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30 Cards in this Set
- Front
- Back
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Stage IV colon cancer requires which of the following treatment approaches (select all)
Surgery Radiation Chemo |
Chemo only
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Stage I colon cancer requires which treatment approach? (select all)
Surgery Radiation Chemo |
Surgery only
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Stage IIA colon cancer requires which of the following treatments? (select all)
Surgery Radiation Chemo |
Surgery only
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Stage IIB colon cancer requires which of the following treatments? (select all)
Surgery Radiation Chemo |
Surgery and Radiation
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Which stage(s) of colon cancer require surgery, radiation, and chemo for treatment?
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Stage IIIA, IIIB, IIIC
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What is the standard treatment following surgery for colon cancer?
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6 months of chemo (every 2 weeks)
Category 1: FOLFOX: 5FU/Leucovorin/Oxaliplatin mFOLFOX6: modified CapeOX: Capecitabine + Oxaliplatin FLOX Category 2A: Capecitabine 5FU/Leu |
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Describe the dose limiting toxicity of Oxaliplatin
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Myelosupporession
Cold induced peripheral neuropathy) May add gabapentin. This is why we only give FOLFOX for 6 months |
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What is a common SE of 5FU?
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diarrhea
mouth sores GI toxicity |
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T or F: Leucovorin causes SE of 5FU to be more tolerable but decreases effect on cancer
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False. Leucovorin causes 5FU to be more efficacious but the side effects will be worse
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What is first line therapy for stage II and III colon cancer?
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FOLFOX
*Mosaic trial |
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T or F: The use of FOLFOX showed greater benefit in pts with stage III colon cancer than stage II
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True
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What toxicities do you expect from mFOLFOX6?
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OX: myelosuppression, cold induced neurpoathy, N/V
5FU: diarrhea, mouth sores, loose hair Leucovorin: Makes 5FU work better but worsens toxicities of 5FU |
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Describe the grading of dose limiting toxcities
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0: no toxicity
3/4: interruptionin therapy needed 5: death |
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What is the most common site of mets?
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LIVER
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Are mets found in the liver resectable?
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Not usually, usually they are found in multiple spots on the liver
Cannot remove by surgery |
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What is KRAS?
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Patients with KRAS mutation dont respond well to cetuximab. Recommend genotyping to be done when tumor is sampled
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Why don't we use FOLFOX for stage II CRC?
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Benefits were limited adn toxicities were seen and can be severe
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Which of the following are common sites for mets? (select all)
Liver Bone Brain Toenail |
Liver
bone brain (not common) other organs too |
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Why don't we use irinotecan or avastim in the curable setting for CRC
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showed increased mortality
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Which drugs can be used in the curable setting
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FOLFOX
5FU/leucovorin/oxaliplatin capecitabine |
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What are the initial chemo regimens for mCRC?
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Category 1A:
FOLFIRI: Irinotecan, 5fu, leucovorin FOLFOX: 5fu, leucovorin, oxaliplatin CapeOx: capecitabine + oxaliplatin 5FU + Leucovorin Capecitabine 2A: Irinotecan, Oxaliplatin, 5FU, Leucovorin (FOLFOXIRI) Biologic therapies: bevacizumab, cetuximab, panitumumab (if no KRAS mutation) |
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What tx should you start with for mCRC?
What if it progresses? |
FOLFOX + Bevatizumab
If progresses switch to FOLFIRI |
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If you have an 85 yr old man with mcrc what therapy should you avoid?
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FOLFOX: bc of myelosuppression, neurpathy, risk of falling
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What is the intense three drug therapy used for mcrc known as the triplet?
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5FU, Leucovorin, Oxaliplatin
(FOLFOX) |
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What is a less intense three drug therapy used for mcrc?
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5FU, Leucovorin
OR capecitabine OR irinotecan |
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What are the side effects of bevacizumab (Avastin)
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bleeding risk
proteinuria high bp impaired wound healing STOP 30 to 40 days prior to surgery adn wait 30 to 40 days after to start |
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What are the AE of irinotecan
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diarrhea
myelosuppression nausea |
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When are MABs indicated for crc?
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In the metastatic setting
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Which drugs are used in the mcrc setting but not in the curable setting?
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Avastin, Irinotecan
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T or F: Colong cancer is the leading cause of cancer in both women and men and has the highest cancer mortality rate.
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False: Colong cancer is the 3rd leading cause of cancer in both women and men and has the third highest cancer mortality rate
Highest mortality rate: Lung cancer Leading cause of cancer in women: breast men: prostate |
