What is a carcinoma?
Cancer that starts in skin or tissues that line or cover internal organs
What is a leukemia?
Cancer of WBCs
What is a lymphoma?
Cancer of lymphatic system
What is a sarcoma?
Cancer of connective tissue
What is multiple myeloma?
Cancer of the bone marrow
At what age and how frequently should women receive screenings for breast cancer?
45-54 years: yearly mammograms
?55 years: mammograms every 2 years (or continue annually)
At what age and how frequently should women receive screenings for cervical cancer?
Age 21-29: Pap smear every 3 years
Age 30-65: Pap smear + HPV test every 5 years
At what age and how often should men and women receive screenings for colon cancer?
? 45 years
-Fecal immunochemical test (FIT) yearly
-Fecal occult blood test (gFOBT) yearly
-Multi-targeted stool DNA test every 3 years
-Colonscopy every 10 years
-Flexible sigmoidoscopy (FSIG) every 5 years
Who should receive screenings for lung cancer?
Adults 55-74 years old should get an annual CT scan of chest if all of the following:
-In good health
-30 pack-year smoking history
-Still smoking or quit within last 15 years
What is neoadjuvant therapy?
Radiation or chemotherapy given BEFORE primary therapy (usually surgery) to shrink tumor
What is adjuvant therapy?
Radiation or chemotherapy given AFTER primary therapy (usually surgery) to eradicate residual disease and decrease recurrence
What is the maximum cumulative lifetime dose for bleomycin and the reason?
400 units; pulmonary toxicity
What is the maximum cumulative lifetime dose for doxorubicin and the reason?
450-550mg/m�; cardiotoxicity
What is the maximum dose per cycle of cisplatin and the reason?
100mg/m�; nephrotoxicity
What is the maximum single dose of vincristine and the reason?
2mg; neruropathy
Which chemotherapy agents are NOT associated with myelosuppression?
-Asparginase
-Bleomycn
-Vincristine
-Most monoclonal antibodies
-Many TKIs
Which chemotherapy agents most-associated with nausea and vomiting?
-Cisplatin
-Cyclophosphamide
-Ifosamide
Which chemotherapy agents are most associated with mucositis?
-Fluorouracil
-Capecitabine
-Irinotecan
-Methotrexate
-Many TKIs
Which chemotherapy agents are most associated with diarrhea?
-Fluorouracil
-Capecitabine
-Irinotecan
-Many TKIs
Which chemotherapy agents are most associated with constipation?
Vincristine
Which chemotherapy agents are most associated with cardiotoxicity?
-Anthracyclines
-HER2 inhibitors (trastuzumab, pertuzumab...)
Which chemotherapy agents are most associated with pulmonary toxicity?
-Bleomycin
-Bulsulfan
-Carmustine
-Lomustine
Which chemotherapy agents are most associated with hepatotoxicity?
-Antiandrogens (bicalutamide, flutamide, nilutamide)
Which chemotherapy agents are most associated with nephrotoxicity?
-Cisplatin
-Methotrexate
Which chemotherapy agents are most associated with hemorrhagic cystitis?
-Ifosfamide (all doses)
-Cyclophosphamide (high doses)
Which chemotherapy agents are most associated with neuropathy?
-Vinca alkaloids (vincristine, vinblastine, vinorelbine)
-Platinums (cisplatin, oxaliplatin)
-Taxanes (paclitaxel, docetaxel, cabazitaxl)
Which chemotherapy agents are most associated with thromboembolism?
-Aromatase inhibitors (anastrozole, letrozole)
-SERMS (tamoxifen)
Which adjunctive medication is given with cisplatin?
Amifostine (Ethyol); to prevent nephrotoxicity
What adjunctive medication is given wth doxorubicin?
-Dexrazoxane (Zinecard, Totect) to prevent cardiomyopathy and treat extravasation
What adjunctive medication is given with fluorouracil?
Leucovorin or levoleucovorin (Fusilev); to enhance efficacy
What adjunctive medication is given with Ifosfamide?
Mesna (Mesnex); to prevent hemorrhagic cystatis
What adjunctive medication is given with irinotecan?
Atropine or Loperamide (to prevent or treat diarrhea)
What adjunctive medication is given with methotrexate?
Leucovorin or levoleucovorin (Fusilev); given after methotrexate to reduce myelosuppression and mucositis.
What medication is an antidote for fluorouracil or capecitabine?
Uridine triacetate (Vistogard)
What medication is an antidote for methotrexate?
Leucovorin/levoleucovorin (Fusilev)
When is the nadir during a cycle of chemotherapy?
7-14 days after chemotherapy
How long does it take for WBC and platelets to recover after chemotherapy?
3-4 weeks post treatment
What is the definition of neutropenia (according to American Society of Clinical Oncology?
ANC <1000 cells/mm�
What is severe neutropenia?
ANC <500 cells/mm�
What is profound neutropenia?
ANC < 100 cells/mm�
How do you calculate ANC?
ANC = WBC * [(%segs + % bands)/100]
What are common side effects with G-CSF?
bone pain
When are G-CSF agents given?
No sooner than 24 hours after chemo.
Filgrastim given daily; Pegfilgrastim given once per chemo cycle
Which antibiotics should be used for empiric coverage of febrile neutropenia?
Antibiotics with good gram-negative coverage, including pseudomonas.
(e.g. Ciprofloxacin, levofloxacin, cefepime, ceftazadime, meropenem, piperacillin/tazobactam)
What are patient-specific risk factors for CINV?
-Female gender
-Age < 50
-Dehydration
-History of motion sickness
-History of nausea/vomiting with prior regimens
What is acute CINV?
Nausea and vomiting within 24 hours after chemo
What is delayed CINV?
Nausea and vomiting 1-7 days after chemo
What is anticipatory CINV?
Nausea and vomiting before chemo
Which medications help with acute CINV?
5HT3 receptor antagonists (e.g. ondansetron, granisetron, dolasetron)
Which medications help with delayed CINV?
NK1 receptor antagonists (e.g. aprepitant, fosaprepitant), corticosteroids (dexamethasone), palonosetron (the only 5HT3 receptor antagonist with a labeled indication for delayed emesis)
Which medications help with anticipatory CINV?
Benzodiazepines (lorazepam)
What medication regimens are recommended for chemotherapy regimens with high emetic risk?
1. NK1-RA + 5HT3-RA + Dexamethasone
2. Nutepitant/palonosetron + Dexamethasone
3. Olanzepine + Palonosetron + Dexamethasone
Which medications can be considered for breakthrough CINV?
-5HT3-RAs
-Dopamine Receptor Antagonists
-Cannabinoids
Which antiemetic comes in a patch?
Granisetron (Sancuso)
Which 5HT-3-RA has the highest risk of QT prolongation?
Dolasetron IV (DO NOT USE)
What are important safety considerations and side effects with 5HT-3 receptor antagonists?
-QT prolongation (dose dependent; highest risk with dolasetron IV)
-Serotonin syndrome when used in combination with other serotonergic drugs
-Common side effects: headache, constipation
What are important safety considerations and side effects with dopamine receptor antagonists?
-Can decrease seizure threshold
-QT prolongation
-Acute EPS (treat with anticholinergics: benztropine, diphenhydramine)
-Sedation
-Anticholinergic side effects
Which chemotherapy agents are associated with hand-food syndrome (palmar-plantar erythrodysesthesia)?
-Fluorouracil
-Capecitabine
-Cytarabine
-Doxarubicin (liposomal)
What is used for the treatment for hand-foot syndrome?
-Cold compresses
-Emollients
-Steroids and pain medications
What is used in the event of extravasation of vinca alkaloids?
Warm compress + hyaluronidase
What hormonal therapy for breast cancer is preferred in premenopausal women?
Tamoxifen
What hormonal therapy for breast cancer is preferred in postmenopausal women?
Aromatase inhibitor
What medication can be used in men with breast cancer?
Tamoxifen
What are side effects of tamoxifen?
-DVT/PE
-Menopausal symptoms
-Hot flashes
-Flushing
-Edema
-Weight gain
-Hypertension
-Mood changes
-Amenorrhea
-Vaginal bleeding/discharge
How do SERMS and aromatase inhibitors differ for adverse effects?
-Aromatase inhibitors decrease bone density; SERMS are good for bones
-Aromatase inhibitors have a higher risk of CVD compared to SERMS
-SERMS can increase risk of uterine or endometrial cancers
-SERMS can increase risk of getting cataracts
What is another name for gonadotropin-releasing hormone (GnRH) agonists?
Luteinizing hormone releasing hormone (LHRH) agonist
How do GnRH agonists work in treating prostate cancer?
Reduce testosterone through negative-feedback mechanism; initially giving drug will cause a surge in testosterone followed by a gradual decrease. Initial surge in testosterone can cause "tumor flare"; important to give antiandrogens when initiating GnRH a
What are important safety considerations and side effects with GnRH agonists?
-Risk of osteoporosis (supplement with calcium & vitamin D)
-Can cause tumor flare when initiating; give antiandrogens when initiating.
-Side effects: hot flashes, impotence, gynecomastia, peripheral edema, bone pain, injection site pain, QT prolongation,
How do first and second generation antiandrogens differ?
-First generation antiandrogens (e.g. bicalutamide) MUST be used in combination with a GnRH agonist; cannot be used as monotherapy
-Second generation antiandrogens (e.g. enzalutamide) CAN be used as monotherapy
How do you calculate BSA using the Mosteller Equation?
BSA (m�) = ?[Ht (cm) � Wt (kg)]/3600
What are the most important toxicities with cyclophosphamide?
Hemorrhagic cystitis
What are the most important toxicities with ifosfamide?
Hemorrhagic cystitis
What are the most important toxicities with Busulfan?
Pulmonary toxicity
What are the most important toxicities with Carmustine?
Pulmonary toxicity
What are the most important toxicities with Cisplatin?
-Nephrotoxicity
-Ototoxicity
-Neuropathy
-Highly emetogenic
How are doses of Carboplatin calculated?
Calvert formula
What are the most important toxicities with Oxaliplatin?
Acute sensory neuropathy (exacerbated by exposure to cold, including; cold beverages)
What are the most important toxicities with Doxorubicin?
-Cardiac toxicity (maximum lifetime cumulative dose 450-550 mg/m�)
-Myelosuppression
-Vesicant
-Red discoloration of urine/fluids
What are the most important toxicities with Vincristine
-Peripheral and autonomic (constipation) neuropathies
-DO NOT PUT IN A SYRINGE- IV piggyback only (Intrathecal administration is FATAL)
-Vesicant (use WARM compress)
-Max 2mg/dose (regardless of calculated mg/m�)
What are the most important toxicities with Taxanes?
-Peripheral sensory neuropathies
-Infusion-related hypersensitivity reactions
-Use non-PVC bag and tubing
What are the most important toxicities with Irinotecan?
-Diarrhea (early treat with atropine, late treat with loperamide)