Cancer 1st Line Tx

Question 1

Breast:
- ER/PR(+)
- HER2(-)

Answer 1

RS <26: EndoTx
- PreMeno: Tx5yr +/- OS or AIx5yr + OS (Still PreMeno: Tx5yr or stop // Now PostMeno: AI or T x5yr)
- PostMeno: AIx5yr then AIx5yr OR Tx2-3yr then AIx5yr

RS >26: ChemoTx then EndoTx
- Dose Dense AC then Paclitaxel or TC (Docetaxel + Cytoxin)

Question 2

Breast:
- ER/PR(+)
- HER2(+)

Answer 2

Tumor <0.5cm: adju EndoTx (PreMeno: Tx5yr +/- OS or AIx5yr + OS (Still PreMeno: Tx5yr or stop // Now PostMeno: AI or T x5yr)
- PostMeno: AIx5yr then AIx5yr OR Tx2-3yr then AIx5yr) +/- Chemo +HER2Tx (APT (adju Paclitaxel +Trastuzumab) or TCH+/- P (Docetaxel + Carbo + Trastu +/- Pertuzumab)

Question 3

Breast:
- TNBC

Answer 3

Pembrolizumab + Paclitaxel + Carbo then Prembro + Doxorubucin + Cytoxin

Question 4

Breast:
- Meta-HER2(+)

Answer 4

1st: Trastuzumab + Pertuz + Docetaxel
2nd: Trastu-Deruxtecan

Question 5

Breast:
- Meta-HER2(-)

Answer 5

1st: AI + CDK4/6-i (Palbociclib)
2nd: Fulvestrant + CDK4/6-i

Question 6

Prostate:
- Localized

Answer 6

ADT (GNRH agonist) +/- Anti-androgen Tx (Abiraterone or Enzalutamide)

Question 7

Prostate:
- M0HSPC

Answer 7

GNHR agonist +/- ADT

Question 8

Prostate:
- M0CRPC

Answer 8

Continue ADT and add ONE of: Enzalutamide, Apalutamide, Darolutamide

Question 9

Prostate:
- M1HSPC

Answer 9

• LOW Volume: ADT or ADT + Abiraterone and Prednisone, Enzalutamide, or Apalutamide
• HIGH Volume: Docetaxel + ADT +/- Abiraterone or Daralutamide

Question 10

Prostate:
- M1CRPC

Answer 10

1st: Docetaxel + Prednisone
2nd: Cabazitaxel + Prednisone
- IF PSMA(+) use: Pluvicto

Question 11

Lung:
- SCLC

Answer 11

• Limited: Radiation + EP or EC (Etop, cisP/Carbo)
• Extensive: EC + Atezolizumab or Durvalumab

Question 12

Lung:
- NSCLC (Resectable)

Answer 12

• Non-Squamous: Cisplatin + Pemetrexed (or Carbo)
• Squamous: Cisplatin + Gemcitabine or Docetaxel (or Carbo)

Question 13

Lung:
- NSCLC (UnResectable)

Answer 13

• Non-Squamous: Carbo/Cis + Pemetrexed OR Cis + Etop
• Squamous: Paclitaxel + Carbo OR Cis + Etop
  (If any Tx not working: Durvalumab x1yr)

Question 14

Lung: NSCLC
- Metastatic (Mutations Present)

Answer 14

Osimertinib (EGFR), Dabraf/Tramet (BRAF), Sotoasib (K-RAS)

Question 15

Lung: NSCLC
- Metastatic (NO mutations)

Answer 15

• Non-squamous: Carbo + Pemetrexed + Pembrolizumab
• Squamous: Carbo + Prembrolizumab + Paclitaxel

Question 16

Colorectal:
- Stage II (high risk)

Answer 16

FOLFOX or CapeOX

Question 17

Colorectal:
- Stage III

Answer 17

FOLFOX or CapeOX

Question 18

Colorectal:
- Metastatic

Answer 18

FOLFOX, CapeOX, FOLFIRI, FOLFIRINOX +/- Bevacizumab
- No K-RAS mut: + cetuximab or panitumumab
- dMMR or MSI-H (+): Nivolumab + Ipilimumab or Pembrolizumab
- HER2(+): Tastu +Pertu/Lapatinib or Trastu-Deruxtecan

Question 19

Melanoma:
- Stage 1B or 2A

Answer 19

Clinical trial, observation

Question 20

Melanoma:
- Stage 2B or 2C

Answer 20

• Clinical trial, observation, or Pembrolizumab

Question 21

Melanoma:
- Stage III

Answer 21

Nivolumab, Prembrolizumab, or Dabraf/Tramet (if BRAF mut)

Question 22

Melanoma:
- Metastatic

Answer 22

• Anti-PD1 MonoTx or BRAF mut Tx
• if high risk: Nivoumab/ipilimumab
  -2nd Line: Pembro/Low dose Ipilimumab

Question 23

Ovarian:
- Initial

Answer 23

Paclitaxel + Carbo (Carbo dose= AUCx(GFR + 25)
- if BRCA mut: PARP-i

Question 24

Ovarian:
- Metastatic

Answer 24

• Plat Sensitive: Carb/Cis + Paclitaxel
• Plat Resistant: Liposomal Doxorubucin

Question 25

Hodgkin Lymphoma: - Stage I-II Favorable

Answer 25

- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine) - Radiation

Question 26

Hodgkin Lymphoma: - Stage I-II Unfavorable

Answer 26

- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine) - Radiation

Question 27

Hodgkin Lymphoma: - Stage III-IV

Answer 27

- ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine) +/- Radiation - If young pt: AAVD (Swap Bleo for Brentuximab Vendotin) (more toxic)

Question 28

Hodgkin Lymphoma: - Relapse

Answer 28

- Autologous stem cell rescue

Question 29

Non-Hodgkin Lymphoma: - Diffuse Large B-Cell Lymphoma (DLBCL) All stages

Answer 29

R-CHOP (Rituximab, Cytoxin, Doxorubicin, Vincristine, Prednisone)

Question 30

Non-Hodgkin Lymphoma: - DLBCL Stage III/IV + IPI >2 or Bulky Stage II

Answer 30

Pola-R-CHP (Polatuzumab Vedotin, Rituximab, Cytoxin, Doxorubicin, Prednisdone)

Question 31

Non-Hodgkin Lymphoma: - Relapsed DLBCL/Aggressive NHL

Answer 31

- Salvage chemo then autologous stem cell rescue - CAR-T - Epcoritamab or Glofitamab (BiTE's)

Question 32

Multiple Myeloma

Answer 32

Autologous stem cell transplant candidate? - Yes: 3 drug regimen, then stem cell harvest - No: 3 drug regimen

Question 33

Chronic Myeloid Leukemia (CML)

Answer 33

BCR-ABL-i: Dasatinib, Nilotinib, Bosutinib, or Imatinib - if T3151 mut: Ponatinib or Ascimib

Question 34

Chronic Lymphoid Leukemia (CLL) - Stage III/IV

Answer 34

- Zanubrutinib or Acalabrutinib (ATK-i) +/- Obinutuzumab (or Rituximab) - Venetoclax + Obinutuzumab

Question 35

Acute Myeloid Leukemia (AML) - Induction

Answer 35

- High intensity: Cytarabine (7d) + Anthracycline (3d) (7+3) - Low Intensity: Venetoclax + Azacitidine or Decitabine - if FLT3 mut: Midostaurin, quizartinib, or gilteritinib

Question 36

Acute Myeloid Leukemia (AML) - Consolidation

Answer 36

- HiDAC (High dose Cytarabine) - or Continue Venetoclax +Aza/Decitibine

Question 37

Acute Lymphoblastic Leukemia (ALL) - Induction

Answer 37

- HyperCVAD (PART A: Hyper-fractionated Cytoxin, Vincristine, Doxorubicin, Dexamethasone --> PART B: High dose Methotrexate, Cytarabine, Methylprednisolone) - If BCR-ABL(+): add TKI - Peds: +/- Pegaspargase

Question 38

Acute Lymphoblastic Leukemia (ALL) - Maintenance

Answer 38

- BCR-ABL (+): TKI, Vincristine, Prednisone - BCR-ABL (-): Methotrexate, 6=MP, Vincristine

Question 39

Lymphoma: Non-Hodgkin L - maintenance for high risk after stem cell transplant

Answer 39

Brentuximab vedotin