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54 Cards in this Set
- Front
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Non-Small Cell Lung Cancer (adenocarcinoma, squamous cell carcinoma (SCC) and large cell carcinoma) 85% of all lung cancers |
1- Lobectomy with ipsilateral mediastinal dissection (if can't resect do stereotactic ablative radiotherapy) 2 - Lobectomy + adjuvant chemo 3 - consolidation chemo-radiation 4 - Chemotherapy + palliative radiation
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TNM Staging |
N1 - Metastasis in ipsilateral peribronchial and/or ipsilateral hilar nodes and intrapulmonary nodes, including involvement by direct extension N2 - Metastasis in ipsilateral mediastinal and/or subcarinal node N3 - Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene node, or supraclavicular node |
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Stage 1a
Stage 1b Stage 2 |
Surgical resection Surgical resection +/- chemo Surgical resection + adjuvant chemo (radiation if no resection for 1 and 2) |
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Stage Three Stage Four |
Concurrent chemoradiotherapy Palliative approach (Therapy in this situation should be guided by the mutation status of the tumor whenever possible) |
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Workup |
CT chest and abdomen CBC Creat, lytes Alk phos AST ABG if suspect respiratory failure |
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EGFR in Metastatic Adenocarcinomas EGFR TK inhibitors get KRAS testing done prior to initiating TKI |
EGFR cobas EGFR mutation test (exon 19 deletion or exon 21 substitution mutation) exon 20 mutation - acquired resistance to TKI therapy. All metastatic NSCLC adeno with EGFR mutations use the TKI erlotinib(Tarceva), gefitinib (Iressa) |
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ALK inhibitors Test ALK with FISH in all mets NSCLC Crizotinib exhibited markes antitumor activity in ROS 1 mets NSCLC pts |
Crizotinib (Xalkori), ceritinib (Zykadia for pts who progress or intolerant to crizotinib), brigatinib (Alunbrig) ALK rearrangement - no benefit from EGFR TKIs marker for aggressive disease and poor prognosis. |
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Prognostic factors NSCLC SCLC |
Stage, performance, weight loss stage, performance, weight loss, high LDH, male, low Na, high AST |
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Signs of regional spread Paraneoplastic syndrome Squamous cell Adenocarcinoma NSCLC SCLC |
SVC syndrome Recurrent laryngeal nerve, phrenic, brachial root high ca due to PTHrP trousseau syndrome hypertrophic osteoarthropathy SIADH (serum osmolality < 280 mOsm/kg, and high urine osmolality Ectopic ACTH Eaton Lambert syndrome |
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Platinum-based chemotherapy |
intercaleters - cause cross linking of DNA cisplatin carboplatin - allergic oxaliplatin S/E Neurotox- deafness Nephrotoxic |
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Taxanes |
Micro-tubule inhibitors Paclitaxel (Taxol) - Anaphlaxis, peripheral neuro, low myelosuppressive Docetaxel (Taxotere) - edema, pleural effusion |
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Bevacizumab (Avastin) not for squamous ca |
Inhibiting vascular endothelial growth factor A Bleeding, HTN |
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gemcitabine (Gemzar) breast, ovarian, non-small cell lung, pancreatic cancer |
nucleoside analog myelosuppressive, flu-like symptoms |
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vinorelbine |
inhibition of mitosis through interaction with tubulin Neuropathy |
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cetuximab (Erbitux) |
epidermal growth factor receptor (EGFR) inhibitor Rash, diarrhea Not myelosuppressive |
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pemetrexed (Alimta) |
Folate antagonist myelosuppressive |
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Etoposide |
Topoisomerase inhibitor orally given Rash, diarrhea, myelosuppressive |
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topotecan Irinotecan |
topoisomerase inhibitor |
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necitumumab (Portrazza) |
binds to the epidermal growth factor receptor |
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nivolumab (OPDIVO) pembrolizumab (KEYTRUDA) |
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Follicular Lymphoma |
Initial R- CVP R- CHOP Bendamustine + Rituximab Refractory/Relapse Bortezomib + Rituximab Lenolidamide + Rituximab |
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Idelalisib/Zydelig |
Inhibitor of the delta isoform of phosphatidylinositol 3-kinase (PI3Kδ), highly expressed in malignant lymphoid B-cells For - relapsed follicular B-cell non-Hodgkin lymphoma /relapsed small lymphocytic lymphoma (SLL) S/E - pneumonia, pyrexia, sepsis, febrile neutropenia, diarrhea, or pneumonitis. |
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Diffuse B-Cell Lymphoma |
Germinal Center DLBCL R-CHOP-21 Activated B-Cell DLBCL R-CHOP + Lenalidomide R-CHOP + Ibrutinib R-CHOP + Bortezomib R-ACVBP (pts <60 yrs) - Rituximab, Doxorubicin, Cyclophosphamide, Vindesine, Bleomycin, and Prednisone Double Hit DLBCL: c-MYC translocation plus gene rearrangement of BCL-2, BCL-6, or both EPOCH-R - Etoposide, Doxorubicin, Vincristine, Cyclophosphamide, and Prednisone plus Rituximab) |
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CAR T-Cell Therapy |
CARs are proteins that allow the T cells to recognize a specific protein (antigen) on tumor cells. |
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Small Lymphocytic Lymphoma/CLL |
Younger patients (<70 years) Unmutated FCR – Fludarabine + Cyclophosphamide + Rituximab FR - Fludarabine + Rituximab Older adults ( >70 years) Initial – Chlorambucil + Obinutuzumab or Ofatumumab Decreased renal function or other comorbidities – Bendamustine + Rituximab (BR) Del(17p) are high risk of not responding/relapsing – Ibutinib (Bruton's tyrosine kinase inhibitor) Younger/fit patients are considered for non-myeloablative allogeneic hematopoietic cell transplantation Other Drugs Purine Analogs - Pentostatin Monoclonal Antibodies – Alemtuzumab Novel Agents - PI3-kinase - Idealasilib BCL2 Inhibitor - Venatoclax |
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Ibrutinib |
For MCL/CLL/WM S/E - diarrhea, fatigue, pyrexia, and nausea |
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Hairy cell leukemia |
CDA Pentostatin Interferon vemurafenib(Zelboraf) - Rash and arthralgia |
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Multiple Myeloma |
CRAB Criteria Vincristine, Adriamycin, dexamethasone (VAD) Melphalan and prednisone Immune modifying drugs - Thalidomide, Lenalidomide, Pomalidomide Proteosome inhibitors - Bortezomib, Carfilzomib HDAC inhibitors - Panobinostat Monoclonal antibodies - Elotuzomab(SLAM-7 antibody), Daratumomab(anti-CD-38 antibody, Siltuximab (IL- 6 antibody) Selinexor - selective inhibitor of nuclear export |
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Renal Cell Cancer |
gjk |
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Breast cancer |
Stage 1 - surgery - sentinel biopsy, radiation except elderly or low grade. Stage 2 - lymph node positive Stage 3 - locally advanced -consolidation Stage 4 - metastatic - palliative radiation Prognostic factor - lymph node involvement > size
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Breast cancer |
Already treat brain mets first. Younger pts are more likely all negative. Bone only mets have best prognosis Visceral mets respond best to chemo In Her2 > triple negative - brain meets are more aggressive |
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Stage one |
Node negative - triple negative - give chemo (6 cycles) ER/PR can get chemo, hormoradiation. Er/PR positive - oncotype - low/ intermediate grade gets hormonal High grade gets chemo. |
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Stage 0 DCIS |
Not break the basement membrane Adjuvant hormonal +_ radiation (poor risk) Treatment decreases recurrence not overall survival |
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Node positive |
Sentinel positive do axillary Chemo all |
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Stage 3 |
Neochemo ( Decs size and peau d orange) If no response - neoradiation If positive - check patho response - residual left do chemo radiation |
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Stage 4 |
If Bone - bisphos if kidney normal Xgeva if not normal Visceral- chemo till progression Give holidays for bm recovery Look at co morbidity All younger pts get oopherectomy |
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Breast cancer - genetic tests |
Brca + give neratinib to Er positive Her negative (oral cyclic kinase) Never combine chemo with radiation except for ibrance
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Her2 positive |
Herceptin (cardiotoxic) if early give for one year, all others get life long Lapatinib- doesn't work in adjuvant only in mets Perjeta+Herceptin for mets |
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HNPCC (Lynch) |
larger less aggressive right sided colon CA compared to FAP. More responsive to chemo Also cause - endometrial/ovary/pancreas/liver/brain |
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FAP |
more aggressive, distal leasions Also causes - gastric cancer/desmoid tumors |
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Li-Fraumeni |
Breast CA, Sarcoma, Brain tumors, Leukemia |
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BRCA |
Breast, Ovarian, Pancreatic, Prostate |
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Peutz - Jeghers |
hamartomas dark spots on lips and anus Increased risk of gastric, pancreatic, cervix, ovarian, breast cancer |
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HDGC |
CDH1 genetic testing Family with 2 or more cases of stomach CA( at least 1 diffuse) 1 person with diffuse < 40 Personal or FH of diffuse gastric + lobular breast with one less than 50 Family with 2 or more lobular before 50 Multiple lobular breast ca before 50 in one person. |
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Prostate CA |
Local - Surgery + RTMets - flutamide (TR) then leuprolide/ goserelin GnRH agonist) |
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Ovarian CA |
Surg debulk + chemo |
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Testicular markers |
Nonseminoma -AFPSeminoma - beta hcg, LDH, AFP |
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Venetoclax |
CLL second line in 17p deletion pts Targets BCL-2 protein Daily oral S/e - pneumonia, neutropenia with fever, fever, autoimmune hemolytic anemia, anemia, and tumor lysis syndrome |
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Colorectal screening with colonoscopy |
decreases deaths in 50-75 age only |
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Colorectal cancer facts |
garlic consumption doesn't effect risk pts with breast ca have higher risk of proximal crc higher bmi is associated with higher risk of crc in females compared to males |
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55 - 80 30 pack year history |
yearly low dose CT Stop is not smoked for 15 years |
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Stage Three Stage Four |
Concurrent chemoradiotherapy Palliative approach (Therapy in this situation should be guided by the mutation status of the tumor whenever possible) |
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EGFR in Metastatic Adenocarcinomas EGFR TK inhibitors get KRAS testing done prior to initiating TKI |
Metastatic EGFR T790M mutation in NSCLC who progressed during or after EGFR TKI therapy |
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Platinum based therapy |
Cisplatin vinorelbine Pemetrexed for non squamous |
