ABIM Med Oncology cheat sheet

Hormone receptor-positive, HER2-negative early breast cancer: adjuvant endocrine therapy for 5-10 years; premenopausal women may receive ovarian suppression plus aromatase inhibitor or tamoxifen.

Triple-negative early breast cancer with residual disease after neoadjuvant chemotherapy: adjuvant capecitabine (CREATE-X) or olaparib if germline BRCA1/2 mutated (OlympiA).

HER2-positive early breast cancer: neoadjuvant pertuzumab plus trastuzumab plus taxane; residual disease at surgery warrants adjuvant T-DM1 (KATHERINE).

Metastatic HR-positive, HER2-negative disease: first-line CDK4/6 inhibitor plus endocrine therapy; ESR1 mutation supports fulvestrant-based regimens; PIK3CA mutation supports alpelisib with fulvestrant.

HER2-low metastatic disease (IHC 1+ or 2+/ISH-negative) is eligible for trastuzumab deruxtecan after prior chemotherapy.

Germline BRCA-mutated metastatic breast cancer: PARP inhibitors olaparib or talazoparib are active alternatives to chemotherapy.

Inflammatory breast cancer is a clinical diagnosis (erythema, edema, peau d'orange over one-third or more of the breast) and is treated with neoadjuvant systemic therapy followed by mastectomy and radiation.

Sentinel lymph node biopsy is standard for clinically node-negative axilla; axillary dissection is reserved for clinically positive nodes or failed mapping.

Resectable NSCLC stage IB-IIIA: adjuvant platinum doublet for tumors 4 cm or larger or node-positive disease; adjuvant osimertinib for EGFR exon 19 deletion or L858R after complete resection.

Advanced NSCLC with sensitizing EGFR mutation: osimertinib first line; ALK rearrangement: alectinib, brigatinib, or lorlatinib; ROS1: entrectinib or crizotinib.

Metastatic NSCLC without driver alteration: PD-L1 TPS 50% or greater permits single-agent pembrolizumab; otherwise platinum doublet plus checkpoint inhibitor.

Small cell lung cancer limited stage: concurrent platinum-etoposide with thoracic radiotherapy started early; extensive stage: platinum-etoposide plus atezolizumab or durvalumab.

Malignant pleural mesothelioma: platinum plus pemetrexed with bevacizumab or ipilimumab-nivolumab for unresectable disease.

Locally advanced head and neck squamous cell carcinoma: concurrent cisplatin with radiation; pembrolizumab with chemotherapy for recurrent or metastatic disease.

Nasopharyngeal carcinoma is associated with EBV; HPV-positive oropharyngeal cancer has better prognosis and is staged separately.

Thymic tumors: thymoma and thymic carcinoma are staged surgically; platinum-based chemotherapy is used for unresectable or metastatic disease.

Metastatic colorectal cancer molecular testing: RAS and BRAF for anti-EGFR eligibility; MSI-high or dMMR tumors respond to pembrolizumab or nivolumab; HER2 amplification supports trastuzumab-based therapy.

Colorectal cancer first line: FOLFOX or FOLFIRI plus bevacizumab, or anti-EGFR antibody if RAS/BRAF wild type and left-sided primary.

Gastric and gastroesophageal junction adenocarcinoma: HER2 testing required; trastuzumab added to platinum-fluoropyrimidine for HER2-positive; nivolumab added for advanced disease.

Hepatocellular carcinoma: sorafenib, lenvatinib, or atezolizumab-bevacizumab for advanced disease; AFP, imaging criteria, and Child-Pugh class guide treatment.

Pancreatic adenocarcinoma: FOLFIRINOX or gemcitabine-nab-paclitaxel for metastatic disease; germline BRCA mutation supports platinum-based therapy and maintenance olaparib.

Esophageal and GEJ cancer: neoadjuvant chemoradiation followed by surgery for locally advanced disease; pembrolizumab with chemotherapy for HER2-negative advanced adenocarcinoma.

Anal squamous cell carcinoma: chemoradiation with mitomycin and fluorouracil is definitive therapy; salvage abdominoperineal resection for persistent or recurrent disease.

Cholangiocarcinoma: gemcitabine-cisplatin plus durvalumab or pembrolizumab first line; IDH1 mutation supports ivosidenib; FGFR2 fusion supports pemigatinib.

Metastatic castration-sensitive prostate cancer: androgen deprivation therapy plus docetaxel, abiraterone, enzalutamide, or apalutamide improves survival.

Metastatic castration-resistant prostate cancer: next-generation androgen receptor inhibitor; PARP inhibitor if HRR gene mutation; lutetium-177 PSMA-617 after prior taxane and AR pathway inhibitor.

Germline and somatic HRR gene testing is recommended for metastatic prostate cancer; BRCA2 alterations carry the strongest PARP inhibitor signal.

Muscle-invasive bladder cancer: neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy; bladder preservation with chemoradiation is an alternative.

Metastatic urothelial carcinoma: platinum-based chemotherapy, then maintenance avelumab for disease without progression; enfortumab vedotin and erdafitinib (FGFR alteration) are later options.

Renal cell carcinoma: clear cell histology treated with ipilimumab-nivolumab or VEGF inhibitor plus checkpoint inhibitor; cytoreductive nephrectomy selected for good-performance patients.

Testicular germ cell tumors: platinum-based regimens (BEP) are curative in most cases; tumor markers AFP, hCG, and LDH guide staging and response.

Upper tract urothelial carcinoma is associated with Lynch syndrome and aristolochic acid exposure; adjuvant nivolumab is used for high-risk resected disease.

High-grade serous ovarian cancer: germline and somatic BRCA/HRD testing; maintenance PARP inhibitor after platinum response, with greatest benefit in BRCA-mutated or HRD-positive disease.

Ovarian cancer first-line: cytoreductive surgery plus platinum-taxane chemotherapy; bevacizumab added for high-risk disease.

Endometrial cancer: molecular classification (POLE ultramutated, MSI-high/dMMR, p53 abnormal, no specific molecular profile) guides prognosis and adjuvant therapy.

Recurrent or advanced endometrial cancer: carboplatin-paclitaxel plus pembrolizumab for dMMR tumors; lenvatinib plus pembrolizumab for mismatch repair-proficient disease.

Cervical cancer: concurrent cisplatin with radiation for locally advanced disease; pembrolizumab added to platinum-paclitaxel-bevacizumab for PD-L1-positive recurrent disease.

Melanoma: BRAF V600 mutation testing guides BRAF/MEK inhibitor therapy; checkpoint inhibitor combinations are used for BRAF wild-type or high-risk disease.

Soft tissue sarcoma: doxorubicin-based regimens are first line for advanced disease; imatinib is standard for KIT-positive gastrointestinal stromal tumor.

Gestational trophoblastic neoplasia is staged by WHO score; low-risk disease treated with single-agent methotrexate or actinomycin D, high-risk with EMA-CO.

Acute myeloid leukemia: cytogenetics and molecular testing (FLT3, NPM1, IDH1/2, CEBPA) determine risk and targeted therapy; 7+3 induction with cytarabine consolidation.

Acute promyelocytic leukemia: PML-RARA; treat with all-trans retinoic acid plus arsenic trioxide; watch for differentiation syndrome and coagulopathy.

Chronic myeloid leukemia: BCR-ABL1 by PCR; tyrosine kinase inhibitors (imatinib, dasatinib, nilotinib) with BCR-ABL1 transcript monitoring for response.

Diffuse large B-cell lymphoma: R-CHOP for six cycles; limited-stage disease may receive abbreviated chemotherapy plus radiation.

Hodgkin lymphoma: ABVD first line; brentuximab vedotin and checkpoint inhibitors for relapsed disease; PET-directed therapy guides escalation or de-escalation.

Multiple myeloma: CRAB criteria plus SLiM features define disease; quadruplet induction with proteasome inhibitor, IMiD, anti-CD38 antibody, and dexamethasone.

Chronic lymphocytic leukemia: del(17p) and TP53 mutation predict poor response to chemoimmunotherapy; BTK and BCL2 inhibitors are preferred.

Myeloproliferative neoplasms: JAK2 V617F, CALR, and MPL mutations define essential thrombocythemia and myelofibrosis; ruxolitinib for symptomatic splenomegaly.

Tumor suppressor genes (TP53, RB1, APC, BRCA1/2) typically require biallelic loss; oncogenes (KRAS, MYC, EGFR) are activated by gain-of-function alterations.

Two-hit hypothesis: hereditary retinoblastoma requires germline plus somatic RB1 inactivation; bilateral disease presents earlier than unilateral.

Lynch syndrome: germline mismatch repair gene mutation; tumors show MSI-high and loss of MLH1, MSH2, MSH6, or PMS2 by immunohistochemistry.

BRCA1/2 function in homologous recombination repair; loss confers sensitivity to PARP inhibitors through synthetic lethality.

Tumor mutational burden, MSI status, and PD-L1 expression are predictive biomarkers for immune checkpoint inhibitor response.

Liquid biopsy detects circulating tumor DNA for genotyping, minimal residual disease, and resistance monitoring when tissue is insufficient.

Pharmacogenomics: TPMT and NUDT15 variants predict thiopurine toxicity; DPYD variants predict fluoropyrimidine toxicity; UGT1A1 variants predict irinotecan toxicity.

Cancer predisposition syndromes: Li-Fraumeni (TP53), familial adenomatous polyposis (APC), von Hippel-Lindau (VHL), MEN1, and hereditary diffuse gastric cancer (CDH1).

TNM staging defines extent by tumor size/invasion (T), nodes (N), and metastases (M); stage grouping determines prognosis and therapy.

Immunohistochemistry panels establish lineage: cytokeratin for carcinoma, CD45 for lymphoma, S100/SOX10 for melanoma, desmin for sarcoma.

Breast biomarker panel: ER, PR, HER2 by IHC with ISH for equivocal 2+ results; Ki-67 informs proliferation but is not a stand-alone decision tool.

Grading describes differentiation; staging describes anatomic extent; both independently influence prognosis.

Next-generation sequencing panels identify actionable alterations; germline testing requires appropriate consent and genetic counseling.

PET-CT has high sensitivity for metabolically active disease but false positives occur with inflammation and infection.

Fine-needle aspiration provides cytology; core needle biopsy provides architecture and permits biomarker testing.

Frozen section is used for intraoperative margin and node assessment but is less reliable for small or subtle lesions.

Febrile neutropenia: absolute neutrophil count below 500/microL with fever 38.3 C once or 38.0 C sustained; empiric antipseudomonal beta-lactam within 60 minutes.

Antiemetic prophylaxis for highly emetogenic regimens: NK1 receptor antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine.

Vincristine is fatal if given intrathecally; methotrexate requires leucovorin rescue and urine alkalinization at high doses.

Anthracycline cardiotoxicity is dose-related; dexrazoxane is used for cardioprotection; baseline and serial ejection fraction monitoring is standard.

Bleomycin pulmonary toxicity and cisplatin nephrotoxicity, ototoxicity, and neuropathy are cumulative; renal function determines cisplatin eligibility.

Immune-related adverse events from checkpoint inhibitors: colitis, hepatitis, thyroiditis, pneumonitis; grade 3-4 events require holding therapy and corticosteroids.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; prevention with hydration and allopurinol or rasburicase.

G-CSF primary prophylaxis is indicated when febrile neutropenia risk is 20% or greater; dose-dense regimens routinely require it.

Survivorship care plans address surveillance schedules, late effects, health promotion, and coordination between oncology and primary care.

Chemotherapy-induced peripheral neuropathy is cumulative and dose-limiting; duloxetine is used for painful neuropathy.

Cancer-related fatigue: screen and treat reversible causes (anemia, thyroid, depression, sleep); exercise and psychosocial interventions have the strongest evidence.

Bone health: aromatase inhibitors and androgen deprivation therapy accelerate bone loss; DXA monitoring and calcium/vitamin D supplementation are recommended.

Fertility preservation should be discussed before gonadotoxic therapy; options include sperm banking, oocyte or embryo cryopreservation, and ovarian suppression.

Palliative care improves quality of life and can be delivered alongside disease-directed therapy; hospice eligibility generally requires prognosis of 6 months or less.

Opioid prescribing requires assessment of risk, bowel regimen for constipation, and naloxone education; opioid rotation addresses tolerance and toxicity.

Informed consent requires capacity, disclosure of risks and alternatives, and voluntariness; advance directives and health care proxies guide care when capacity is lost.