6303 intro to cancer & therapeutics

max cumulative dose of this drug is 450 mg/m2

doxorubicin

this class of drug causes harmless red urine

anthracycline (-rubicin)

chemoprotectant for cyclophosphamide or ifosfamide (mesnex)

mesna

chemoprotectant for cisplatin (ethyol)

amifostine

Examples of oncogenes (k, c)

KRAS, C-Myc

which side effect is peculiar to ifosfamide vs cyclophosphamide?

encephalopathy

1. Uncontrolled growth
2. Lack of differentiation
3. Angiogenesis
4. Loss of contact inhibition
5. metastasis
6. ability to. avoid apoptosis
these are characteristics of which cells?

cancer cells

max dose of cisplatin

100 mg/m2/cycle

Which side effect is lessened by leucovorin when given after MTX? (my, mu, d)

myelosuppression, mucositis, diarrhea

Which side effect of EGFR-1 Moab has a positive correlation with tumor response?

Dermatologic toxicities

What is the generic of xtandi?

enzalutamide

main side effect of Ara-C (cytosar/ cytarabine)

Cerebellar toxicity

what agents can cause hypomagnesemia? (ci, ce, pa)

Cisplatin, cetuximab, panitumumab

What is not a side effect of SERM (selective estrogen receptor modifier/ ex) tamoxifen) in post menopausal women?

Osteoporosis

Progression free survival always correlates with overall survival. True or false.

false

What type of cancer is the leading cause of death amongst male and female?

lung cancer

Active metabolite of cyclophosphamide & ifosfamide that causes irritation to the lining of the bladder.

Acrolein

what is the brand name of erlotinib?

Tarceva

Which agent is most likely to cause HTN and VTE? (avastin)

Bevacizumab

Which medication requires you to infuse over > 1 hr to lower risk of hypotension?

monoclonal antibody

Which drug is used with zytiga to reduce corticosteroids inducing side effects & its dosing?

Prednisone 5 mg PO BID

What is the oral prodrug for 5-FU? (xeloda)

capecitabine

Antidote for Fluorouracil DPD related toxicity (uridine triacetate)

vistogard

Interstitial pulmonary fibrosis is a side effect of what medication?

bleomycin

What is the chemoprotectant used for doxorubicin?

dexrazoxane

This class of medication is associated with the assembly of microtubules.

vinca alkaloid

Premedication with dexamethasone, H1 antagonist, and H2 antagonist is used for the prevention of hypertensive reactions of what class of medication?

taxan

You must check the status of what virus prior to starting rituximab as it can cause a reactivation?

HBV

Which class of medication displaces methotrexate from the binding site?

Sulfonamides

Which medication causes neuropathy exacerbated by cold exposure?

oxaliplatin

What medication has the side effects such as hepatitis, colitis and pneumonitis? (keytruda)

Pembrolizumab

Which class of drug causes diarrhea, hypothyroidism, QTc prolongation, CYP 3A4 interactions, rash, and LFT abnormalities?

TKI (tyrosine kinase inhibitors)

What DDI would you be concerned with when using 5-FU or capecitabine?

warfarin

It is part of the REMS program and needs 2 forms of contraception. (thalomid)

thalidomide

What prodrug uses UGT1A1 to metabolize its active drug SN-38? (camptosar)

irinotecan

When using anthracyclines, you should avoid concurrent chemotherapy with what? (t, p)

Transtuzumab, paclitaxel

Which of the following agents is not associated with tumor flare?
1. Lupron
2. Zoladex
3. Firmagon
4. None of the above

3

Which of the following medications does not cause hand-foot syndrome?
1. Sunitinib
2. Capecitabine
3. Bevacizumab
4. sorafenib

3

Brand & generic names. Which match is correct?
1. Keytruda-imatinib
2. Firmagon-zoladex
3. Gleevec- pembrolizumab
4. Xtandi- enzalutamide

4

LM has stage 3 lung cancer and stays in bed > 50% of the time, what is the PS?
1. ECOG PS 5
2. Karnofsky PS 80%
3. Karnofsky PS 20%
4. ECOG PS 3

4

Which cytotoxic agent does NOT cause myelosuppression?
1. Bleomycin, vincristine, prednisone
2. Bleomycin, vinblastine, prednisone
3. Cisplatin, irinotecan, vincristine
4. Irinotecan, bleomycin, vincristine, prednisone

1

What vaccines are available to prevent cancer?
1. Gardasil-9, Hep B vaccine
2. Hep A, gardasil-9, Hep B vaccine
3. Hep A, gardasil-9
4. Gardasil-9, hep A

1

When using tamoxifen, which drug can cause a DDI?
1. Duloxetine, bupropion
2. venlafaxine, bupropion
3. Venlafaxine, citalopram, bupropion

1

60 y/o female who smokes 2 packs of cigarettes per day x 15 yrs. What cancer screenings are recommended for her? (M,C,L,H)

Mammogram, colonoscopy, low dose helical CT scan, HPV

anastrazole- breast cancer, arthralgias (manage -> APAP/NSAID), menopause sx, OP, bone mineral density, pregnancy x

Arimidex

Bicalutamide- prostate cancer, hot flashes, constipation, diarrhea, mhepatotoxicity, OP, chemoprotectanct = amifostine

Casodex

Cyclophosphamide- hemorrhagic cystitis, PO QAM, chemoprotectant = mesna

Cytoxan

Doxorubicin- max dose 450 mg/m2, harmless urine discoloration, chemoprotectant = dexrazoxane

Adriamycin

Erlotinib- QTc, rash (continue tx)

Tarceva

Paclitaxel - hypersensitivity reactions, bone marrow suppression, H1/H2 antagonists, CS to prevent anaphylaxis

Taxol

Pembrolizumab - PD-1 inhibitor, immune-related toxicities

Keytruda

Rituximab- CD20, infusion site rxn, Hep B serology before tx,

Rituxan

Trastuzumab- cardiomyopathy, infusion-related rxn, pulmonary toxicity, birth defect

Herceptin

tumor suppressor genes

P53, BRCA 1,2

Sites of metastasis (lu, li, ly, br, bo, bom)

lung, liver, lymph nodes, brain, bone, bone marrow

chemo agents that can cause leukemia

alkylating agents, topoisomerase 2 inhibitors

5 types of non-cancer cells that can commonly be affected by cytotoxic chemo (f, c, b, g, h) b/c they a re rapidly dividing cells

fetus, cancer cell, bone marrow, gi mucosa, hair follicle

2 vaccines prevent cancer (h (9-45 y/o),he (newborns))

HPV, Hep B

vitamin _ increase risk of lung cancer, vitamin _ (folic acid) increase risk of colorectal cancer

A, B9

Anogenital warts- common in immunosuppressed & pregnant pts, usually asx, recurrence common, 90% caused by HPV _ & __, which is considered as low risk subtypes, this warts is called __

6, 11, condylomata acuminata

HBV subtypes that are associated to cervical cancer are HIV _ and _

16,18

ugly duckling sign- ABCDE

asymmetry, border, color, diameter > 6 mm, evolving

TNM system

T- tumor spread
N- node involvement
M- presence of distant metastasis

Cancer Stages

0-4, 0 is in situ, 1 localized, 2 limited spread, 3 regional spread, 4 metastasis

ECOG scale

0 normal, 1 sx, 2 in bed < 50%, 3 in bed > 50%, 4 in bed 100% 5 dead

Karnofsky Performance Scale

100% normal, 80% sx, 60% in bed < 50%, 40% in bed > 50%, 20% in bed 100%, 0% dead

3 most common causes of cancer-related death in men (l, c, p)- men 1:2 probability of developing cancer

lung; colorectal, prostate

3 most common causes of cancer-related death in women (l, c, b)- women 1:3 probability of developing cancer

lung, colorectal, breast

Log-kill hypothesis

A particular log fraction of cancer cells are killed with every chemotherapy treatment. The goal is to eventually reach a threshold from which the cancer cannot recover.

secondary leukemia agents (d,-latency 1-3 yrs, e- latency 1-3 yrs, i- latency 5-7 yrs)

doxorubicin, etoposide, ifosfamide

Hemorrhagic cystitis

Cyclophosphamide, ifosfamide

alkylating agent that has side effects of MAOI activity, disulfiram reaction, CNS change (depression, nigghtmare, hallucination, dizziness), PO only

procarbazine

alkylating agent need to take on empty stomach & and at bedtime

temozolomide

Oxaliplatin toxicity

can cause cold induced neuropathy, and N/V

Cisplatin toxicity

nephrotoxicity, ototoxicity. neuropathy

Carboplatin toxicity

myelosuppression

Etoposide (topoisomerase 2 inhibitor) brand name

VP-16

Topoisomerase 1 inhibitor, produce ss-DNA nick, brand name camptosar, dose-limiting diarrhea (give atropine SQ, loperamide), active metabolite SN-38, glucuronidated by UGT1A1

irinotecan

topoisomerase 2 inhibitor, brand name VP-16, , dose not interchangeable, hypotension, ppt (use filter, final diluted conc. 0.4 mg/ml), no fridge, secondary leukemia risk in 1-3 yrs

etoposide

anthracycline cardiomyopathy- risk increased with concurrent chemotx with __, __ (t,p)

trastuzumab, paclitaxel

vinblastin toxicity

myelosuppression

Vincristine side effects

peripheral neuropathy, constipation
no myelosuppression

vincristine constipation management with s__ + d__

senna, DSS

red colored urines in classes of a__, v__

anthracycline, vinca alkaloid

potent vesicants are classes of a__, v__

anthracycline, vinca alkaloids

Docetaxel brand

Taxotere

Paclitaxel brand name

Taxol

paclitaxel side effects

hypersensitivity (rash)
neurotoxicity
bone marrow suppression

paclitaxel solvent responsible for fatal type 1 immediate hypersensitivity reaction

cremophor EL

docetaxel solvent responsible for fatal type 1 immediate hypersensitivity reaction

polysorbate 80

taxan hypersensitivity management with premedications (d__, H1 (D__), H2 (C__, R__, F__) 30 minutes prior taxans

dexamethasone 20 mg, diphenhydramine 50 mg IV, cimetidine 300 mg, ranitidine 50 mg, famotidine 20 mg IV

paclitaxel give in __ container & give __ filter, no __

non-pvc, in-line, refrigerator

hepatic adjustment classes- a__, an__, v__, ta__

alkylating agent, anthracycline, vinca alkaloid, taxans

tamoxifen brand name - used in both pre-& post menopausal breast cancer

Nolvadex

Fulvestrant brand name - used for second line post-menauposal breast cancer

Faslodex

anti epileptic medications that are not interact with tamoxifen, so recommended -> v__, c__

venlafaxine, citalopram

aromatase inhibitor side effects -> o__, ar__, my__, V__

OP, arthralgia, myalgia, VTE

GnRH antagonist that is used for prostate cancer, brand name is firmagon, no hormone surge (no tumor flare), QM dosing, no need to use with antiandrogens

degarelix

QTc prolonging medications -> de__ (GnRH antagonist)

degarelix

antiandrogen - bicalutamide brand name

casodex

antiandrogen - enzalutamide brand name

xtandi

Androgen biosynthesis inhibitor, brand name zytiga

abiraterone

empty stomach agents -> t__ (alkylating agent), ab__ (zytiga)

temozolomide, abiraterone

drug used for mineralocorticoid excess of abiraterone (zytiga) & dosing --> p__ 5 mg BID or e__

prednisone, eplerenone

cytarabine, gemicitabine, fluorouracil, capecitabine are which class of cancer agents?

pyrimidine analog

fludarabine, mercaptopurine, azathioprine, thioguanine are which class?

purine analog

Cytarabine Brand name and class

Cytosar, Ara-C, antimetabolite

gemicitabine brand name

gemzar

Capecitabine Brand name and class

Xeloda, antimetabolite

cerebellar toxicity associated with high dose of which drug?it's brand name is ara-c , cytosar

cytarabine

Mercaptopurine (6-MP) brand name

purinethol

Thioguanine (6-TG)

MECH: purine metabolite that inhibits many enzymes in purine metabolism
USE: leukemias and lymphomas

Azathioprine

Imuran

Fludarabine

Fludara
Purine antimetabolite (adenosine analog)

purine analog side effects ex) fludarabine

immunosuppression (prolonged t cell recovery, opportunistic infection risk)

Pemetrexed

Alimta
Antifolate antimetabolite

Hep B reactivation is related to which agent? it is moniclonal ab work against CD-20

rituximab

this side effect is found on all CD targeted moabs due to JC virus

leukoencephalopathy

autoimmune diseases such as colitis, hepatitis, pneumonitis are common side effect of this immune checkpoint inhibitor, its brand name is keytruda

pembrolizumab

Trastuzumab (Herceptin) MOA

By binding to the HER2 protein, trastuzumab inhibits the growth of tumor cells and mediates antibody-dependent cellular cytotoxicity (ADCC) in cancer cells that overexpress the HER2 protein

trastuzumab (herceptin), pertuzumab, etuximab (erbitux), panitumumab are which class?

EGFR targeted monoab

management for non-severe dermatologic toxicities of EGFR targeted monoab (cetuximab (erbitux), panitumumab)

continue tx, topical clindamycin or TCN, steroid

VEGF inhibitors

Bevacizumab (AVASTIN)

Bevacizumab (Avastin) side effects

BIG TIP HTN (bleeding, impaired wound healing, GI perforation, thromboembolism, infusion related rxn, proteinuria, HTN)

BRAF mutation

melanoma

BCR-ABL

myelogenous leukemia

Erlotinib (Tarceva)

Tyrosine Kinase inhibitor
Inhibit epidermal growth factor receptor (EGFR) tyrosine kinase
Non-small lung cancer; pancreatic cancer
Rash, diarrhea, appetite loss, N & V, stomach pain, fatigue, shortness of breath, mouth sores, dry skin, itching, cough
Live

cyclophosphamide, capecitabine, imatinib (gleevec) requires take with

food

REMS program

thalidomide (thalomid), immunomodulatory agent

can be used for tx of breast cancer or prostate cancer (l)

leuprolide

nystagumus and ataxia can occur with higgh dose of c__-

cytarabine

omeprazole and ibuprofen may decrease clerance of M__

MTX

DPD deficiency -> side effect includes diarrhea, myelosuppression

genomic biomarker for 5-FU, capecitabine