E2 Colorectal Cancer

Question 1

all of the risk factors for this one are self explanatory so im not typing them

Answer 1

maybe just recognize crohns and colitis and FAP (not that fap)

Question 2

T or F:
>95% of colorectal cancers are adenocarcinomas

Answer 2

true

Question 3

2 testing-work up options

Answer 3

microsatellite instability (MSI)
and
DNA mismatch repair (DNA MMR) (testing for loss of genes involved with that)

Question 4

T or F:
pts with stage II disease have increased benefit from adjuvant 5-FU compared to stage III

Answer 4

false, stage III benefits from 5-FU, stage 2 does not

Question 5

T or F:
chemo is the gold standard in stage II colon cancer and above

Answer 5

false, dont do it in stage II

Question 6

T or F:
radiation therapy is well established for rectal cancer and not colon cancer

Answer 6

true

Question 7

what stages of colorectal cancer are potentially curable

Answer 7

stage I, II, III

Question 8

T or F:
surgery alone is definitive therapy in stages I and II

Answer 8

true

Question 9

what is FOLFOX

Answer 9

5-FU
leucovorin
Oxaliplatin

Question 10

what is CapeOX

Answer 10

capecitabine
oxaliplatin

Question 11

what is in FOLFIRI

Answer 11

5-FU
leucovorin
irinotecan (theres I’s in folfiri) and it ends with iri

Question 12

T or F:
Capecitabine is = to bolus 5-FU and leucovorin in stage III

Answer 12

true

Question 13

T or F:
Bevacizumab, cetuximab, panitumumab, and irinotecan play a major role in stage III

Answer 13

false, they do not play a role at all

Question 14

what stages do you use FOLFOX or FOLFIRI

Answer 14

stage II

Question 15

T or F:
FOLFOX has more toxicities due to oxaliplatin

Answer 15

true (paresthesia and neutropenia) + GI oops

Question 16

NCCN preferred regimens in low risk

Answer 16

capeox 3 months
folfox 3-6 months

Question 17

NCCN preferred regimens in high risk

Answer 17

capeox 3-6 months
FOLFOX 6 months

Question 18

requires port for administration
A. FOLFOX
B. CapeOX

Answer 18

A

Question 19

hand foot syndrome
A. FOLFOX
B. CapeOX

Answer 19

B

Question 20

which drug used in capeox requires renal dose adjustments *

Answer 20

capecitabine

Question 21

T or F:
capecitabine is IV bolus administered

Answer 21

false, oral

Question 22

what 3 things listed on slide 39 determine which chemo regimen to use?

Answer 22

neuropathy
UGT1A1 deficiency (irinotecan)
1 vs 2 vs 3 drugs (?)

Question 23

T or F:
pembro and nivolumab show benefit in the metastatic setting

Answer 23

true

Question 24

T or F:
pembro and nivolumab are approved for patients before FOLFOX and FOLFIRI

Answer 24

false, after

Question 25

2 predictive biomarkers

Answer 25

K-RAS BRAF

Question 26

Mutations predict lack of response to anti-egfr mabs A. KRAS B. BRAF

Answer 26

A. KRAS

Question 27

DO NOT USE cetuximab and panitumumab A. KRAS B. BRAF

Answer 27

A. KRAS

Question 28

when is bevacizumab appropriate in colorectal cancer?

Answer 28

in stage IV -> metastatic

Question 29

1st line metastatic disease regimens: no targeted mutations (2 choices)

Answer 29

5-FU + leucovorin OR capecitabine +/- bevacizumab

Question 30

1st line metastatic disease KRAS wild type, left sided

Answer 30

cetuximab or panitumumab (EGFR targets) -> these two are only effective when there are no mutations to KRAS

Question 31

1st line metastatic disease: dMMR/MSI-H

Answer 31

nivolumab +/- ipilimumab or pembro

Question 32

1st line metastatic disease: HER2 positive

Answer 32

trastuzumab +/- pertuzumab/lapatinib/tucatinib

Question 33

2nd line therapy: disease progression with prior oxaliplatin based regimens. *

Answer 33

FOLFIRI* OR irinotecan (this was the first in the list out of 7 so im sure just know this one)

Question 34

2nd line therapy: disease progression with prior irinotecan-based regimen *

Answer 34

FOLFOX or CapeOX (this was the first in the list out of 5 so im sure just know this one)

Question 35

disease progression with prior oxaliplatin based regimens A. FOLFIRI B. FOLFOX

Answer 35

A. FOLFIRI

Question 36

disease progression with irinotecan based regimens A. FOLFIRI B. FOLFOX

Answer 36

B. FOLFOX

Question 37

2 screening tests she told us to know that PRIMARILY detect cancer *

Answer 37

fecal occult blood test (FOBT) and fecal immunohistochemical test (FIT)

Question 38

detects hemoglobin: A. FIT B. FOBT

Answer 38

A. FIT

Question 39

2 tests to primarily detect cancer AND advanced lesions

Answer 39

endoscopy and colonoscopy -> gold standard

Question 40

what age do you get screened if you have a 1st degree relative with colorectal cancer hx

Answer 40

40 instead of 45

Question 41

T or F: calcium-rich diet decreases proliferative response to fatty acids and bile acids

Answer 41

true

Question 42

3 things listed under colon cancer prevention (not including diet stuff which is obvious -> high fiber, less fat)

Answer 42

- cyclooxygenase inhibitors -> says FDA indication removed in 2011 so thats odd - NSAIDS or aspirin - colectomy

Question 43

5-FU: - converted in vitro to _____ and ____ - FUTP incorporates into ____ and impairs protein synthesis - ______ binds thymidylate synthase and reduces rate of dna synthesis, replication, and repair

Answer 43

- FUTP, FdUMP - RNA - FdUMP

Question 44

5-FU extensively metabolized by _____ in the liver

Answer 44

DPD (you should remember this)

Question 45

a few common toxicities with 5-FU

Answer 45

diarrhea, mucositis, myelosuppression

Question 46

Leucovorin stabilizes the binding of _____ to _______ resulting in enhancement of the toxicity of fDUMP

Answer 46

fDUMP to thymidylate synthase (TS)

Question 47

SN-38

Answer 47

irinotecan

Question 48

cholinergic symptom of irinotecan that is treated with atropine *

Answer 48

early onset diarrhea

Question 49

okay so if you see irinotecan and you're thinking about side effects and shit what do you think of

Answer 49

diarrhea

Question 50

unique toxicities oxaliplatin (3) *

Answer 50

neuropathy, COLD INTOLERANCES, sensation of not being able to breathe

Question 51

dose limiting toxicity of Capecitabine *

Answer 51

hand-foot syndrome and diarrhea

Question 52

Cetuximab binds to the (intracellular/extracellular) domain of EGFR

Answer 52

extracellular

Question 53

2 underlined adverse events for cetuximab * (both of these also had **)

Answer 53

acneiform rash hypomagnesemia

Question 54

pre-medicating with an ___ ___________ is recommended with Cetuximab

Answer 54

H1 antagonist

Question 55

Recombinant IgG2 monoclonal antibody and binds specifically to EGFR

Answer 55

Panitumumab

Question 56

2 underlined and asterisked toxicities of Panitumumab

Answer 56

acneiform rash hypomagnesemia

Question 57

binds VEGF

Answer 57

Bevacizumab

Question 58

T or F: Bevacizumab is given in combo with 5-FU, leuco, and irino

Answer 58

True, not a solo drug

Question 59

significant toxicities (a few but one main one i think) for bevacizumab

Answer 59

BLEEDING htn proteinuria thromboembolism GI perforations decreased wound healing (bleeding)

Question 60

T or F: Cetuximab has many black box warnings

Answer 60

false, bevacizumab does (i mean the name sounds kind of scary so i guess it makes sense)