- ARDS - bone pain - bleomycin lung toxicity has higher incidence when given with GCSF - sickle cell crisis - splenic rupture - MDS/AML

Miscellaneous Flashcards by Ned Jones

LEMS mechanism

reduced acetylcholine (ACh) release from the presynaptic nerve terminals

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LEMS clinical features

slowly progressive muscle weakness
proximal lower extremity weakness (gait alteration, difficulty arising from a chair)
Oculobulbar findings (ptosis, diplopia)
Improvement in strength with vigorous muscle activation
Respiratory failure in late stages

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Effect of finasteride for chemoprevention of prostate cancer

25% reduced incidence of prostate cancer
small but significant increase in risk of high-grade prostate cancer (likely from detection bias)
no effect on OS

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Management of G1 pneumonitis from T-Dxd (asymptomatic) per package insert

steroids
Stop enhertu until resolved to G0
If resolved in 28 days or less, maintain dose
If resolved in greater than 28 days, dose reduce

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Clinical features of inflammatory breast cancer

rapid-onset breast erythema (No more than 6 month history) + edema + peau d’orange appearance + warm breast

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Differential for anterior mediastinal mass

small cell lung cancer →
lymphoma (T-ALL, nodular sclerosing HL, primary mediastinal b-cell lymphoma) →
germ cell tumor → carcinoma) (50%) →

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Differential for posterior mediastinal mass

Neurogenic →
Meningocele →
Thoracic spine lesions →

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Differential for middle mediastinal mass

Lymphadenopathy (most commonly) →
Benign cystic tumor →
Cardiovascular aneurysm or anomaly →
Esophageal tumor →

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Most common symptoms of leptomeningeal disease

pain
seizures

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1) Newly approved NTRK inhibitor 2) clinical benefit

Repotrectinib
*high ORR in second line + CNS penetraton

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NTRK inhibitors target what specifically

FUSIONS

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GCSF indications

1) neutropenic fever risk > 20%
2) ***Maintain dose density

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Risk factors to consider GCSF for intermediate risk for neutropenic fever

prior chemo or radiation
age > 65
liver dysfunction
CrCl <50
chronic immunosuppression
bone marrow involvement
recent surgery or wounds

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Risk factors to consider GCSF for intermediate risk for neutropenic fever

prior chemo or radiation
age > 65
liver dysfunction
CrCl <50
chronic immunosuppression
bone marrow involvement
recent surgery or wounds

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Other brand name for pegfilgrastim

Udenyca

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GCSF toxicity

ARDS
bone pain
bleomycin lung toxicity has higher incidence when given with GCSF
sickle cell crisis
splenic rupture
MDS/AML

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Management of bone pain from GCSF

NSAIDs
loratadine

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GCSF contraindication

Within 14 days of CAR-T (exacerbating CRS)

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Chemo induced thrombocytopenia management per boards

1) plt transfusion as per standard goals
2) dose reduce subsequent cycle
3) consider romiplostim

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Chemo induced anemia transfusion goals per boards

goal hgb 7, 8 if comorbid cardiovascular disease

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Chemo induced anemia transfusion goals per boards

goal hgb 7, 8 if comorbid cardiovascular disease

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Use of ESAs for chemo related anemia per boards

can be considered if CKD + cancer

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Use of ESAs for chemo related anemia per boards

can be considered if CKD + cancer (already receiving)
declining and refusing transfusions

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Breast cancer screening modality and timing for women with history of chest wall radiation + at what age it is indicated

MRI + mammogram annually (typically alternated every 6 months)
annual breast MRI after age 25

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Most common testicular cancer histology in older men

Seminoma

HPV vaccination recommendation

- age 11-12 up to age 26 *can be offered 27-45 to those most likely to benefit

alcohol and BMI and exercise as RF's for breast cancer

*High BMI is only a a risk factor for postmenopausal women, in premenopausal women low BMI is actually a RF - minimal alcohol intake (even if less than 1 drink per day) has been shown to increase breast cancer risk *sedentary/lack of physical activity is also a risk factor *increased breast density is also a RF

In what ALL subtype is CRLF2 gene rearrangement found in?

Ph-like ALL

Ethnic + genetic variant RF for Ph-like ALL

1) latino 2) GATA3

How to reduce risk of pancreatic cancer

- weight loss, including bariatric surgery

Most common environmental RF for lung cancer

- residential radon exposure

Drug that requires fixed dosing as opposed to actual weight

Bleomycin

Blood thinner contraindicated with tamoxifen

Warfarin

Mutations seen in prostate cnacer with neuroendocrine differentiation

TP53 RB1

Statistical test that is less sensitive to outliers

Wilcoxon rank-sum test

Trial design that allows determination of efficicacy and ability to terminate early for futility

Simon two-stage design

Statistical test best suited to compare populations with small sample sizes

Fisher exact test

Pemetrexed mechanism

Folate antagonist

Drug contraindicated with second generation BCR-ABL TKI's

PPI’s (pH dependent absorption)

Problems of 3+3 phase I design

- doesn't minimize sample size - can give poor estimate of MTD

First line for NETs per boards

SSA

Point of a Phase 4 trial

- evaluate toxicity and outcomes after a new treatment has been approved under real-life conditions

What is the healthy volunteer effect?

Volunteers are healthy and not representative

Most common mechanism of radiation-induced cell death in solid tumors

mitotic castastrophe

VHL funtion

Tumor suppressor

Recurrent metastatic head and neck

IF recurrence <6 months (platinum refractory), IF low-moderate volume of disease AND PD-L1+, pembrolizumab IF high volume disease, cetuximab + pembro (Phase II, OS, ORR benefit) IF PD-L1 negative, cetuximab + pembro IF recurrence >6 months, treat as de novo metastatic

Antibody associate with paraneoplastic cerebellar degeneration in SCLC

Ant0Hu

CRC in surveillance imaging indication

CT torso q6-12 months

Stage IA ovarian cancer management in patient desiring fertility

- unilateral salpingo-oophorectomy with adjuvant carbo/taxol (stage IA is isolated involvement of one ovary, this is the only scenario in ovarian where fertility preservation is possible)

What qualifies as low risk PC

PSA <10 T2a or lower Grade group 1

Low risk PC options

IF life expectancy >10 years Active surveillance (preferred) XRT RP without ADT

Very low risk PC options

Active surveillance if life expectancy >10 years IF <10 years, observation (do nothing)

Unfavorable intermediate PC

- Grade group 3 - >50% positive biopsy cores - PSA 10-20

favorable vs. unfavorable intermediate risk PC in terms of ADT w/ RT

- ADT only indicated with RT if unfavorable

When zytiga is indicated for localized prostate cancer

node positive on conventional scan OR 2 of following: T3/T4, grade group 4 to 5 (GS 8-10), PSA ≥40 ng/mL

Clinical benefit of cetuximab added to RT vs. RT alone

- OS benefit but still understudied so hasn't replaced standard of care

Stage IIb cervical cancer management

Chemoradiation w/ cisplatin then brachytherapy

What defines tage IIb cervical cancer

parametrial involvement

Chemo-induced neuropathy treatment

- duloxetine - gabapentine

Indications for treatment in WM

hyperviscosity hepatosplenomegaly cryoglobulinemia cold agglutinin disease b symptoms bulky adenopathy (>5cm) Cytopenias

Metastatic merkel cell - prognosis better w/ known vs. uknown primary

Better prognosis if unknown primary

First line for MSI-H BRAF V600 E mutant metastatic colon

chemoimmunotherapy - mFOLFOX + pembro (Accumulating evidence that sporadic MSI-H has high disease heterogeneity. BRAF mutant needs upfront intensification of therapy but dMMR/BRAF still do better than pMMR/BRAF)

Anticipatory nausea management

Behavioral therapy per guidelines Lorazepam 0.5 mg-2mg before pretreatment if no improvement with behavioral therapy

Biomarker predictive of improved response from margetuximab vs. trastuzumab

CD16A 158F allele

management of pulmonary toxicity from chlorambucil in CLL

steroids

Drugs for lowering potassium in TLS

IF available, sodium zirconium cyclosilicate (SZC) 10 g TID for 48h (preferred, since more rapid acting) IF SZC not available, patiromer 8.4 g daily (repeated daily as needed) Avoid sodium polystyrene sulfonate (bowel necrosis, toxicity)

When to hold and discontinue bev for proteinuria

>2 = hold >3.5 = permanently discontinue

Opioid risk tool - score indicating high risk

Greater than or equal to 8

Biomarker used in CLL IPI

beta-2

most common genetic abnormality in SCLC

p53 mutations (nearly all SCLC tumors)

First line for papillary thyroid cancer

RAI

localized NPC treatment

definitive XRT

locally advanced NPC management

induction chemo then CRT

Effect of CYP3A inducers on chemo drugs

Decrease concentration and efficacy

Examples of CYP3A inducers

- seizure drugs - TB - PPI's - St. John's wort

Effect of CYP3A inhibitors on chemo drugs

- increase serum chemo levels and increase opioid toxicity

Examples of CYP3A inhibitors

- grapefruit - HIV - Fungal drugs - macrolides - fluoroquinolones - anti-depressants

Smear findings in cirrhosis

- acanthocytes (spur cells) *see photo online

Drug in CRC that's contraindicated with bili >2

irinotecan

Why does brigatinib require step up dosing?

pulmonary toxicity

CLL pts for whom chemoimmunotherapy (eg FCR) is contraindicated

- IGHV unmutated - p53 mutant

Paget's disease management

central breast excision

second line for papillary thyroid cancer

lenvatinib

clinical benefit of sunitinib for RCC

PFS

Miscellaneous Flashcards

(84 cards)