Oncology Flashcards
(162 cards)
1
Q
2 main NTs involved in the patho of CINV
A
5-HT3
NK-1
2
Q
risk factors for CINV (6)
A
emesis during pregnancy, age <50, female, anxiety pretreatment, little/no alcohol use, history CINV/prone to motion sickness
3
Q
CINV treatment
HIGH RISK PARENTERAL
A
day 1- olanzapine, dexamethasone, NK1RA, 5-HT3 RA
day 2-4- olanzapine, dexamethasone +/- aprepitant
4
Q
CINV treatment
MOD RISK PARENTERAL
A
day 1- dexamethasone, 5-ht3 RA
day 2-3- dexamethasone or 5-ht3 ra
5
Q
CINV treatment
LOW RISK PARENTERAL
A
dexamethasone > metoclopramide > prochlorperazine > 5-ht3 ra
6
Q
CINV treatment
MOD/HIGH RISK ORAL
A
5-HT3 RA
7
Q
CINV treatment
what do you do if breakthrough emesis?
A
add agent from another class
8
Q
CINV treatment
what do you do if there is anticipatory emesis
A
lorazepam
behavioral therapy
9
Q
which 5HT3-ra are short acting and best for acute NV
A
ondansetron, granisetron
10
Q
which 5ht3-ra is long acting and good for acute or delayed
A
palonosetron
11
Q
which agents are NK1 RAs used for CINV
A
aprepitant, fosaprepitant, rolapitant, etc.
12
Q
NK1 RA can only be used for ___ of CINV
A
prevention
NOT TREATMENT
13
Q
2 options for refractory CINV
A
dronabinol
scopolamine
14
Q
major offender causing chemo diarrhea
A
irinotecan
15
Q
main 2 options for chemo diarrhea?
alternatives?
A
loperamide, diphenoxylate-atropine
alt- hyoscyamine, atropine, octreotide
16
Q
patient risk factors for mucositis (6)
A
smoking, poor oral hygiene, oral lesions at baseline, female, younger age, pretreatment nutrition
17
Q
major offender for mucositis
A
melphalan
18
Q
treatments for mucositis
A
cryotherapy
mouthwash (bland/oncology/dexamethasone)
etc
19
Q
patient risk factors for febrile neutropenia
A
prior chemo/radiation, persistent neutropenia, bone marrow involvement, recent surgery/wounds, liver/renal dysfunction, age >65 receiving full chemo intensity
20
Q
when are growth factors used for primary prevention
A
high risk no matter the risk factors– yes
int risk with 1 risk factor- maybe
21
Q
when is growth factors needed DURING febrile neutropenia
A
if received prophylactic filgrastim– continue
no prophylaxis— assess risk factors
22
Q
short acting growth factor given daily until recovery starting up to 3-4 days post chemo
A
filgrastim
23
Q
long acting growth factor given up to 3-4 days post chemo and there should be 12 DAYS BETWEEN DOSE AND NEXT CHEMO
A
pegfilgrastim
24
Q
long acting growth factor given 24 hours post chemo
DO NOT ADMIN 14 DAYS BEFORE & 24 HOURS AFTER CHEMO
A
eflapegrastim, efbemalengrastim
25
3 subtypes of breast cancer
hormone receptor pos
HER2 pos
triple negative
26
patho of breast cancer
proliferative abnormality in lobular and ductal epithelium
27
non modifiable risks for BC
female, older, FH/PH, genetics, breast changes, ionizing radiation, breast density, early menarche/late menopause
28
modifiable risks for BC
nulliparity or older age for 1st child, menopausal hormone therapy, post menopause obesity, physical inactivity, alcohol
29
which type of BC has skin edema, redness, warmth, induration, cancer cells in dermal lymphatics with very quick onset and poor prognosis
inflammatory BC
30
treatment for NONINVASIVE lobular carcinoma in situ? ductal?
lobular-- monitor
ductal-- lumpectomy + radiation or mastectomy +/- endocrine therapy
31
2 regimens used for HER2+ DIRECTED therapy
docetaxel/carboplatin/trastuzumab +/- pertuzumab
or
paclitaxel + trastuzumab
32
criteria for pertuzumab use in BC
>T2 or >N1, HER2 +, high recurrence risk
33
endocrine therapy options for ER/PR + BC?
when is each class preferred?
tamoxifen--- premenopause aromatase inhibitor-- postmenopause
34
if an aromatase inhibitor is used premenopause, what is also required
ovarian suppression
35
what treatment is required post-chemo for HER+?
continue trastuzumab or pertuzumab/trastuzumab to complete 1 year
36
what general treatments are started for ER/PR+ and HER2+ BC
chemo (HER2 directed) + endocrine therapy
37
what general treatment is started for ER/PR+ and HER2- BC
chemo + endocrine therapy
38
what are the 2 preferred chemo regimens for ER/PR+ and HER2-
1. doxorubicin/cyclophosphamide --> paclitaxel Q2W
2. docetaxel and cyclophosphamide
39
when is oncotype dx used in BC
hormone + and HER2 - cancer with small tumor to determine if chemo is needed
40
general treatment option for ER/PR- and HER2+ BC
chemo (HER2 directed)
41
general treatment option for triple negative BC
chemo
42
neoadjuvant and adjuvant chemo regimen options for TRIPLE NEG BC
neo: pembrolizumab + paclitaxel/carboplatin --> pembrolizumab + doxorubiicn/cyclophosphamide
adj: pembrolizumab
43
endocrine therapy options for HR+ HER2- MBC (4)
which 2 can be added in stage II/III w/ high risk?
palbociclib
ribociclib **
abemaciclib **
everolimus
44
endocrine therapy option for HR + HER2-, PIK3CA/AKT1/PTEN mutated MBC
capivasertib
45
additional adjuvant if needed for HER2+ or ER/PR+
neratinib
46
regimen for HER 2 + MBC
pertuzumab + trastuzumab + docetaxel/paclitaxel
47
what can be added for BC treatment to help with internalization of chemo?
antibody drug conjugates
48
agents that can be added for bone metastases in BC?
which ones need renal adjustment
zoledronic acid, pamidronate- renal
denosumab
49
which drugs for BC treatment causes neuropathy?
taxanes- paclitaxel, docetaxel
50
which 2 agents/classes cause cardiotoxicity for BC treatment
doxorubicin
HER2 therapies
51
important PK/DDI for tamoxifen
prodrug w/ hep metabolism
DDI w/ CYP2D6 inhibitors (SSRI/SNRI)
52
3 aromatase inhibitors
anastrazole, letrozole, exemestane
53
counseling for tamoxifen
menopausal sx, menstrual changes, uterine/endometrial cancer, VTE, stroke, avoid during pregnancy
54
counseling for aromatase inhibitors
menopausal sx, musculoskeletal sx, increased bone loss, high cholesterol, CV risk
55
patho of lung cancer
acquire molecular lesions --- cell division/death --- malignant transformation
56
2 subtypes of lung cancer
non-small cell (most common)
small cell (more aggressive)
57
common metastatic sites of lung cancer
contralateral lung, lymph nodes, CNS
58
2 common presenting signs of lung cancer
pulmonary symptoms, SUperior Vena Cava Syndrome
59
general 2 neoadjuvant regimens for lung cancer
immunotherapy + platinum based chemo
platinum chemo alone (if not candidate for ICI)
60
3 immunotherapy options for neoadjuvant lung cancer treatment
nivolumab, pembrolizumab, durvalumab
61
lung cancer PLATINUM REGIMENS
non-squamous
cisplatin/pemetrexed
62
lung cancer PLATINUM REGIMENS
squamous
cisplatin/gemcitabine
63
lung cancer PLATINUM REGIMENS
not candidate for cisplatin
carboplatin/paclitaxel
carboplatin/gemcitabine
carboplatin/pemetrexed (non-squamous)
64
which platinum is preferred? which has worse AEs?
cisplatin preferred, worse AEs (except thrombocytopenia)
65
dose calculation for carboplatin (after weight & CrCl)
dose (mg) = target AUC x (CrCl + 25)
66
2 common AEs of paclitaxel, docetaxel (taxanes)
alopecia, neuropathy
67
pemetrexed can only be used for which lung cancer histology
non-squamous
68
when should pemetrexed be avoided?
what can it cause deficiency in?
avoid crcl <45
b12 and folate deficiency
69
2 options for advanced NSCLC with EGFR mutation
osimertinib, lazertinib
70
common AE of EGFR inhibitors and how to manage if mild/mod/sev?
rash
mild- hydrocortisone/clinda topical
mod- hydrocortisone cream + PO doxy/minocycline
sev- hold treatment & dose reduce, use above
71
4 options for advanced NSCLC with ALK mutation
alectinib, brigatinib, lorlatinib, ensartinib
72
which ALK inhibitor has the best potency and penetration of the BBB
lorlatinib
73
2 options for advanced NSCLC with KRAS mutation AFTER receipt of 1 prior therapy
sotorasib, adagrasib
74
avoid coadministartion of sotorasib with
PPI, H2RA
75
which KRAS inhibitor may cause renal impairment and QT prolongation
adagrasib
76
what is started for metastatic NSCLC with negative biomarkers/mutations based on PD-L1 status
immunotherapy alone (>50) or with chemo (PDL1 <50)
77
ICI added to platinum chemo regimen for metastatic NSCLC with negative actionable biomarkers
pembrolizumab, atezolizumab, cemiplimab
78
common AE of immunotherapy (ICI)
and how to manage
induction of autoimmune processes
steroid if grade 3 or higher, hold therapy
79
2 immunotherapy agents that inhibit VEGF receptors (ICI)
bevacizumab, ramucirumab
80
aes of VEGF inhibitors
bleed, thromboembolic events, acute HTN
81
SCLC treatment
LIMITED stage
cisplatin/carboplatin + etoposide + concurrent RT +/- durvalumab
82
SCLC treatment
EXTENSIVE STAGE
carboplatin/cisplatin + etoposide + ICI (atezolizumab/durvalumab)
83
additional agents for SCLC treatment
etoposide, topotecan, lurbinectedin, tartalamab
84
SCLC treatment
t cell engager that directs t cells to cancer cells expressing DLL3
tartalamab
85
BBW for tartalamab
cytokine release syndrome, neurologic toxicity
86
3 major risk factors for prostate cancer
african american
65-74 y/o
FH (1st deg rel, Lynch, BRCA2)
87
how does localized, invasive, and advanced prostate cancer present?
localized- asymptomatic
invasive- urinary sx
advanced- back pain, lower edema, anemia, weight loss, etc
88
glycoprotein produced by the prostate specific for the prostate?
normal range?
range at higher risk for cancer?
PSA
normal <= 4 ng/ml
risk >10
89
risk/grade group
gleason score <=6
pattern <= 3+3
low, group 1
90
risk/grade group
gleason score 7
pattern 3+4
intermed favorable
group 2
91
risk/grade group
gleason score 7
pattern 4+3
intermed unfav
group 3
92
risk/grade group
gleason score 8
pattern 4+4, 3+5, 5+3
high
group 4
93
risk/grade group
score 9 or 10
pattern 4+5, 5+4, 5+5
high
group 5
94
preferred treatment method
very low or low risk grade group 1 PC
surv <10 years- observation
surv >10 years- active surveillance
95
preferred treatment method
favorable intermed group 2 PC
surv <10 yrs- observation
surv >10 yrs- active surveillance
96
preferred treatment method
unfavorable int grade group 3 PC
surv <10 yr- observation > EBRT+ADT
surv >10 yr- RP +/- PLND > EBRT + ADT
97
preferred treatment method
high/very high grade group 4 PC
add what if regional disease (nodal)
surv <5 yr asympt- observ or ADT
surv >5 yr or sympt- EBRT + ADT (+abiraterone if regional)
98
preferred treatment method
castrate naive NONMETASTATIC PC
monitoring
99
preferred treatment method
castrate naive METASTATIC PC
continue ADT + abiraterone or enzalutamide or apalutamide or docetaxel
100
preferred treatment method
castrate resistant RECURRENT (M0) based on PSADT PC
continue ADT +
PSADT >10 mos- monitor or other secondary
PSADT <10 mos- apalutamide or darolutamide or enzalutamide or other
101
preferred treatment method
castrate resistant METASTATIC PC
adenocarcinoma vs small cell
adeno- continue ADT + abiraeterone, docetaxel, enzalutidmide
(consider cabazitaxel, olaprib, rucaparib)
small cell- chemo with platinum + etop or taxane
102
4 LHRH agonists
goserelin, leuprolide, triptorelin, histrelin
103
acute AEs of LHRH agonists
long term
acute tumor flare
long osteoporosis, fracture
104
how to mitigate tumor flare with LHRH agonists
1st gen antiandrogen
105
2 major counseling points for LHRH agonists
tumor flare
supplement Ca and Vit D
106
2 LHRH antagonists
degarelix, relugolix
107
2 pros of LHRH antagonists
rapid test. decline (7 days)
no tumor flare
108
3 1st gen antiandrogens
bicalutamide, flutamide, nilutamide
109
3 2nd gen antiandrogens
apalutamide, enzalutamide, darolutamide
110
AEs of antiandrogens
inc LFTs, diarrhea, gynecomastia, hot flashes
111
which 2 antiandrogens have a risk for seizures
apalutamide
enzalutamide
112
antiandrogen enzalutamide has DDI with
CYP2C8 inhibitors
CYP3A4 inducers
113
which antiandrogen has renal dose adjustments & BID dosing
darolutamide
114
how is docetaxel admin for PC?
caution in?
with BID prednisone
caution hepatic impairment
115
abiraterone is admin with?
key point about the 2 brand names
with steroids
not interchangeable brands!!
116
PARP inhibitor for HRR mutated metastatic CR prostate cancer
olaparib
117
PARP inhibitors have was risk
double risk developing secondary cancer
118
alpa-emitting radiopharmaceutical for mCRPC with symptomatic bone metastases and no visceral metastases
radium-223
119
dendritic cell vaccine used for mCRPC
sipuleucel-t
120
taxane derivate used secondarily in mCRPC in COMBO W/ PREDNISONE
cabazitaxel
121
beta-minus emitting radiopharmaceutical used for PSMA+ M1CRPC
Lu 177
122
risk factors for colon cancer )
pmh polyps, IBD, FH, smoking, heavy alcohol use, physical inactivity, genetic predisposition, low socioeconomic, increased age, race
123
2 genetic predispositions for COL cancer
familial adenomatous polyposis (FAP)
lynch syndrome/HNPCC
124
presentation of COL cancer
generally changes in bowel habits
weight loss no reason, fatigue, NV
125
when is screening started for COL cancer if avg risk? what is gold standard
45 years
colonoscopy
126
when is screening for COL cancer started if personal history
8 years after symptom onset
colonoscopy
127
when is screening for COL cancer started if 1st degree relative
with CRC?
with advanced adenoma?
crc- age 40 or 10 yrs before earliest diagnosis
adv adenoma- age 40 or age of onset of adenoma
colonoscopy
128
when is screening for COL cancer started if 2nd degree relative
age 45 colonoscopy
129
when is screening for COL cancer started with lynch syndrome
age 20-25 or 2-5 years prior to earliest colon cancer if dx <25
colonoscopy
130
when is screening for COL cancer started if FAP
colonoscopy age 10-15
131
how is 5FU admin?
IV or bolus ususally with leucovorin
132
important metabolism & testing point for 5-FU
metabolized by DPD
deficiency --> toxicity potential
133
AEs of 5FU & capecitabine?
bolus 5FU?
hand-foot, diarrhea, mucositis
bolus5FU- myelosuppression
134
prodrug of 5FU
requires dose adjustment for ?
capecitabine
adjust renal
135
DDI of capecitabine
CYP2C9 inhibitor
affects drugs like warfarin & phenytoin
136
contraindications to capecitabine
crcl<30
DPD deficiency
137
acute AE of oxaliplatin
chronic ?
acute- cold intolerance
chronic- peripheral neuropathy!!!!!
138
2 AEs of irinotecan
diarrhea!!!!!!!
alopecia
139
how to manage acute irinotecan diarrhea? delayed?
acute- atropine +/- diphenoxylate
delayed- loperamide
140
moab VEGF-a inhibitor used for metastatic COLREC cancer in combo with f-FU regimens
bevacizumab
141
AEs of VEGF inhibitors
hemorrhage, wound healing, epistaxis, VTE, proteinuria, htn
142
2 major AE points for VEGF inhibitors (bevacizumab or ramuciraumab) to consider when starting and/or d/c
htn must be controlled
d/c 4 weeks before surgery & start 4 weeks after
143
VEGF2 inhibitor used in comb with FOLFIRI in pt who progressed on 1st line with bevacizumab COLREC cancer
ramucirumab
144
2 EGFR inhibitors for KRAS wildtype metastatic CRC
cetuximab, panitumumab
145
major AE of EGFR inhibitors for CRC and how to manage
acneiform rash
topical steroid, PO abx, or PO steroid based on severity
may need to hold/dc treatment
146
multikinase inhibitor for mCRC used later in line as single agent salvage
regorafenib
147
2 HER2 directed agents used in CRC with overexpression
trastuzumab or pertuzumab
148
agent used for mCRC if previously tried F, OX, IRI regimens, anti-VEGF, and EGFR if eligible.... late line
trifluridine + tipiracil
149
trifluridine + tipiracil usually given in combo with
bevacizumab
150
warning for trifluridine + tipiracil?
AEs?
warn-severe myelosuppresion
aes- anemia, neutropenia, fatigue, NV
151
2 immunotherapy options for MSI high stage IV CRC
pembrolizumab, nivolumab
152
BRAF inhibitor for CRC in combination with an EGFR inhibitor (cetuximab) in those with BRAF V600E mutation
encorafenib
153
general treatment of stage I CRC
surgery w/ surveillance
154
general treatment of stage II CRC if no high risk IIA?
high risk IIA, IIB, IIC?
usually just surgery + observation
higher risk consider adjuvant chemo
155
adjuvant chemo regimens used in stage II CRC
folfox, capeox, capecitabine, 5FU/leucovorin
156
general treatment for stage III CRC
surgery + adjuvant chemo
157
what should NOT be used as adjuvant chemo for stage III CRC
targeted therapy or irinotecan
158
preferred adjuvant chemo for stage III CRC (2)
alt?
Capeox, FOLFOX
alt if no ox- capecitabine, 5FU/leuco
159
general treatment for stage IV CRC if resectable lung or liver
surgery + chemo
160
adjuvant chemo regimens for resectable stageIV CRC?
neoadjuvant?
adj: capeox, folfox
neoadj- folfiri, capeox, folfox +/- beva/panitumumab/cetuximab
161
general treatment for stage IV CRC if unresectable
chemo
162
preferred chemo regimens for unresectable stage IV CRC
folfox or capeox or folfiri +/- bevacizumab
folfox or folfiri + cetuximab or panitumumab
