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EXAM 4 TREATMENT
| CANCER | TREATMENT | NOTES |
|---|---|---|
| early stage hodgkins disease with FAVORABLE prognosis | 2 cycles of radiation and chemo (UNFAVORABLE 4-6 cycles) Chemo: Doxorubicin (adriamycin), Bleomycin,, Vinblastine, Dacarbazine (ABVD) | radiation can cause secondary cancer after initial cycles, pet scan and repeat treatment (AVBD+/- B) if UNFAVORABLE prognosis: do BrECADDx2 cycles + GCSF (Brentuximab, Etoposide, Cyclophos, Doxo(Adriamycin), Dacarbazine, Dexamethasone + CGSF) |
| advanced (in organs or top and bottom of diaphragm) stage III-IV HD therapy age 18-60 | Initial treatment: Nivo + AVD (Doxo, vincristine, dacarbazine) OR BrECADD + G-CSF 4-6 cycles | if over 60 years old send them to a clinical trial OR nivolumab-AVD radiation not useful in advanced setting |
| Indolent (follicular) lymphoma therapy | Early stage: radiation only Advanced stage (not curable): waitful waiting then chemos CHOP + CD20 (obinutuzumab or rituxumab) Bendamustine + CD20 CVP + CD20 Lenalidomide + rituximab (R2) Or rituximab alone if low tumor burden or unfit) | after initial therapy continue chosen CD20 as maintenance therapy |
| Aggressive Lymphoma (B-cell lymphoma) - rit works on b cells - do not use obi in aggressive lymphomas | Early stage: R-CHOP (Rituxumab + CHOP) OR Pola-R-CHP AND radiation Advanced stage: R-CHOP (Rituxumab + CHOP) OR Pola-R-CHP and NO radiation | CHOP = Cyclophosphamide, doxorubicin (hydrocxyrubicin), Vincristine (oncovin), Prednisone Pola = Polatuzumab-Rit-CHP (no vincristine) os apparently better unless they have peripheral neuropathy |
| ALL Induction 4-6 weeks | Induction: PART A -21-28 days = HyperCVAD (high dose Cyclophosphamide and mensa, vincristine, doxo/adria, dexamethasone) | Induction after part A, PART B: High dose MTX (use IV leucovorin as rescue) AND Ara-c (cytarabine) CNS prophylaxis it intrathecal cytarabine and MTX are given constantly |
| ALL Consolidation 20-30 weeks | Same as induction + L-asparaginase + Blinatumomab | Still on It meds MTX and cytarabine |
| ALL Maintenance 2+ years | POMP (purinethol (6-mercaptopurine), oncovin (vincristine), mehtothrexate, prednisone | For recurrent pts consider re-induction or clinical trial |
| AML Induction | 7 + 3 and if FLT3 add midostaurin on days 8-21 7 dyas cytarabine (ara-c) 3 days ida or dona rubacin | on day 14 marrow shows no cells do post remission and if shows leukemia repeat 7+3 |
| AML Consolidation (post remission) | HiDAC (high dose ara-C +/- gemtuzumab (if CD33 mutation) (higher dose than induction | Neurotoxicity is the main concern for HiDAC |
| AML Maintenance | If received allotransplant no maintenance if no FLT3 mutation, if they do have it give midostaurin if no transplant give azacitadine | |
| AML - Low Intensity Induction | 5-azacitidine + venetoclax (may take 4-6 cycles to see benefit) | |
| Polyps prevention for pts with FAP CRC | ASA, NSAIDs, Coxibs | |
| Colorectal cancer stage I and II | Surgery only (but everyone gets surgery) | Consider 5FU/leucovorin OR capecitabine (or FOLFOX or CAPEOX in high risk groups) in stage 2 |
| Stage III (lymph node positive) CRC Early Stage Curable | pMMR/MSS = FOLFOX or CAPEOX 6 months dMMR/MSI-H = FOLFOX or CAPEOX + atezolizumab for 6 months then atezolizumab alone to complete 12 months | add aspirin in stage 2-3 if PIK3CA mutation FOLFOX = folinic acid (leucovorin), flurorouracil (5-fu), oxaliplatin CAPEOX = capecitabine, oxaliplatin |
| Preoperative chemo for CRC w possible resectable mets (non-metastatic) | pMMR/MSS = FOLFOX or CAPEOX 6 months dMMR/MSI-H = nivo +/- ipilimumab or pembrolizumab or dostarlimab (also options for 1st line metastatic) | reassess every 2 months for resection if on dMMR treatment and still cancer progression switch to pMMR algorithm |
| Metastatic CC pMMR/MSS Intensive 1st line | FOLFOX, CAPEOX or FOLFIRI +/- bevacizumab KRAS/NRAS/BRAF WT and left sided tumors only = FOLFOX, CAPEOX or FOLFIRI + cetuximab or panitumumab BRAFS V600E mutation + = encorafenib + cetuximab or panitumumab + FOLFOX | bevacizumab is NOT used in non-metastatic, and do not use within 4 week window pre/post major surgery due to would healing |
| Metastatic CC pMMR/MSS NOT INTENSIVE 1st line | FOLF +/- bevacizumab KRAS/NRAS/BRAF WT and left sided tumors only = cetuximab or panitumumab HER2-amplified and RAS and BRAF WT = trastuzumab + pretuzumab/lapatinib/tucatinib | |
| Limited Stage SCLC | Surgery + Chemo + XRT (4 cycles of chemo) First line: RT + Chemo (cisplatin + etoposide) 4 cycles Consolidation for Limited SCLC: durvalumab q28d | use carboplatin instead of cisplatin if pts has renal failure |
| Extensive stage SCLC | NO surgery or radiation (rad if small area target) Chemo only: Carbop;atin + etoposide + atezolizumab or durvalumab carboplatin AUC dose calculation = AUC x (CrCl + 25) | can add lurbinectedin to atezolizumab regimen if they are fit and willing |
| Recurrent SCLC | comes back in 6 months or less = tarlatamab more than 6 month give original treatment | a clinical trial is preferred |
| Neoadjuvant (before surgery)treatment for resectable NSCLC | checkpoint inhibitor (nivolumab, pembrolizumab, burvalumab) + platinu-doublet therapy (cisplatin + gemcitabine(squamous), paclitaxel (any) or pemetrexed (nonsquamous) ) | |
| Adjuvant (after surgery)treatment for resectable NSCLC | if not given neoadjuvant give platinum-doublet, then give ALK (alectinib), EGFR exon 19/21 L848R (osimertinib), PDL over 1% without EGFR/ALK (atezolizumab), or continure neoadjuvant checkpoiint inhibitor if no biomarkers | |
| Unresectable lung cancer (stage IIIB) | Chemoradiation: cis/carbo + pemetrexed, paclitaxel + carboplatin, cisplatiun + etoposide and then consolidation: osimertinib, durvalumab | |
| Advanced or metastatic NSCLC UNFIT - treat based on biomarker | ALK (alectinib, brigatinib, lorlatinib, ensartinib), ROS1 (entrectinib, crizotinib, repotrectinib), EGFR (osimertinib, afatinib), BRAF (dabrafenib + trametinib, encorafenib + binimetinib), PDL1 (pembrolizumab, atezolizumab), no mutation + supportive care | can use chemo or FIT pts with no mutations unlike UNFIT |
| FIT metastatic NSCLC with no mutations | Prembrolizumab/cemipilimab + carboplatin + pemetrexed (non)/paclitaxel (squamous) | basically the neoadjuvant treatment |
| CLL (chromic lymphocytic leukemia) | Venetoclax + obinutuzumab +/- acalabrutinib, or zanubrutinib, or acalabrutinib +/- obinunutuzumab | |
| CML (chronic myelogenous leukemia) | Low risk sokal score bekow 0.8: imatinib, dasatinib, nilotinib, bosutinib, asciminib (BCR-ABLs) sokal 0.8 or more: dasatinib, nilotinib, bosutinib, asciminib. (no imatinib in higher risk sokal) T315l mut: panatinib (preferred), asciminib | no anemia or thrombocytopenia like CLL asciminib targets T315l mut in CML imatinib only used in low risk sokal |
| Prevention of prostate cancer | Best treatment is dutasteride + tamoxifen, better than 5a- inhibitor on its own | no vit E by itself, decrease risk but dont get rid of it |
| Localized Curable PC | Surgery OR radiation + ADT, consider abiraterone and prednisone for high risk pts ADT: GnRH agonists (leuprolide, gosereslin) +/- antiandrogen (bicalutamide, flutamide, nilutamide) if flare OR GnRH antag ( degarelix/relugolix) | ADT at gleason 4+3 or more, PSA 10-20 give abiraterone and predisone as well is there is regional spread (node positive) |
| Nonmetastatic castration resistant (testesterone levels rise over 50 in 10 months or less) PC | Continue ADT therapy and add either: apalutamide, darolutamide or enzalutamide | |
| Metastatic castration sensitive PC | Continue ADT and add: docetaxel (with prednisone) + darolutamide or abiraterone, or apalutamide or darolutamide or enzalutamide | |
| Metastatic castration resistant PC | NO BRCA mutation: pick 1 - docetaxel, abiraterone, rad223, enzalutamide BRCA + or HHRm: Niraparib or olaparib + abiraterone OR talazoparib + enzalutamide MSI-High: pembrolizumab | treat bone mets with zoledronic acid (every 12 weeks) or denosumab |
Created by:
beezy41