Issues in Oncology

Question 1

How are immune checkpoint inhibitors useful in destroying cancer?

Answer 1

Immune checkpoint inhibitors are useful in destroying cancer because they deactivate checkpoints that would otherwise suppress the immune system, and so facilitate the patient’s own immune surveillance efforts to destroy the cancer.

Question 2

How do immune checkpoint inhibitors work in destroying cancer cells?

Answer 2

Immune checkpoint inhibitors

Question 3

What is the expanded role of molecular profiling and precision therapeutics?

Answer 3

Molecular profiling is

Question 4

What is genomic profiling of cancer cells?

Answer 4

Genomic profiling of cancer cells involves

Question 5

Solid tumors are staged using what system of staging?

Answer 5

The T, M, N system of staging.

Question 6

What do the letters in the staging system for solid tumors stand for?

Answer 6

T: (T1-T4) refers to the size or extent of local invasion of the primary tumor

N: (N0-N3) indicates loco-regional lymph node involvement

M: M indicates the absence (M0) or presence (M1) of distant metastases.

Question 7

What is generally the most accurate indicator of prognosis and largely dictates the therapeutic strategy?

Answer 7

Staging, in a patient with cancer.

Question 8

What are the two most commonly used scales for performance status?

Answer 8

Karnofsky Score

Eastern Cooperative Oncology Group (aka the Zubrod Scale)

Question 9

What do studies suggest about initiating supportive care in addition to concurrent anti-cancer treatment?

Answer 9

Studies suggest that such supportive care, when instituted early in conjunction with anticancer therapy, helps patients better tolerate their cancer care and should not be delayed to the point at which no more active cancer therapy is considered.

Question 10

Overall survival is defined as:

Answer 10

Overall survival is defined as the amount of time from the start of treatment until death.

Question 11

Cure of cancer is defined as:

Answer 11

Cure means that the cancer is gone, no further treatment is required, and the patient can be expected to live out his or her life without seeing that cancer again.

Question 12

Median survival from cancer studies is defined as:

Answer 12

Median survival values from cancer identify the center of an often-broad, bell-shaped curve, and may be meaningful for populations, but cannot predict an outcome for any one individual patient.

Question 13

significant improvement in survival refers to what exactly?

Answer 13

significant refers to the statistical certainty of the finding but is often misinterpreted as a substantial improvement in survival.

Question 14

Response rate is defined as:

Answer 14

Response rate is the percentage of patients in a clinical trial whose tumors shrink to a prespecified degree (as indicated on imaging studies such as CT or MRI) with treatment.

Question 15

What is also important about response rate regarding overall survival and how it affects the patient emotionally and clinically?

Answer 15

Response rate may not correlate with overall survival, but there is a strong emotional benefit to patients when the tumor is regressing, and in symptomatic patients, such shrinkage is likely to alleviate or delay symptoms.

Question 16

What are the classic cancer treatment modalities?

Answer 16

The classic cancer treatment modalities are surgery, irradiation, and chemotherapy.

Question 17

With the advancement of cancer chemotherapies what are better nomenclature for the modalities of treatment besides surgery, chemotherapy and radiation?

Answer 17

As current technology has advanced, chemotherapy is best subdivided into:

1. classical cytotoxic chemotherapies
2. targeted or precision therapies
3. Immunotherapies.

Question 18

What do the terms neoadjuvant and adjuvant chemotherapy mean regarding its timing in the treatment of localized tumors?

Answer 18

Neoadjuvant (preoperative) or adjuvant (postoperative) treatment with irradiation, chemotherapy, or both may be used to eradicate residual microscopic disease and increase the chance for cure.

Question 19

What is conversion therapy?

Answer 19

Conversion therapy seeks to convert an unresectable tumor to one that is resectable by shrinking it away from critical structures and creating a plane for resection that was previously lacking.

Question 20

Is conversion therapy the same as neoadjuvant chemotherapy?

Answer 20

This type of treatment differs from neoadjuvant chemotherapy, which targets micrometastases of an already resectable tumor.

Question 21

What is the difference between a predictive and a prognostic assay?

Answer 21

Predictive assays identify the subset of patients who will or will not benefit from an intervention.

Prognostic assays can identify the subset of patients at higher or lower risk but do not offer guidance in selecting treatment to mitigate that risk.

Question 22

What are the current developments centered on in creating chemotherapies in modern cancer treatment?

Answer 22

Current developments in chemotherapy are centered on creating agents that target specific driver mutations in a particular cancer.

Question 23

What does the term “driver mutation” refer to in chemotherapy?

Answer 23

The term driver mutation refers to

Question 24

What is the goal of “precision medicine” in identifying pathways for therapeutics?

Answer 24

The goal of precision medicine is to identify specific markers, mutations or alterations that are driving growth and survival in a particular tumor and to treat with agents designed to inhibit that aberrant pathway.

Question 25

What is trastuzumab?

Answer 25

Trastuzumab, a monoclonal antibody against the human epidermal growth factor receptor 2 (HER2) on the cell surface, is only active in breast or gastroesophageal tumors that overexpress HER2.

Question 26

What is an inclusionary marker for treatment?

Answer 26

Markers can be either inclusionary, in that they include a patient in a therapy that otherwise might not be considered.

Question 27

What is precision medicine with regards to specific chemotherapeutics?

Answer 27

Precision medicine refers to agents that target specific markers, mutations or alterations that are driving growth and survival in a particular tumor.

Question 28

What are Immunotherapies?

Answer 28

Immunotherapy agents are drugs that do not attack the cancer directly but rather mobilize the patient’s own immune system to do so.

Question 29

What are immune checkpoints?

Answer 29

Immune checkpoints prevent the immune system from attacking both normal tissues (self) and malignant cells; immunotherapy can take advantage of this process by inhibiting the checkpoints and allowing the immune system to aggressively attack cancer cells.