ABIM Med Oncology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Adjuvant capecitabine in TNBC

For triple-negative breast cancer with residual invasive disease after neoadjuvant chemotherapy, adjuvant capecitabine improves survival compared with observation alone, especially in patients who did not achieve pathologic complete response.

Adjuvant T-DM1

In HER2-positive early breast cancer with residual invasive disease after neoadjuvant trastuzumab plus taxane, adjuvant ado-trastuzumab emtansine improves invasive disease-free survival compared with trastuzumab alone.

CDK4/6 inhibitor role

In hormone receptor-positive, HER2-negative metastatic breast cancer, adding a CDK4/6 inhibitor to endocrine therapy improves progression-free and overall survival compared with endocrine therapy alone.

Adjuvant osimertinib

For completely resected EGFR-mutant non-small cell lung cancer with exon 19 deletion or L858R, adjuvant osimertinib for three years improves disease-free survival and is standard for eligible patients.

PD-L1 TPS 50% rule

In metastatic non-small cell lung cancer without a targetable driver alteration, a PD-L1 tumor proportion score of 50% or greater permits first-line single-agent pembrolizumab rather than chemotherapy plus immunotherapy.

Limited-stage SCLC therapy

Limited-stage small cell lung cancer is treated with concurrent platinum-etoposide chemotherapy and thoracic radiotherapy, with radiotherapy started early in the course; prophylactic cranial irradiation may follow.

MSI-high colorectal cancer

Mismatch repair-deficient or microsatellite instability-high metastatic colorectal cancer responds to first-line immune checkpoint inhibitors such as pembrolizumab, and immunotherapy is preferred over chemotherapy in this setting.

RAS and anti-EGFR therapy

Anti-EGFR antibodies such as cetuximab and panitumumab are ineffective in metastatic colorectal cancer harboring RAS or BRAF V600E mutations, so these alterations must be tested before use.

HER2 testing in gastric cancer

Gastric and gastroesophageal junction adenocarcinomas require HER2 testing; HER2-positive advanced disease receives trastuzumab added to platinum and fluoropyrimidine chemotherapy.

Prostate cancer castration-sensitive therapy

Metastatic castration-sensitive prostate cancer is treated with androgen deprivation therapy combined with docetaxel, abiraterone, enzalutamide, or apalutamide, each of which improves overall survival.

PSMA radioligand therapy

Lutetium-177 PSMA-617 is indicated for PSMA-positive metastatic castration-resistant prostate cancer after prior androgen receptor pathway inhibition and taxane chemotherapy, improving overall survival.

Maintenance avelumab in urothelial cancer

After first-line platinum-based chemotherapy for advanced urothelial carcinoma without progression, maintenance avelumab improves overall survival and is standard of care.

HRD and PARP maintenance

In high-grade serous ovarian cancer, homologous recombination deficiency or BRCA mutation predicts greater benefit from maintenance PARP inhibitor therapy after response to platinum-based chemotherapy.

Endometrial molecular classification

Endometrial carcinoma is classified into POLE ultramutated, mismatch repair-deficient, p53-abnormal, and no specific molecular profile groups, which differ in prognosis and adjuvant treatment selection.

Low-risk GTN treatment

Gestational trophoblastic neoplasia with a low WHO risk score is treated with single-agent methotrexate or actinomycin D, while high-risk disease receives multiagent EMA-CO chemotherapy.

APL targeted therapy

Acute promyelocytic leukemia carries the PML-RARA fusion and is treated with all-trans retinoic acid plus arsenic trioxide, with attention to differentiation syndrome and coagulopathy.

Myeloma defining events

Multiple myeloma diagnosis requires clonal plasma cells plus CRAB features or SLiM criteria, including 60% or greater marrow plasma cells, involved-to-uninvolved free light chain ratio of 100 or more, or one or more MRI lesions.

CLL high-risk marker

Deletion 17p and TP53 mutation predict poor response to chemoimmunotherapy in chronic lymphocytic leukemia, so targeted agents such as BTK or BCL2 inhibitors are preferred.

Two-hit hypothesis

Inherited cancer syndromes from tumor suppressor genes require inactivation of both alleles; a germline mutation is the first hit and a somatic event is the second, explaining early onset and bilateral disease.

Synthetic lethality with BRCA

BRCA1 or BRCA2 loss impairs homologous recombination repair, so PARP inhibitor blockade of base excision repair causes accumulated DNA damage and selective death of tumor cells.

Lynch syndrome testing

Lynch syndrome results from germline mismatch repair gene mutations; tumors show microsatellite instability-high and loss of MLH1, MSH2, MSH6, or PMS2 on immunohistochemistry, prompting germline confirmation.

HER2 IHC scoring

HER2 is scored by immunohistochemistry as 0, 1+, 2+, or 3+; 3+ is positive, 0 and 1+ are negative, and 2+ requires in situ hybridization to determine amplification.

Core needle biopsy advantage

Core needle biopsy preserves tissue architecture and provides sufficient material for histologic grading, immunohistochemistry, and molecular testing, unlike fine-needle aspiration cytology.

Tumor grading versus staging

Grading describes microscopic differentiation and proliferative activity of tumor cells, whereas staging describes anatomic extent by tumor size, nodal involvement, and distant metastasis.

Febrile neutropenia definition

Febrile neutropenia is an absolute neutrophil count below 500 per microliter with a single temperature of 38.3 C or higher, or 38.0 C sustained over one hour.

Tumor lysis syndrome

Tumor lysis syndrome produces hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia from rapid cell breakdown; prevention uses hydration with allopurinol or rasburicase.

Immune-related colitis management

Checkpoint inhibitor colitis with grade 3 or higher severity requires holding immunotherapy and high-dose corticosteroids, with infliximab or vedolizumab for steroid-refractory cases.

Intrathecal vincristine hazard

Vincristine must never be administered intrathecally because it causes fatal ascending paralysis and encephalopathy; only preservative-free formulations intended for intrathecal use may be given by that route.

G-CSF prophylaxis threshold

Primary granulocyte colony-stimulating factor prophylaxis is recommended when a chemotherapy regimen carries a febrile neutropenia risk of approximately 20% or greater.

Fertility preservation timing

Fertility preservation counseling should occur before starting gonadotoxic therapy; options include sperm banking, oocyte or embryo cryopreservation, and ovarian suppression depending on patient sex and urgency.

Hospice eligibility

Hospice enrollment generally requires a prognosis of six months or less if the disease follows its expected course, plus a focus on comfort rather than disease-directed therapy.

Informed consent elements

Valid informed consent requires patient capacity, disclosure of the diagnosis, proposed treatment, material risks, benefits, and alternatives, and voluntary agreement without coercion.