1
Q
What are the risk factors for Prostate Cancer?
A
- Older Age
- African American
- Family History
2
Q
What are the symptoms of Early Prostate Disease?
A
Asymptomatic
3
Q
What are the symptoms of Late Prostate Disease?
A
- Frequent Urination
- Weak/Slow Urine Flow
- Dysuria
- Nocturia
- Hematospermia
- Erectile Dysfunction
4
Q
What are the symptoms of Metastatic Prostate Disease?
A
- Back Pain
- Spinal Cord Compression
- Pathological Fracture
- Anemia
- Fatigue
- Weight Loss
5
Q
What is the Goal of Prostate Cancer Screening?
A
Identify: High Risk - Localized Prostate Cancer that can be successfully treated, thereby preventing the morbidity/mortality
6
Q
Screening and Early Detection of Prostate Cancer is most beneficial for men aged what?
A
55-69 yrs
7
Q
What is the Diagnosis Test for Prostate Cancer?
A
PSA Test
8
Q
Define PSA
A
- Total PSA
- Prostate specific antigen is a glycoprotein produced by both epithelial cells and cancer cells of the prostate gland
- Liquifies Seminal Secretions
9
Q
PSA is specific to the prostate bu not specific for ____.
A
Cancer
10
Q
T/F: A single PSA measurement is NOT diagnostic
A
True
11
Q
T/F: A PSA Test is NOT a valuable tool to predict recurrence
A
False
12
Q
What are factors that can INCREASE PSA?
A
- BPH
- Infections
- Prostatitis
- Age
- Prostatic Manipulation
13
Q
How long should men abstain from ejaculation to prevent a false increased PSA?
A
48 hours
14
Q
What are factors that can DECREASE PSA?
A
5-AIRS:
1. Finasteride
2. Dutasteride
15
Q
Finatsteride and Dutasteride can cause a ____ decrease in PSA?
A
50%
16
Q
Define PSA Velocity
A
Rate of Change in PSA over time
17
Q
How do you determine a PSA Velocity?
A
3 Separate PSA values calculated over at least an 18 month period
18
Q
How long does it take for PSA to Double: PSA Doubling Time?
A
< 10 months = progressing quickly
19
Q
Define Percent Free PSA
A
% PSA is significantly lower in men who have prostate cancer
-Approved in men >50
20
Q
If PSA is < ___%, Biopsy is recommended
A
25
21
Q
Define PSA Density
A
Size of prostate gland measured by TRUS and divide PSA by prostate volume
22
Q
Ideally PSA Density should be < ____ ng/ml/g
A
0.15
23
Q
Large Prostates tend to have ____ PSA values
A
Higher
24
Q
For Observation in Prostate Cancer, when is it preferred?
A
- Low Risk Patients AND
- Life Expectancy <10 years
25
How often do you monitor PSA in the Observation Treatment Modality?
Monitor PSA NOT more than every 6 months
26
Define the Active Surveillance Treatment Modality of Prostate Cancer
Monitor the course of disease with the intent to deliver potentially curative therapy upon progression of disease
27
When is Active Surveillance preferred in Prostate Cancer?
1. Very Low Risk Disease AND
2. Life Expectancy >20 years
OR
1. Low Risk Disease AND
2. Life Expectancy >10 years
28
How often do you monitor PSA in Active Surveillance Treatment Modality
Monitor PSA NOT more than every 6 months unless clinically indicated
29
Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection] is a Treatment Modality in Prostate Cancer, but when is it appropriate?
Radical Prostatectomy RP is appropriate if the tumor is confined to prostate and is definitive curative therapy
30
When is Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection] Treatment Modality preferred in Prostate Cancer patients?
Life Expectancy 10 years and NO serious comorbid conditions
31
PSA should be UNDETECTABLE after Surgery [Radical Prostatectomy +/- Pelvic Lymph Node Dissection], if a persistent PSA is present, what does that indicate?
Inadequate Surgery or Metastases
32
Radiation +/-Adjuvant ADT is used when in Prostate Cancer?
1. Early Stage HIGH RISK
2. Early Stage Intermediate RISK
33
What is the Goal of Hormonal Therapy [Androgen Deprivation Therapy (ADT)]?
To achieve castrate levels of serum testosterone <50 ng/dL
34
What are the methods of ADT?
1. Surgical Castration
2. Chemical Castration
35
How is Chemical Castration ADT done?
1. LNRH/GnRH Agonist +/-
2. First Generation Antiandrogen (-tamide)
3. LNRH Antagonist
36
What drugs are classified as LHRH Agonists?
1. Goserelin -- SubQ implant
2. Leuprolide -- IM
3. Triptorelin
4. Eligard -- SubQ
37
What is the MOA of LHRH Agonists?
Paradoxical depletion of luteinizing hormone LH. Decreased LH release and testosterone production.
38
Synthetic LHRH Agonists have a ____ affinity to the receptor and _____ susceptibility.
Higher; Lower
39
How long does it take for LHRH Agonists to cause down regulation and castrate levels of testosterone?
3-4 weeks
40
What are AEs of LHRH Agonists?
1. Hot Flashes
2. Lethargy
3. ED
41
What are the Latent Effects of LHRH Agonists?
1. Bone Loss
2. Fractures
3. Metabolic Syndrome
4. CV Disease
5. Diabetes
6. VTE
42
What drugs are classified as LHRH Antagonists?
1. Degarelix -- SubQ
2. Relugolix -- PO
43
What is the MOA of LHRH Antagonists?
Antagonists irreversibly bind to LHRH receptors on pituitary gland and reduce production of testosterone to castrate levels
44
Which LHRH class is associated with Tumor Flare?
Agonists
45
What are the AEs associated with LHRH Antagonists?
1. Injection Site Problems
2. MAJOR CV for Relugolix
46
What drugs are classified as Antiandrogens?
1. Bicalutamide
2. Flutamide
4. Nilutamide
47
What is the FDA indication of Antiandrogens?
Used in conjunction with ADT
48
What is the place of therapy for Antiandrogens?
Prevent Flare Phenomenon in LHRH Agonists
49
For a patient with Unfavorable, Intermediate Risk in Prostate Cancer what is the recommended therapy regimen?
EBRT + ADT
50
For a patient with High Risk in Prostate Cancer what is the recommended therapy regimen?
EBRT + Neoadjuvant/Adjuvant/Concurrent ADT After Radiation
51
For a patient with Regional Disease N1,MO in Prostate Cancer what is the recommended therapy regimen?
1. EBRT
2. Abiraterone
3. ADT
52
Define Castrate Sensitive
1. Patients who have not been treated with ADT and those who are not an ADT at the time or progression.
2. Patients have been neoadjuvent, adjuvant, or concurrent ADT as part of RT provided they have RECOVERED TESTICULAR FUNCTION.
53
Define Castration Resistant
Progression of disease despite castrate levels of testosterone <50 ng/mL
54
For Non-Metastatic Castration Sensitive Disease M0SPC what is recommended therapy for a patient with a shorter PSADT <10 months/Rapid PSA Velocity?
Consider ADT earlier rather than later
55
For Non-Metastatic Castration Sensitive Disease M0SPC what is recommended therapy for a patient with a longer PSADT >12 months/Older Age?
Candidate for observation
56
For Non-Metastatic Castrate Resistant Disease M0CRPC what is the recommended therapy for PSADT >10 months?
Continue ADT to maintain castrate level testosterone <50 ng/mL
57
For Non-Metastatic Castrate Resistant Disease M0CRPC what is the recommended therapy for PSADT <10 months?
Continue ADT + Aplatutamide or Enzalutamide or Darolutamide
58
What is the Dose of Enzalutamide?
160 mg PO QD without regard to food
59
What are the AEs of Enzalutamide?
1. Falls
2. Dizziness
3. Insomnia
4. Seizures
60
T/F: You can initiate Enzalutamide therapy in a patient with a history of seizures?
False
61
What are the DDIs of Enzalutamide?
CYP3A4 Inducer, interacts with DOACs
62
What is the dose for Apalutamide?
240 mg QD without regard to food
63
What are the AEs of Apalutamide?
1. Maculopapular Rash
2. Hypothyroidism
64
What are the DDIs of Apalutamide?
Strong CYP3A4 and CYP2C19 Inducer
65
What is the dose of Darolutamide?
600 mg BID to be taken WITH FOOD
66
Does Darolutamide need renal dose adjustment? If so, what is the CrCl cutoffs?
YES, Needed for CrCl <30 mL/min
67
Which "tamide" is associated with the least amount of DDIs and CNS side effects?
Darolutamide
68
What is the backbone therapy for Metastatic Hormone Sensitive Disease Prostate Cancer?
ADT
69
What therapy regimens are recommended in High Volume Metastatic Prostate Cancer?
1. ADT + Docetaxel + Abiraterone + Prednisone OR
2. ADT + Docetaxel + Darolutamide
70
Which High Volume Metastatic therapy regimen is better according to the STAMPEDE Trial?
ADT + Docetaxel + Abiraterone + Prednisone
71
What is the MOA of Abiraterone?
Blockade of CYP17 enzyme = reduction in serum cortisol = increase in ACTH
72
T/F: Abiraterone has to be given with a glucocorticoid agent: Prednisone.
True
73
What is the administration of Abiraterone?
Must be taken on an empty stomach
74
What are the AEs of Abiraterone?
1. HTN
2. Hypokalemia
3. Fluid Retention -- monitor monthly
75
When is use of Aniraterone cautioned?
Patients with a history of cardiovascular disease
76
If patients demonstrate progression of disease after ADT + Docetaxel therapy, what should be given based on the ENZAMET Trial?
Enzalutamide + ADT
77
What is the Standard of Care in Metastatic Prostate Cancer?
Triplet Therapy
1. ADT + Docetaxel + Abiraterone (+Prednisone)
2. ADT + Docetaxel + Darolutamide
78
T/F: In Metastatic Castrate Resistant Prostate Cancer CRPC, ADT is NOT continued.
FALSE - ADT is continued in the castrate resistant setting
79
What is approved for the pre-/post- Docetaxel setting for CRPC?
1. Abiraterone
2. Enzalutamide
80
Abiraterone + Predisone CANNOT be used in what patient population for CRPC?
Patients with VISCERAL Metastases
81
What is the MOA of Taxanes?
Anti-Microtubular
82
What 2 Taxanes have FDA indications for CRPC use?
1. Docetaxel
2. Cabaxitaxel
83
How should Docetaxel be given in CRPC?
Give with Prednisone
84
What are the AEs of Docetaxel?
1. Peripheral Edema
2. Myelosuppression
3. Alopecia
4. Peripheral Neuropathy
85
T/F: Docetaxel does NOT contain Cremphor and therefore, has a lower risk of hypersensitivity.
True
86
What is co-administered with Docetaxel to decrease Peripheral Edema?
Dexamethasone
87
What is the Contraindication of Docetaxel?
Severe Hepatic Impairment
88
If a patient does not respond to Docetaxel due to multi-drug resistance mechanisms, what should be used?
Cabaxitaxel
89
What is the specific indication of Cabazitaxel?
Metastatic hormone refractory prostate cancer only in patients who previously progressed on Docetaxel
90
How should Cabazitaxel be adminstered?
1. Given with Prednisone
2. Premedicate with H1 and H2 block and IV Corticosteroid 30 minutes prior to admin
91
Why do you have to premeditate with Cabazitaxel?
Polysorbate 80
92
What are the AEs of Cabazitaxel?
1. Myelosuppresion
2. Fatigue
3. Hypersensitivity Rxns
93
What is the Indication of Sipuleucel-T?
Only indicated for asymptomatic or minimally symptomatic patients with no liver metastases, life expectancy > 6 months, and good performance status
94
What are the AEs of Sipuleucel-T?
1. Chills
2. Pyrexia
3. Headaches
95
What is the premedication routine for Sipuleucel-T?
APAP 650 mg
Diphenhydramine 50 mg
96
What is the Indication for Radium 223 Xofigo?
Patients with metastatic CRPC with symptomatic bone only metastases, NO KNOWN Visceral metates before or after Docetaxel
97
Radium-223 Xofigo is not recommended to be used with any chemotherapy except what:
1. ADT
2. Denosumab
3. Bisphosphonate
98
What are the AEs of Radium-223 Xofigo?
1. Myelosuppression
2. N/V
3. Diarrhea
4. Peripheral Edema
99
When is Germline Testing Recommended?
For patients with family history for cancer, or gremlin mutations
100
In Metastatic CRPC Second Line Options what are 2 agents recommended?
1. Pembrolizumab
2. Olaparib
101
When would Pembolizumab be recommended in CRPC Second Line?
After progression on prior treatment
102
When would Olaparib be recommended in CRPC Second Line?
After progression on prior novel hormonal therapy
103
ADT is known to cause Osteoporosis, what is recommended daily supplementation?
Vitamin D and Calcium
104
Which drug is superior in preventing skeletal-related events: Denosumab or Zolendronic Acid?
Denosumab
105
What are the 4 most common types of Epithelial Ovarian Cancer?
1. Serous
2. Mucinous
3. Endometrioid
4. Clear Cell
106
What are the Negative Risk Factors of Ovarian Cancer?
1. Increasing Age
2. Obesity
3. Infertility/Nulliparity
4. Hormone Therapy after menopause
5. Endometriosis
6. PCOS
7. Use of IUD
8. Cigarette Smoking
9. Genetics
107
What are the Protective/Positive Risk Factors of Ovarian Cancer?
1. Previous Pregnancy
2. Hx of Breastfeeding
3. Oral Contraceptives
4. Tubal ligation
108
What is a screening used in high risk patients for Ovarian Cancer?
CA-125 = NORMAL 0-46 IU/mL
109
What is CA-125?
Biomarkers that may be elevated in ovarian cancer but also with pelvic inflammatory disease, uterine fibroids, menstruation
110
T/F: No effective screening test currently recommended for ovarian cancer.
True
111
What are forms of prevention of Ovarian Cancer?
1. Decreasing Lifetime Ovulation: multiple pregnancies, breastfeeding, contraceptive use
2. Tubal Ligation
3. Prophylatic Oophorectomy
112
What is used in the Diagnosis of Ovarian Cancer?
1. Ultrasound
2. CT/MRI
3. Chest CT or X Ray
4. Labs
4. CA-125
113
What is the difference between Stage I and II Ovarian Cancer?
Stage I: limited to one or both ovaries/Fallopian tubes
Stage II: extends to other pelvic structures
114
What are the 2 most common metastatic sites associated with Ovarian Cancer?
1. Lung
2. Liver
115
What is Primary Therapy in Ovarian Cancer?
Surgery
116
T/F: Neoadjuvant therapy is given in Ovarian Cancer with the sole purpose to shrink the tumor to surgical removal.
True
117
Ovarian Cancer Adjuvant Chemotherapy is _____ -based.
Platinum
118
When would Fertility Sparking: Unilateral Salpingo Oophorectomy USO be an option in Ovarian Cancer?
Stage I
119
Is Radiation recommended in Ovarian Cancer?
NO
120
What is the Goal and Treatment option for Grade 1-IA/IB Ovarian Cancer?
Goal: Cure
Surgery followed by observation
121
What is the Goal and Treatment option for Grade 2-1A/1B Ovarian Cancer?
Goal: Cure
Surgery with observation or IV chemotherapy
122
What is the Goal and Treatment option for Grade 3-1A/1B Ovarian Cancer?
Goal: Cure
Surgery + Platinum Based Chemotherapy
123
What is the Goal and Treatment option for Stage II, III, IV Ovarian Cancer?
Goal II, III, IVA = Cure
Goal IVB = Prolong Life
Surgery + Platinum Based Chemo
124
How long is platinum-based chemotherapy usually in Ovarian Cancer?
3-6 cycles
125
What is the preferred regimen for Stage I Ovarian Cancer?
Paclitaxel/Carboplatin = platinum doublet
126
What is the preferred regimen for Stage II-IV Ovarian Cancer?
Platinum Doublet Backbone +/- Bevacizumab 6-8 cycles
127
What are the indications for Intraperitoneal Therapy in Ovarian Cancer?
1. Stage II/III
2. Optimally Debulked < 1 cm of disease
3. No prior history of bowel surgey
4. Age <65 yrs
128
What drugs are used in Intraperitoneal Therapy of Ovarian Cancer?
1. Paclitaxel
2. CISPLATIN
129
Intraperitoneal Therapy is known to have higher grades of AEs/Complications, would you start this in patient even thought they are not willing to finish the entire cycle?
YES, 1 cycle is better than none, finish the rest of the cycles via IV
130
What is the first-line Maintenance Therapy for Stage I Ovarian Cancer?
Observation
131
What is the first-line Maintenance Therapy for Stage II-IV Ovarian Cancer?
1. Bevacizumab = ONLY if it was used in primary regimen
2. Olaparib = ONLY for BRCA1/2
3. Niraparib
132
Define Platinum Sensitive Disease in Ovarian Cancer
>6 months from the time of last chemotherapy
133
Define Platinum Resistance Disease in Ovarian Cancer
<6 months from the time of last chemotherapy
134
Define Platinum Refractory Disease in Ovarian Cancer
Progression or NO Response on platinum-based therapy
135
What is given in Recurrence of Platinum Resistant Disease?
1. AVOID Platinum = NON Platinum-Based CHemo
2. Supportive Care
136
What is given in Recurrence of Platinum Sensitive Disease?
1. Platinum Based Chemo
2. 2nd Line Chemo
137
What are AEs of Bevacizumab?
1. HTN = DLT
2. Hemorrhage
3. Myalgia
4. Impaired wound healing
5. GI perforation/fistula
138
What are the AEs of IP Chemotherapy?
1. Painful
2. Port Malfunction
139
What are the AEs of Platinums?
1. Myelosuppresion = DLT
2. Peripheral Neuropathy
3. Nephrotoxicity
140
What are the AEs of Taxanes?
1. Myelosuppression
2. Peripheral Neuropathy
3. Fluid Retention
141
Cisplatin vs Carboplatin: Which has the worse N/V?
Cisplatin
142
Cisplatin vs Carboplatin: Which needs a dose reduction for patients with bone marrow fibrosis?
Carboplatin
143
Cisplatin vs Carboplatin: Which has increased hypersensitivity reactions with cycles 6-8?
BOTH
144
PARP Inhibitors are used FIRST LINE for what type of Ovarian Cancer?
BRCA Mutation related
145
List the factors that lead to INCREASED Cervical/Endometrial Cancer
1. Persistent HPV Infection
2. Smoking
3. Parity (increase # of births)
4. Oral Contraceptive Use
5. Early age onset of sexual activity
6. Increased number of sexual partners
7. Certain autoimmune diseases/long term immunosuppresion
146
What is the number 1 contributing factor that increases the risk of Cervical/Endometrial Cancer?
HPV Infection
147
What 5 factors decreases the risk of Cervical/Endometrial Cancer?
1. HPV Vaccination
2. Reduce exposure to HPV
3. Practice safe sex
4. Reduce number of sexual partners
5. Smoking cessation
148
What is the HPV Vaccine called?
Gardasil 9 Papillomavirus 9-Valent Vaccine
149
What is the recommended HPV Vaccination schedule for Children 9-14 yrs?
2 Dose Series: IM 0.5 mL at 0 and 6-12 months
3 Dose Series: IM 0.5 mL at 0, 2, and 6 months
150
What is the recommended HPV Vaccination schedule or Adults 15-45 yrs?
3 Dose Series: IM 0.5 mL at 0, 2, 6 months
151
What are 2 screening tools used in Cervical/Endometrial Cancer?
1. PAP Test
2. HPV Test
152
What is the Primary Treatment for Early Stage Disease of Cervical/Endometrial Cancer?
Surgery or RT
153
What is the Primary Treatment for Advanced Disease IB3-IVA Cervical/Endometrial Cancer?
Chemoradiation
154
What is the Primary Treatment for Metastatic Disease IVB Cervical/Endometrial Cancer?
Systemic Chemotherapy
155
What are the 2 Radiation Options for Cervical/Endometrial Cancer?
1. External Beam Radiation EBRT
2. Brachytherapy Internal Radiation
156
What is the Primary Systemic Chemotherapy for Cervical/Endometrial Cancer?
1. CISPLATIN = given with RT
2. Carboplatin = given with RT ONLY if patient is Cisplatin Intolerant
157
What is the Treatment for Localized Recurrence after initial treatment in Cervical/Endometrial Cancer?
1. RT and/or Chemotherapy or Pembrolizumab
2. Surgery
3. Clinical Trial
158
What is the Treatment for Recurrence after 2nd Line Therapy (POOR Prognosis) in Cervical/Endometrial Cancer?
1. Systemic Chemotherapy
2. Clinical Trial
3. Best supportive care
159
What is the Therapy for Recurrent Disease in Cervical Cancer if PD-L1+?
1. Cisplatin + Paclitaxel +/- Bevacizumab +/- Pembrolizumab
2. or sub Cisplatin with Carboplatin
160
What are the other Therapy options for Recurrent Disease Cervical Cancer?
1. Tisotumab Vedoin
2. Single Agent: Cisplatin/Carboplatin/Paclitaxel
161
What is the Therapy for Recurrent Disease if PDL1+ or MSI-H/dMMR Uterine tumors?
Pemrbolizumab or Nivolumab single agent
162
What is considered most effective therapy for Metastatic Disease of Cervical/Endometrial Cancer?
Cisplatin + Paclitaxel +/- Bevacizumab
163
When would Pembrolizumab be added to therapy regimen for Metastatic Cervical/Endometrial Cancer?
CPS Score >1 PDL1+
164
What are the 6 Risk Factors of Uterine Cancer?
1. Increased levels of estrogen (obesity, diabetes)
2. Reproductive history of infertility
3. Age >55 yrs
4. Genetics, FH (Lynch Syndrome)
5. Hormone replacement therapy
6. Tamoxifen
165
What would quantify Delineation of Treatment?
1. Disease limited to uterus
2. Cervical involvement
3. Suspected extrauterine disease
166
What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage I Uterine Cancer?
1. Observation OR
2. RT +/- Systemic Therapy
167
What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage II Uterine Cancer?
EBRT and/or Brachytherapy
168
What is Therapy Regimen for Disease Limited to uterus or with Cervical Involvement Stage III-IV Uterine Cancer?
Systemic Therapy +/- EBRT +/- Vaginal Brachytherapy
169
What are the agents used in Continuous Progestin Therapy for Fertility Sparing Options of Disease Limited to Uterus?
1. Megestrol
2. Medroxyprogesterone
3. Levonorgestrel IUD
170
What is used for Adjuvant Treatment in Primary Systemic Chemotherapy of Uterine Cancer?
Carboplatin + Paclitaxel
171
What is used for Recurrent/Metastatic HER2+ Therapy Regimens for Uterine Cancer?
Carboplatin + Paclitaxel +/- Trastuzumab
172
What is used for Recurrent/Metastatic MSI-High/TMB-H Therapy Regimens for Uterine Cancer?
Pembrolizumab
173
What is used for Recurrent/Metastatic NOT MSI-H or dMMR Therapy Regimens for Uterine Cancer?
Pembrolizumab + Lenvatinib
174
What is used for Recurrent/Metastatic dMMR Therapy Regimens for Uterine Cancer?
Nivolumab
175
What is used for Recurrent/Metastatic NTRK Gene Fusion Therapy Regimens for Uterine Cancer?
Larotrectinib or Entrectinib
176
What is used for Hormonal Therapy in Uterine Cancer?
1. Megestrol Acetate AND
2. Tamoxifen
177
What are the Supportive Care Medications for Infusion of Carboplatin?
1. NK1 Antagonist
2. 5HT3 Antagonist
3. Dexamethasone +/- Olanzapine
178
What are the Supportive Care Medications for Infusion of Cisplatin?
1. Hydration + Electrolytes
2. NK1 Antagonist
3. 5HT3 Antagonist
4. Dexamethasone +/- Olanzapine
179
What is the main AE of Paclitaxel?
Neuropathy
180
There are allergic reactions with Paclitaxel due to Cremphor, what are the 3 medications that must be used?
1. Diphenhydramine
2. Famotidine
3. Dexamethasone
181
What are the AEs of Bevacixumab (VEGF Inhibitor)?
1. HTN --> BIGGEST CONCERN
2. Proteinuria
3. Wound Healing Complications
4. GI Perforation
5. Thromboembolism
182
What are the AEs of Doxorubicin?
1. Myelosuppression
2. Hand Foot Syndrome
183
What is used for the prevention of Hand Foot Syndrome?
1. Avoid excessive friction
2. Moisturize BID
3. Cold Packs
4. Avoid hot showers
184
What are the AEs of Pembrolizumab?
1. Diarrhea/Colitis
3. Skin Rash
3. Endocrinopathies
185
What is the toxicity connected to Tisotumab?
Ocular Toxicity
186
What is required to be administered when using Tisotumab?
1. Steroid
2. Vasoconstrictor
3. Lubricating Eye Drops
4. Cold Packs during Infusion
187
T/F: For Uterine Carincoma, Tamoxifen must be used with Megestrol, not monotherapy.
True
188
What are the Modifiable Risk Factors for Colon Cancer?
1. High Fat, Low Fiber
2. Red or Processed Meats
3. Alcohol
4. Smoking
5. Obesity
6. Metabolic Syndrome
7. Vitamin D Deficiency
189
What are the Non-Modifiable Risk Factors for Colon Cancer?
1. Age >50
2. Inflammatory Bowel Disease
3. Polyps
4. FH
5. Genetic Predisposition
190
What are the 2 types of genetic predisposition that are risk factors of Colon Cancer?
1. Lynch Syndrome
2. Familial Adenomatous Polyposis FAP
191
List the 4 things that can be used as Prevention of Colon Cancer
1. Vitamin D + Calcium
2. Healthy Lifestyle
3. High Fiber Diet
4. ASA/NSAIDs
192
T/F: Carcinoembyroinic Antigen CEA is NOT useful in detecting recurrence or metastatic disease.
False
193
T/F: CEA is NOT a diagnostic value for colon cancer.
True
194
What 4 sites is Metastatic Colon Cancer common?
1. Liver
2. Lungs
3. Bone
4. Peritoneum
195
What is recommended therapy for Stage I-Low Risk II Colon Cancer?
Surgery + Observation
196
What is recommended therapy for Stage II-III Colon Cancer?
1. Surgery
2. FOLFLOX 3-6 months OR
3. CapeOx
197
T/F: Stage III patients with Colon Cancer, demonstrated a benefit in survival outcome compared to Stage II patients when Oxaliplatin was added.
True
198
Addition of ______ to a Fluoropyridine improves survival and should be added for Stage III patients with NO contraindications.
Oxaliplatin
199
What drugs are NOT recommended in Stage I-III Colon Cancer?
1. Irinotecan
2. Bevacixumab
3. Cetuximab
4. Panitumumab
200
FOLFOX ____ FOLFIRI
=
201
FOLFOX ____ CAPEOX
=
202
FOLFIRI ___ CAPEIRI
>
203
In Stage IV Colon Cancer what are the Chemotherapy Regimens?
1. FOLFLOX
2. CapeOx
3. FOLFIRI
4. FOLFIRINOX
+/- Targeted Therapy
204
What is the benefit in adding on Bevacizumab?
Addition of Bevacizumab improves response rates and survival when added to 5-FU and Capecitabine based regimens in the metastatic setting
205
Define Right Side Colon Cancer
Cecum -- Transverse Colon
206
Define Left Side Colon Cancer
Splenic Flexure -- Rectum
207
Which side of Colon Cancer is known to have a worse prognosis?
Right Side
208
Which side of Colon Cancer is known to have KRAS/BRAF Mutations aka NOT wild type?
Right Side
209
In Stage IV Colon Cancer when would you add on an EGFR Inhibitor?
Wild Type AND Left Sided Tumor
210
T/F: In Stage IV Colon Cancer all patients should add on Bevacizumab.
False: Contraindications are HTN recent surgery, otherwise add on Bevacizumab
211
If the patient demonstrates Progression of Stage IV Colon Cancer, should Bevacizumab be discontinued?
NO
212
If the patient demonstrates Progression of Stage IV Colon Cancer, and was prescribed an EGFR inhibitor, what would be done next?
DC EGFR Inhibitor
Do NOT add on Bevacizumab
213
If the patient demonstrates Progression of Stage IV Colon Cancer and prescribed Oxaliplatin Therapy, what would be done next?
Switch to Regimen with Irinotecan
214
If the patient demonstrates Progression of Stage IV Colon Cancer and prescribed Irinotecan Therapy, what would be done next?
Switch to Regimen with Oxaliplatin
215
What drugs are NOT recommended and should be avoided in Stage IV Colon Cancer?
1. CapeIRI Regimen
2. VEGF Inhibitor + EGFR Inhibitor Combo
216
What is the MOA of 5-FU?
1. FUTP inhibits RNA synthesis
2. FdUMP inhibits DNA synthesis through inhibition of thymidylate synthetase
217
What is the difference between Bolus and Continuous administration of 5-FU?
Bolus = RNA false base pair
Continuous = TS inhibition
218
What is the DLT of Bolus 5-FU?
1. Myelosuppression
2. Neutropenia
3. Thrombocytopenia
219
What is the DLT of Continuous 5-FU?
1. Diarrhea
2. Hand Foot Syndrome
220
What is the MAJOR DDI of 5-FU?
Warfarin
221
What is the MOA of Leucovorin?
1. Stabilize the complex between FdUMP and Thymidylate Synthetase
2. Help increase cytotoxicity of 5-FU
222
T/F: You can give Leucovorin with Capecitabine.
False, avoid combination due to toxicity
223
When is Capecitabine Contraindicated?
CrCl <30
224
What is the DLT of Capecitabine?
1. Diarrhea
2. Hand Foot Syndrome
225
What is used for the treatment of Hand Food Syndrome?
1. Urea - Keratolytic Cream
2. Steroid Cream
3. Oral Analgesics
226
What is the DLT of Oxaliplatin?
Cumulative Peripheral Neuroapthy
227
Define Acute DLT of Oxaliplatin
1. REVERSIBLE
2. Resolves within 14 days
3. Exacerbated by cold
228
Define Chronic DLT of Oxaliplatin
1. PERSISTENT
2. >14 days
229
What is more common in Oxaliplatin, Thrombocytopenia/Anemia or Neutropenia?
Thrombocytopenia/Anemia > Neutropenia
230
What is the DLT of Irinotecan?
Diarrhea
231
What should be given for EARLY diarrhea in Irinotecan?
Atropine, max dose 1.2 mg
232
What should be given for LATE diarrhea in Irinotecan?
Loperamide
233
What is the dosing of Loperamide in treatment of diarrhea of Irinotecan?
4 mg at onset then 2 mg Q2 hrs until diarrhea free for 12 hours
234
T/F: There is NO Max Dose for Loperamide when concerned with Irinotecan induced Diarrhea.
True
235
Patients with Homozygous ________ allele have increased Neutropenia and Diarrhea with Irinotecan.
UGT1A1*28
236
If patients demonstrate with deficient enzymatic activity due to UGT1A1*28, what can be done with Irinotecan therapy?
1. Dose Reduction
2. Use alternative regimen
3. Accept greater toxicity levels
237
What are the class AEs of VEGF Inhibitors (Bevacizumab/Regorafenib)?
1. HTN
2. Impaired Wound Healing
238
What are the specific AEs of Regorafenib (VEGF Inhibitor)?
1. Hepatotoxicity
2. Hand Foot Syndrome
3. Diarrhea
239
What is the most common AE of EGFR Inhibitors?
Papulopustular Acneiform Rash
240
T/F: You can treat Acneiform Rash with acne products.
False
241
What is used in the Prevention of Acneiform Rash?
1. Hydrocortisone 1%
2. Moisturizer
3. Sunscreen
4. Doxycycline 100 mg BID
x6 weeks
242
What is used in the Treatment of Acneiform Rash?
1. Topical Steroids
2. Clindamycin 1% Gel
3. Doxycycline or Minocycline
4. Oral Steroids = ONLY for severe rash
Hem/Onc Module
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