Germ Cell Tumors

D is for Diagnosis

100

This is the most common presenting symptom in testicular cancer.

What is a testicular mass?

200

This lab result is only elevated in non-seminoma germ cell tumors and its elevation can indicate a poor prognostic indicator

What is AFP (alpha feto-protein)?

300

These are factors in non-seminoma germ cell cancer considered to be poor risk indicators.

What are multiple metastatic sites (liver, bone CNS, viceral mets), significant elevations in LDH, AFP, and/or b-HCG?

400

This is the surgical procedure used for the treatment of the primary tumor in germ cell testicular cancer?

What is an orchiectomy (removal of testis)?

500

As a pharmacist counseling a patient with a new diagnosis of testicular cancer, what is an important issue to address in regards to survivorship?

What is the issue of fertility? Or, What is the issue of secondary malignancies?

Chemo Schemo

100

This chemo regimen can be given for 3-4 cycles as initial therapy for germ cell tumors (number of cycles based on prognostic risk factors)

What is BEP regimen, bleomycin, etoposide, and cisplatin?

200

This chemo regimen is usually given in the recurrent disease setting and involves a 24 hour taxane infusion

What is TIP, paclitaxel, ifosfamide with mesna, and cisplatin?

300

If you had a patient with concerns about lung toxicity, this is the regimen you could subsitutue for first line therapy.

What is either EP for 4 cycles if good risk OR VIP if poor risk (etoposide, ifosfamide, cisplatin)

400

This regimen is usually given in the second or third line setting, after failure of an etoposide containing regimen.

What is VeIP, vinblastine, ifosfamide, cisplatin?

500

These are examples of late toxicites associated with chemotherapy for germ cell tumors

What are: cardiovascular disease and metabolic syndrome (hypercholesterolemia, hypertension and diabetes), hypogonadism, persisting neurotoxicity, Raynaud’s syndrome and ototoxicity?

Keep on Transplanting

100

This is the optimal number of autologous transplants a patients with relapsed/refractory germ cell tumors should receive.

What is 2-3?

200

This is considered to be the backbone conditioning regimen for germ cell tumors.

What is Carboplatin and Etoposide?

300

While not commonly used at our center post autologous stem cell transplant, this supportive care medication is commonly used in Germ Cell Tumor patients to reduce toxicity.

What is granulocyte colony-stimulating factor?

400

Retrospective studies suggest that utilizing autologous stem cell transplant in this line of therapy results in better outcomes for patients with relapsed/refractory Germ Cell Tumors.

What is second line therapy (first salvage)?

500

These are considered to be poor prognostic factors in Germ Cell Tumor patients undergoing autologous stem cell transplantation.

What are: 1)Primary tumor site in the mediastinum? 2) Progressive disease to initial therapy? 3) <3 month profression free interval after first line therapy? 4) HCG >1000 prior to salvage therapy? 5) AFP >1000 prior to salvage therapy? 6) Liver, bone or brain metastasis prior to salvage therapy?

Drugs

100

These tests should be ordered before starting BEP chemotherapy regimen

What are pulmonary function tests (for the bleo), CBC and CMP for the cisplatin and etoposide?

200

This is the main side effect you would watch for in a patient receiving the 24 paclitaxel infusion in TIP.

What is myelosuppression? Many patients require growth factor support with this regimen in the second line setting

300

Your patient reports he is a Jehovah's witness and will not accept any blood prodcuts. Out of these regimens, BEP, VIP, or TIP, this regimen would be preferred in the initial treatment of his disease.

What is the BEP regimen because it has the least amount of hematologic toxicity and is often not given with growth factor, unlike the other 2 regimens.

400

This class of chemotherapy should not be combined with Carboplatin and Etoposide in conditioning regimens for Germ Cell Tumors.

What is oxazophosphorines (ie. cyclophosphamide and ifosfamide)?

500

These medications are given prior to paclitaxel used in conditioning chemotherapy according to FHCRC 2190 (TEC - TIC)

What are: 1. Dexamethasone 20mg 12H, 6H and 30min pre paclitaxel 2. Diphenhdyramine 50mg 30 min pre paclitaxel 3. Ranitidine 50mg IV pre paclitaxel

Fun Facts

100

Germ cell tumors are most commonly diagnosed in these two organs (hint: 1 male and 1 female)

What are the testes and ovaries? (testicular germ cell cancer and ovarian germ cell cancer) Ovarian germ cell is treated the same as testicular germ cell tumors, although ovarian is a much rarer diagnosis.

200

This is the dosing of the BEP regimen

What is bleomycin 30 units days 1, 8, 15, cisplatin 20 mg/m2 days 1-5 or 50 mg/m2 days 1-2 and etoposide 100 mg/m2 days 1-5 or 165 mg/m2 days 1-3

300

While used in FHCRC 2190, this supportive care medication is NOT recommended in FHCRC 2328 as it may exacerbate this complication it is intended to treat.

What is palifermin?

400

This transplant center pioneered the use of autologous stem cell transplant in the treatment of Germ Cell Tumors.

What is Indiana University?

500

The conditioning regimens used in FHCRC 2190 (TEC - TIC) are based on results published from this outside cancer center.

What is City of Hope?