Devita, Hellman, and Rosenberg's Cancer

LWBK1006-38 LWW-Govindan-Review December 12, 2011 20:29

500 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

ANSWERS

Answer 38.1. The answer is B.

Anal cancer in a patient with HIV is considered to be an AIDS-defining

cancer, whereas penile cancer, colon cancer, and anal cancer fall in the

non-AIDS-defining cancer category.

Answer 38.2. The answer is A.

Zidovudine is generally poorly tolerated with chemotherapy because of

myelosuppression. Protease inhibitors are generally well tolerated with

chemotherapy, although they may affect metabolism of many drugs

through effects on cytochrome P450-associated enzymes. Preliminary

results with the most recently approved HIV drugs suggest that the inte-

grase inhibitor raltegravir, coreceptor inhibitor maraviroc, and fusion

inhibitor fuzeon are also well tolerated with chemotherapy.

Answer 38.3. The answer is D.

In patients with favorable-risk KS (confined to skin or lymph nodes, CD4

count>200, no B symptoms or opportunistic infections, and good per-

formance status) who are treatment-na ̈ıve, response rates of up to 80%

have been reported with HAART therapy. However, it is extremely rare

for patients with extensive poor-risk KS (tumor associated edema or ulcer-

ation, extensive oral or gastrointestinal involvement, CD4<200, oppor-

tunistic infections, B symptoms, HIV-related illness, poor PS) to respond

to HAART alone. In addition, worsening of KS may occur with initiation

of HAART, due to an immune reconstitution inflammatory response.

Answer 38.4. The answer is A.

Although the role of rituximab with chemotherapy in non-HIV-infected

patients has been documented, its role in AIDS lymphoma is more con-

troversial. Although several studies have suggested that there is a bene-

fit to the addition of rituximab to CHOP or EPOCH chemotherapy, in

patients with CD4 less than 50 to 100/mm^3 there are reports of excess

neutropenic fevers and infections. Rituximab is usually not beneficial for

treatment of plasmablastic lymphomas and primary effusion lymphomas,

because CD20 is usually not expressed on the malignant cells.

Answer 38.5. The answer is A.

CSF EBV PCR is a rather sensitive (∼80%) and highly specific test (>95%)

for diagnosis of primary CNS lymphoma, and together with a consistent

radiological picture, brain biopsy may not be required to establish the

diagnosis. In patients with low CD4 counts or poor performance status,

cranial radiotherapy is the treatment of choice for primary CNS lym-

phoma, because opportunistic infections cause much greater morbidity

and mortality than recurrent lymphoma. In contrast, for patients with

higher CD4 counts and good performance status, high-dose systemic