Treatment of specific cancers AB Flashcards
(27 cards)
What is the management of resectable gastric cancer?
Staging including laparoscopy is routine
Radical surgery with curative intent
Preoperative chemotherapy
Post-operative chemotherapy and radiotherapy
What is the management of metastatic gastric cancer?
Chemotherapy:
- platinums, taxanes, irinotecan, 5FU
Targeted therapy:
- Possible role for VEGF inhibitors in 2nd line (Ramicrumumab, Regorafenib)
- Trastuzumab added to chemotherapy in the 10-15% who are HER2 positive (improved median survival)
CRC - what is the management of stage I and II disease?
Resection
Adjuvant CTx for stage II is controversial
CRC - what is the management for stage III disease?
Adjuvant CTx (proven survival benefit)
- 5FU or Capecitabine (pyrimidine analogues)
- Folinic acid (Leucovorin)
- Oxaliplatin
Targeted therapy:
- Bevacizumab (first line) in combenation with CAPEOX
- Irenotecam (second line)
- Cetixumab (third line, if KRAS wild type)
CRC - what is the management for stage IV disease?
Palliative chemotherapy - increases OS and PFS
Rectal cancer - what is the treatment?
Surgery - remove the mesorectal envelope including the fascia
CTx and RTx do not improve survival but do reduce local recurrence rate
Anal cancer - what is the treatmetn?
Unlike rectal cancer, anal cancer is treated initially with combination RTx and CTx (Mitomycin + 5FU)
Surgery is NOT indicated as primary treatment. Only for recurrence.
Seminoma - what is the treatment of stage 1 disease?
Orchidectomy followed by surveillance
Adjuvant CTx: Carboplatin
NO RTx
NSGCT - what is the treatment of stage 1 disease?
Radical inguinal orchidectomy followed by active surveillance
Adjuvant BEP (done in US, not Au for stage 1)
Testicular cancer - what is the management of metastatic disease?
BEP and Resection
BEP = Bleomycin, Etoposide, Cisplatiin
Testicular cancer - what is the management of relapsed/refractory diseae?
TIP (Paclitaxel, Ifosfamide, Cisplatin) - high dose with stem cell support
Seminoma does better than NSGCT
What is the first line treatment for metastatic prostate cancer?
GnRH + Docetaxel
If bony mets, need to start testosterone antagonist 7 days before and until 7 days after to prevent flare phenomenon
Improves PF + OS
When is Gefitinib indicated in the treatment of lung cancer?
Lung adenocarcinoma with EGFR mutation (wild type)
Use as single agent
When is Crizotinib indicated in the treatment of lung cancer?
Lung adenocarcinoma when ALK fusion oncogene positive.
Use first line as single agent or for relapsed disease.
Also can be used in ROS1 fusion
What are the main adverse effects of Gefitinib?
Acneiform skin rash
GI symptoms
Interstitial lung disease (rare but severe)
What are the main adverse effects of Crizotinib?
Visual disturbance (shadowing)
GI symptoms
Bradycardia (resolves when drug ceased)
What is the treatment of small cell lung cancer?
Concurrent chemo and radiotherapy (if in one radiation field)
CTx: Platinum + Etoposide
What is the treatment of Mesothelioma?
Palliative chemotherapy (Cisplatin + Pemetrexed) improves survival.
Radical treatment: extrapleural pneumonectomy
Targeted therapy for BRAF positive melanomas?
Dabrafenib - inhibits all V600 mutations
- As good as WBRT
Vemurafenib - selective V600E mutations
- No CNS penetration
Targeted therapy against MEK in melanoma?
Trametinib
Targeted therapy against cKIT in melanoma?
Imatinib
Immunotherapy in melanoma?
Ipilimumab (CTLA4 mAb)
Nivolumab (PD-1 mAb)
What are the indications for chemotherapy in breast cancer?
Node positive
Triple negative
Younger, premenopausal
Large, high grade tumour
What is the treatment of ovarian cancer?
If resectable, surgery followed by chemotherapy (Taxane + Platinum) at all stages
High risk = add Bevacizumab to first line therapy
