 5

Side effects of Trametinib?

Answer 5

Fever

But lower rate of skin SCC vs BRAF inhibitors

Question 6

Current breast screening guidelines

Answer 6

Women 50-74 have free 2yrly mammograms

Question 7

Bowel cancer screening in Australia

Answer 7

5yrly FOBT from age 50-74

If moderate risk/FHx - start screening at 50yo or 10yrs prior to 1st family member diagnosed

Question 8

Cervical cancer screening

Answer 8

2yrly Pap smears for anyone sexually active 18-70yo

Question 9

In what percentage of neutropenic sepsis is a causative organism found?

Answer 9

Causative organism only found in 20-30% (gram + > gram -)

Question 10

What are the common cause of oncological spinal cord compression?

Answer 10

Lung
Prostrate
Breast
Haematological malignancies

Question 11

Most common cause of SVC obstruction

Answer 11

Lung Ca

NHL

Question 12

What is the role of bisphosphonates in malignancy?

Answer 12

Treating malignant hyperCa, bony metastasis, osteoporosis

No impact on survival
Increase time to developing a skeletal complication (pain, fracture, osteoporosis)

Mx: Zoledronic acid (for osteoporosis and bony mets); Denosumab approved only for prostate and breast Ca (higher risk of hypoCa)

Question 13

Toxicity of Antheacyclines (doxorubicin/epirubicin)

Answer 13

Acute: arrhythmias, heart block ventricular dysfunction
Chronic: cardiomyopathy and heart failure

Monitor with 3/12 echo

Question 14

Toxicity of florouracil/capecitabine

Answer 14

Chest pain due to coronary artery spasm
(High rates of spasm with PO > IV 5-FU)

Mx: stop drug, angio if possible

Question 15

Toxicity of anti-angiogenic agents (bevacizumab/sunitinib/sorafenib)

Answer 15

Hypertension

Question 16

Toxicity of Bleomycin

Answer 16

Irreversible pulmonary fibrosis
Retro peritoneal fibrosis
Cardiac fibrosis

Do baseline DLCO and monitor with symptoms

Question 17

Toxicity of Taxanes (docetaxel/paclitaxel)

Answer 17

Diffuse interstitial pneumonia
Pulmonary oedema

Sensory loss (Paclitaxel>Docetaxel>Carbazitaxel) particularly around hand and fingertips - irreversible if drug not stopped early

Question 18

Toxicity of Everolimus/Erlotinib/Gefitinib

Answer 18

Pneumonitis
ILD

Manage with corticosteroids

Question 19

Toxicity of Oxaliplatin

Answer 19

Cold dysaesthesias (lasts

Question 20

Toxicity of Cisplatin

Answer 20

Tinnitus and high frequency hearing loss

Peripheral neuropathy

Question 21

Toxicity of vincristine

Answer 21

Axonal neuropathy sensory>motor

Autonomic neuropathy

Question 22

Which type of cancer is the leading cause of death in Australia?

Answer 22

Lung cancer

Question 23

Cancer marker for monitoring CRC?

Answer 23

CEA

High CEA pre-op has prognostic value and used to monitor recurrence post-treatment

Note: Other causes of elevated CEA are PUD, smoking, COPD, liver disease, diabetes, inflammation

Question 24

Cancer marker for monitoring pancreatic cancer?

Answer 24

CA19.9

Prognostic value at diagnosis, monitoring post-resection and monitor response to treatment

Other causes of elevated CA19.9: colestasis, cholangitis, cirrhosis
Cancer causes of elevated Ca19.9: biliary Ca, HCC, pancreatic NET

Question 25

Cancer marker for monitoring HCC?

Answer 25

AFP Other causes of elevated AFP: pregnancy, Chronic liver disease Cancer causes of elevated AFP: gastric Ca, germ cell tumours

Question 26

Cancer marker used to monitor response to treatment of metastatic breast cancer?

Answer 26

CA15.3 and CEA Note: these markers have no role in relapse. No role in adjuvant setting. Only use in metastatic disease CA15.3 also elevated in: B12 def, sickle cell disease, thalassaemia, liver dysfunction

Question 27

Cancer marker to monitor response to therapy in ovarian cancer?

Answer 27

CA125 CA125 also elevated in: hepatic/heart/renal disease, fibrosis, pleural fluid, ascites. Cancer causes of elevated CA125: any cancers causing ascites or pleural effusion, peritoneal carcinoma, endometrium, breast, lung, pancreas

Question 28

AFP/LDH/BhCG in non-seminoma vs seminoma testicular cancers

Answer 28

NSGCT: - BhCG normal/increased - AFP increased - LDH normal/increased Seminoma: - BhCG normal/increased - AFP normal - LDH normal/increased

Question 29

Tumour marker for monitoring melanoma?

Answer 29

LDH

Question 30

Tumour marker for prostate cancer?

Answer 30

PSA Used for risk stratification at diagnosis, monitoring recurrence post treatment and monitoring response to therapy Other causes of elevated PSA: BPH, prostatitis

Question 31

Tumour marker used to monitor neuroendocrine tumours?

Answer 31

Chromogranin A (CgA) - CgA is a reflection of tumour bulk, not aggressiveness of the tumour. CgA is more sensitive than urinary 5HIAA but less specific CgA used to monitor relapse after treatments, response to treatment Other causes of elevated CgA: PPI therapy, renal disease, liver disease, atrophic gastritis, IBD

Question 32

Tumour marker to monitor medullary thyroid carcinoma

Answer 32

Calcitonin and CEA Both have prognostic significance pre-op and monitor response to treatment of advanced disease Benign causes of elevated calcitonin: hyperCa, hypergastrinaemia, PPI therapy, BB, steroids, goitre, chronic autoimmune thyroiditis Cancer causes of elevated calcitonin: NET, all thyroid cancers

Question 33

Tumour marker for differentiated thyroid cancer?

Answer 33

Thyroglobulin (Tg) Used for prognostication and to evaluate response to treatment, and to monitor recurrent disease post-treatment