Head/neck

Question 1

Older patients with differentiated thyroid cancer

Answer 1

worse prognosis

Question 2

• Concurrent chemotherapy regimens with primary chemoradiation (NCCN category 1) for head and neck

Answer 2

o Cisplatin

• Cisplatin is considered the recommended agent; cetuximab is considered an alternative for patients who are not candidates for cisplatin
• Consider KPS and comorbidities

o Carboplatin / 5-FU

o Cetuximab

• Superior outcomes with RT + Cetuximab vs RT alone

Question 3

• Post-operative / Adjuvant chemoradiation in poor risk disease head and neck

Answer 3

o High risk features for locoregional recurrence -> add chemotherapy to post-op RT

• Positive margins (primary tumor)
• Extracapsular spread /Extranodal Extension (locoregional LNs)

Question 4

• Induction chemotherapy in HN

Answer 4

o Acceptable per NCCN guidelines

o Despite high response rates and a decrease in the incidence of distant metastatic disease, an improvement in OS has not been demonstrated

o TPF (docetaxol, cisplatin, 5-FU)

Question 5

• Systemic therapy for recurrent/metastatic disease in HN

Answer 5

o Platinum-agent (cisplatin or carboplatin), 5-FU, and cetuximab (EXTREME regimen): first-line regimen for fit patients

• Platinum + 5-FU + Cetuximab > Platinum + 5-FU (RR, PFS, and OS)
• Platinum + 5-FU = Platinum + Taxol; extrapolate and will substitute taxol for 5-FU

o Pembrolizumab and Nivolumab are approved for platinum-refractory R/M disease

Question 6

nasopharynx cancer trtmt

Answer 6

Large Primary and/or +LNs: Stage III, IVA, IVB
* Chemoradiation (with cisplatin) +/- adjuvant chemotherapy (cisplatin +5-FU)
o Small primary and No LNs: Stage I-II
* Radiation alone

Question 7

nasopharynx cancer trtmt met

Answer 7

o R/M Disease

* Cisplatin + Gemcitabine > Cisplatin + 5-FU

Question 8

o Medullary Thyroid Cancer

Answer 8

• Vandetanib and Cabozantinib – multikinase TKIs, inhibit RET (PFS benefit)