Selection of Therapy – Select the best option

18. An 80-year-old man with borderline resectable pancreatic adenocarcinoma presents to your clinic. Per discussions with the surgeon, the tumor could become resectable if there was some shrinkage using pre- operative therapy. He has diabetes, stable CAD, and mild renal insufficiency, all of which are under good control through his internist. Which of the following therapies would you recommend?

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    1. I do not see this type of patient
    2. Full dose folfirinox
    3. Gemcitabine and abraxane
    4. Gemcitabine alone
    5. Capecitabine alone
    6. Gemcitabine and capecitabine

19. A 90-year-old male underwent resection of a stage IIIC colon cancer. He has excellent performance status and no major comorbidities. His creatinine clearance is 30. He lives independently and takes care of his own activities of daily living. He is afraid of falling and breaking his hip because this happened to his wife. Which approach would you take in considering adjuvant therapy?

    1. I do not see this type of patient
    2. Do no adjuvant therapy
    3. Use folfox for 6 months
    4. Use capecitabine for 6 months
    5. Use 5FU leucovorin on a weekly schedule for 6 weeks, followed by a 2-week break for 3 cycles
    6. Use folfiri for 6 months

20. An 82-year-old woman is diagnosed with poor risk AML (complex karyotype), which appears to have arisen out of a prior myelodysplastic syndrome. She has multiple comorbidities and is limited in regards to her activities of daily living. She prefers to undergo some form of chemotherapy as long as she can tolerate it. Which treatment would you offer the patient?

    1. I do not see this type of patient
    2. Full-dose induction therapy with 7 and 3, to be followed by consolidation with intermediate-dose ara-C.
    3. High-dose ara-C
    4. Hypomethylating agent
    5. Best supportive care

21. A 78-year-old woman presents with CLL (without del[17p]) with symptomatic enlarged lymph nodes and anemia due to bone marrow infiltration. She has COPD, which is treated with inhalers but otherwise well compensated. However, she also has atrial fibrillation on warfarin and high doses of metoprolol for rate control. Which treatment would you choose?

    1. I do not see this type of patient
    2. FCR
    3. Rituxumab
    4. Ibrutinib
    5. Obinutuzumab + Chlorambucil

22. An 85-year-old female presents with right-sided and metastatic colon cancer, which is not amenable to resection. Extended ras testing and braf testing show no mutations. She has a performance status of 1, hearing loss, and has had some falls at home in the past 6 months. Which of the following would be a reasonable approach?

    1. Do the CARG test before deciding on therapy
    2. Do the CRASH test before deciding on therapy
    3. Consult NCCN guidelines
    4. Proceed with full dose folfox with Avastin and dose adjust depending on side effects
    5. Proceed with full dose folfiri with panitumumab and adjust depending on side effects

23. A 79-year-old woman smoker with rheumatoid arthritis and chronic obstructive pulmonary disease was recently diagnosed with widely metastatic squamous cell carcinoma of the lung. The patient has an ECOG performance status of 1, an unremarkable CBC, serum creatinine of 0.7, and normal liver function tests. She is seeing you to discuss systemic treatment options. Which of the following factors are most predictive of chemotherapy toxicity?

    1. I do not see this type of patient
    2. Advanced age
    3. Poor hearing
    4. One or more falls in the last 6 months
    5. Requiring help with taking medications

24. You are treating an 85-year-old man with metastatic prostate cancer with a GnRH agonist. His family is concerned that the patient has chronic memory issues and that the treatment could worsen it. He denies that he has any disturbances in attention or awareness. What would you do next?

    1. I do not see this type of patient
    2. Stop GnRH agonist
    3. Conduct the Confusion Assessment Method (CAM) assessment
    4. Conduct the MMSE or Mini-Cog assessment
    5. Review his medications for polypharmacy

25. A 90-year-old man is receiving carboplatin and paclitaxel for metastatic squamous cell carcinoma of the lung. His daughter is concerned that he is on “too many medications”. You begin to review his supportive medications. Which of the following has the least risk of significant negative effects in older adults?

    1. I do not see this type of patient
    2. Lorazepam
    3. Diphenhydramine
    4. Mirtazapine
    5. Amitriptyline

26. An 87-year-old lady with anemia secondary to myelodysplastic syndrome has come to your clinic to receive a blood transfusion. The nursing staff has requested both acetaminophen and diphenhydramine as premedication prior to blood transfusion. The patient has not had any previous transfusion reactions and is going to receive leuko-reduced blood product. Which of the following is not true about febrile non-hemolytic transfusion reactions (FNHTR)?

    1. Leuko-reduced blood products reduce the risk of FNHTR
    2. Acetaminophen and diphenhydramine premedication reduces the risk of FNHTR
    3. Diphenhydramine can cause delirium and urinary retention in older adults