| Mutations and Genetics | Gimme Those Drugs | Boards Love This! | So Now What? | Miscellaneous |
|---|---|---|---|---|
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MEN 2A (thyroid cancer, pheochromocytoma, parathyroid hyperplasia/adenomas)
MEN 2B (thyroid cancer, pheochromocytoma, multiple mucosal neuromas and intestinal ganglioneuromas)
What hereditary syndromes are associated with medullary thyroid carcinoma?
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Cisplatin + RT followed by cisplatin/5FU
What is the treatment for stage 2 nasopharyngeal carcinoma?
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Oropharyngeal carcinoma
What H&N cancer is HPV prognostic for?
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IHC for PDL1
In newly diagnosed metastatic head and neck cancers, what is the next test to perform to select first line therapy?
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Zhang et. al. (2019)
Name the trial that showed stage III-IVA nasopharyngeal carcinoma treatment with cis/gem followed by cis-RT?
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EGFR
What is a common receptor that is overexpressed in head and neck SCC?
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5FU/cisplatin/pembro followed by pembro maintenance
What is the treatment for metastatic oropharyngeal carcinoma?
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EBV
What is the virus associated with nasopharyngeal carcinoma?
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Biopsy lung mass
- Confirm laryngeal carcinoma vs NSCLC since there is a high rate of synchronous primary presentation.
Patient with known locally advanced laryngeal carcinoma with new lung masses are found on imaging. What to do next?
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KEYNOTE 048
- pembro + chemo had the best outcomes
Name the study comparing pembro vs pembro + chemo vs cetuximab + chemo in metastatic H&N cancer patients with PDL1 CPS >=1%.
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Fanconi anemia
What is a genetic condition associated with short-stature, skeletal defects, a family h/o of AML and early onset H&N SCC?
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dabrafenib and trametinib
What is the first line treatment for unresectable, BRAF V600E (+) anaplastic thyroid carcinoma?
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1. extracapsular extension
2. positive surgical margins
In RTOG 9501/intergroup phase III trial, name the two high risk features identified on resection in H&N cancers, that would prompt adjuvant chemo + RT.
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Assess tumor for androgen receptor positivity by immunohistochemistry (IHC)
- If AR (+), then can give androgen deprivation therapy with leuprolide and bicalutamide
L parotid mass is discovered and total parotidectomy w/ adjuvant RT is done. Pathology confirms high-grade salivary duct carcinoma with subcarinal adenopathy and lung nodules. What is the next step?
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Poor laryngeal function (aspiration hx, ability to swallow)
What factor affect decision for laryngeal preservation (organ preserving treatment) in laryngeal cancer?
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Diepoxybutane (DEB; 1,3-butadiene diepoxide) analysis
What is the definitive test to look for Fanconi anemia?
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RAI (if avid on RAI scan)
What is the first line treatment for recurrent/metastatic papillary thyroid carcinoma?
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Laryngectomy with bilateral neck dissection
Patient with stage 3 laryngeal SCC underwent resection without adverse features. 6 months later, he develops persistent throat pain and dysphagia. Direct laryngoscopy confirms new 0.5 cm mass which is the only PET avid area. ECOG 0. What is the next step?
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Total thyroidectomy + central neck dissection
- total thyroidectomy d/t >4 cm mass
24 year old woman presents with 5-cm left lobe of the thyroid mass with involved nodes in level VI. FNA reveals well differentiated papillary thyroid cancer. What is the next step?
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Nivolumab monotherapy (Checkmate 141)
What is second line treatment for recurrent and metastatic squamous cell carcinoma of the head and neck, if PDLI CPS is 1% or greater?
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NTRK fusion
What mutation can a subtype of salivary duct carcinoma have?
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TKI (lenvatinib or sorafenib)
What is the second line treatment or treatment for RAI resistant recurrent/metastatic papillary thyroid carcinoma?
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1. Diarrhea
2. Hypertension 3. Palmar-plantar erythrodysesthesia 4. Fatigue
Name 3 adverse effects of sorafenib.
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Cetuximab + doublet chemo
Ex: Cetuximab/docetaxel/carbo followed by cetuximab maintenance
What is the next line of treatment in ECOG 1 patient with recurrent metastatic oropharyngeal cancer, who has progressed through first line?
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Salivary duct carcinoma
There are multiple liver and lung mets and an enlarged subamndibular LN. Pathology from LN bx and liver bx showed comedo-type central necrosis resembling breast ductal carcinoma. No avidity found over breast area on PET. What is the diagnosis?
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