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Onco Regimens
Oncology Regimens
| Question | Answer |
|---|---|
| HR+, HER2- adjuvant therapy | Chemo followed by endocrine therapy |
| HR+, HER2+ adjuvant therapy | Chemo + trastuzumab followed by endocrine therapy. Maintenance w/ trastuzumab +/- pertuxumab x 1 yr |
| HR-, HER2+ adjuvant therapy | Chemo + trastuzumab. Maintenance w/trastuzumab +/- pertuzumab x 1 yr. NO endocrine therapy |
| HR-, HER2- adjuvant therapy | AKA "Triple negative". Chemo only |
| Stage IV/recurrent locoregional | Surgery +/- radiation |
| Stage IV/recurrent HR+, HER2- | AI or fulvestrant +/- CDK4/6i first line. Fulvestrant + CDK4/6 (if not previously used) as second line. |
| Stage IV/recurrent HR+, HER2+ | AI or fulvestrant or tamoxifen +/- trastuzumab |
| Stage IV/recurrent HR-, HER2+ | docetaxel/paclitaxel + pertuzumab + trastuzumab |
| Stage IV/recurrent HR-, HER2- | if PDL1>10%: chemo + pembrolizumab. If PDL1<10%, sequential single agent chemo. |
| Stage IV/recurrent HER2 low or ultra-low | Fam-trastuzumab |
| NSCLC Stage I-II | Surgical resection is standard of care. Radiation if not surgical candidate. Provide counseling and smoking cessation if active smoker. Adjuvant therapy: Non-squamous: cisplatin + pemetrexed Squamous: cisplatin + gemcitabine/docetaxel (NO pemetrexe |
| NSCLC Stage III | Induction chemoradiotherapy then resection in select pts. Chemo or concurrent chemoradiation using platinum-based regimen if PS is reasonable |
| NSCLC Stage IV | Platinum-based doublet chemo regimen, targeted therapy if positive markers or PD-L1 expression. Generally, Non-squamous: pembrolizumab/cemiplimab + -platin + pemetrexed. Squamous: pembrolizumab/cemiplimab + -platin + paclitaxel. |
| NSCLC EGFR mutation | Osimertinib, erlotinib, afatinib, gefitinib, or amivantanab |
| NSCLC ALK gene rearrangement | Alectinib, lorlatinib, crizotinib, ceritinib, brigatinib |
| NSCLC ROS1 gene rearrangement | Entrectinib, crizotinib, repotrectinib |
| NSCLC BRAF V600E point mutation | Dabrafenib |
| NSCLC KRAS G12C point mutation | Adagrasib, sotorasib |
| NSCLC MET exon 14 skipping | Tepotinib, capmatinib |
| NSCLC NTRK fusion | Larotrectinib, entrectinib |
| NSCLC RET gene rearrangement | Selpercatinib, pralsetinib |
| NSCLC ERBB2/HER2 gene mutation | Trastuzumab deruxtecan |
| Prostate Cancer: non-metastatic castration sensitive | ADT including: LHRH agonist + antiandrogen LHRH antagonist LHRH agonist/antagonist + abiraterone (very high risk only) |
| Prostate Cancer: metastatic castration sensitive | Doublet therapy: ADT + apalutamide/enzalutamide/darolutamide/abiraterone. Triplet therapy: ADT + apalutamide/enzalutamide/darolutamide/abiraterone + docetaxel |
| Prostate Cancer: non-metastatic castration resistant | Continue ADT Once PSA doubles in 10 mo or less, add ADT + apalutamide/enzalutamide/darolutamide |
| Prostate Cancer: metastatic castration resistant | Prior ADT only: docetaxel or abiraterone or enzalutamide Prior ADT + antiandrogen only: docetaxel Prior docetaxel only: abiraterone or enzalutamide or cabazitaxel Prior docetaxel + antiandrogen: cabazitaxel, or pluvicto, or docetaxel rechallenge |
| Kidney Cancer: Stage I | Surgery or RT, surveillance only |
| Kidney Cancer: Stage II/III | Surgery or RT, adjuvant pembrolizumab x 1 yr if clear cell histology (stage II must have grade 4 tumors +/- sarcomatoid features), or surveillance if no adjuvant therapy |
| Kidney Cancer: Stage IV | Axitinib + pembrolizumab Cabozantinib + nivolumab Lenvatinib + pembrolizumab Ipilimumab + nivolumab Cabazantinib |
| Colorectal Cancer: early stage and T2 or less | Resect if possible. If unresectable, colostomy w palliative radiation |
| Colorectal Cancer: early stage but greater than T2 | Chemo x 3-6 mo: fluorpyrimidine/5-FU/Capecitabine. Post-op chemoradiation if T4, perforation, or poorly differentiated |
| Colorectal Cancer: aggressive (stage III) | Add oxaliplatin to regimen (FOLFOX/CAPFOX) |
| Colorectal Cancer: metastatic (stage IV) | Targeted therapy: EGFR if KRas + BRAF are WT bevacizumab if mutated or unknown status immunotherapy if MSI-H/dMMR |
| ALL Induction | Ph+: TKI (imatinib, dasatinib) + chemo. Ph-: chemo only. Backbone agents: anthracycline + vincristine + corticosteroid |
| ALL consolidation/intensification | HSCT preferred if Ph +. Blinatumomab or multi-agent chemo +/- TKI, w/ unclear benefit |
| ALL Maintenance | Weekly MTX + daily 6-MP + monthly vincristine/prednisone, Blinatumomab, TKI if Ph + |
| APML Induction | Low-risk: ATRA + ATO + prednisone, High-risk: ATRA + ATO + idarubicin (Substitute gemtuzumab for idarubicin fi low EF) |
| AML supportive care | Blood/platelet transfusion, Infection prophylaxis (antibiotic, antifungal, antiviral), TLS prevention w allopurinol, Hydroxyurea |
| AML remission induction | intensive induction: standard 7+3 (cytarabine + anthracycline) Intensive induction ineligible: venetoclax + hypomethylating agent (azacitidine or decitabine) |
| AML consolidation | favorable/intermediate risk: chemo (high dose cytarabine) If CD33+: receive cytarabine + GO If FLT-3: will receive midostaurin/quizartinib + cytarabine High risk: allogenic hematopoietic cell transplantation (HCT) |
| AML maintenance | Post-chemo: Consider azacitidine, continue midostaurin or quizartinib if no HCT planned Post allogenic HCT: If FLT-3 mutation: gilteritinib, sorafenib, midostaurin, or quizartinib |
| CLL w del17P/TP53 mutation | Venetoclax/Acalabrutinib + Obinutuzumab, Venetoclax/Zanubrutinib, Acalabrutinib +/- obinutuzumab, Zanubrutinib |
| CLL w/o del17P/TP53 mutation | Venetoclax + Obinutuzumab, Venetoclax/Acalabrutinib +/- Obinutuzumab, Acalabrutinib +/- obinutuzumab, Zanubrutinib |
| CML tx | low risk: imatinib, bosutinib, dasatinib, nilotinib, or asciminib intermediate risk: bosutunib, dasatinib, nilotinib, or asciminitib. mutations: ponatinib |
| HL early stage favorable | ABVD --> ABVD or AVD or radiation +/- ABVD |
| HL early stage unfavorable | ABVD --> ABVD or AVD or BrECADD + G-CSF nivolumab/brentuximab + AVD BrECADD + G-CSF |
| HL advanced statge | BrECADD + G-CSF + AVD ABVD Preferred: Nivolumab + AVD BrECADD + G-CSF + AVD |
| HL refractory | ICI --> ASCR/radiation/brentuximab |
| HL relapse | ICI --> (HDT/ASCR) +/- radiation |
| NHL treatment | RCHOP is the backbone |
| NHL 2nd line/refractory | CAR-T cell Candidate: axicabtagene or lisocabtagene + bridge therapy Ineligible: epcortamab or glofitamab Transplant Candidate: rituximab Ineligible: CAR-T cell |
| MM transplant candidate | Daratumumab/isatuximab (monoclonal aby) + Bortezomib/carfilzomib (proteasome inhibitor) + Lenalidomide (immunomodulator) + Dexamethasone (steroid) Followed by high dose chemo w/ autologous HCT |
| MM transplant ineligible | Lenalidomide + dexamethasone |
| MM Maintenance | Lenalidomide or Proteasome inhibitor/monoclonal aby + lenalidomide |
Created by:
hmariner1
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