276 - Chemotherapy Basics Flashcards
Which of the following have the long-term potential side effect of cardiotoxicity? Select all that apply
- Carboplatin
- Trastuzumab
- Etoposide
- Doxorubicin
- Vincristine
B - Trastuzumab
D - Doxorubicin
The large trial is started on IV ferrous derpunmaltose (Punoferric), a new FDA approved treatment for irony deficiency. There has been a concern for numusemia from Punoferric. The trial involved prospective 6 months follow up of ferrous derpunmaltose (Punoferric) and a comparator arm of ferric carboxypuntose (Punjectafer) to evaluate primary safety and efficacy outcomes. A total of 500 patients in each arm are expected to be occurred. What phase best describes this trial?
- Preclinical
- Phase 1
- Phase 2
- Phase 3
- Phase 4
E. Phase 4
After FDA approval to study long-term effects
Which of the following targeted therapies is used in the treatment of Ph+ ALL or CML?
- Pembrolizumab (Keytruda)
- Gemtuzumab ozogamicin (Mylotarg)
- Imatinib (Gleevec)
- Liposomal daunorubicin and cytarabine (Vyxeos)
- Gefitinib (Iressa)
C. Imatinib (Gleevec)
Which of the following are Vinca alkaloids? Select all that apply
- Vincristine
- Paclitaxel
- Eribulin
- Vinorelbine
- Vinblastine
A. VIncristine
D. Vinorelbine
E. Vinblastine
What is the mechanism of action of 5-fluorouracil?
Pyrimidine analog
Normally, thymidylate synthase converts dUMP -> dTMP in DNA synthesis
5-FU causes thymidylate synthase to incorporate FdUMP, a metabolite of 5-FU into cells, resulting in cell death
**Dr. Atillio emphasized that we needed to know FdUMP, the specific metabolite**
Which of the following have the short-term potential side effect of myelosuppression? Select all that apply
- Carboplatin
- Trastuzumab
- Etoposide
- Doxorubicin
- Vincristine
A - Carboplatin
C - Etoposide
D - Doxorubicin
E - Vincristine
Which of the following statements best describes the modern state of oncology pharmaceuticals?
- Thanks to targeted therapy, we have now eliminated off target side effects, offering low side effect options for all cancer states.
- Thanks to modern advancements, oncology care is moving to completely pill based outpatient care setting for all cancer types.
- Thanks to multidisciplinary efforts and recent revolutions in targeted therapy, such as pembrolizumab, we are seeing declining national death rates in cancer patients.
- Despite modern advancements, “old-fashioned” chemotherapy remains the preferred category treatment for all cancer types.
C
Thanks to multidisciplinary efforts and recent revolutions in targeted therapy, such as pembrolizumab, we are seeing declining national death rates in cancer patients.
What is the goal of phase 1 clinical trials?
Define drug toxicity - what dose will you bring into phase 2?
Which if any, require a dose adjustment per Yamazaki et al. Annals of Oncology 2016? https://doi.org/10.1093/annonc/mdw206
A. Grade 2 Platelet count decrease
B. Grade 3 Neutrophil count decrease
C. Grade 1 ALT increase
D. Grade 2 AST increase
B. Grade 3 Neutrophil count decrease
If a patient were to have neutropenia from chemotherapy treatment, when would the nadir of his ANC typically occur?
- ~2 days after treatment
- 7-14 days after treatment
- 21-28 days after treatment
- 3 months after treatment
B. 7-14 days after treatment
Felt like SAS was super nit-picky about “7 days vs. 7-10 days” - Please suggest an edit if you can shed some light :)
Which of the following is be described as chemotherapy dose dense?
- AC: Doxorubicin 60 mg/m2 IVP on Day 1 + Cyclophosphamide 600 mg/m2 IV on Day 1 of every 21-day cycle
- 7 + 3: continuous infusion (CI) cytarabine 200 mg/m2/d on days 1-7, and daunorubicin 90 mg/m2 IV push on days 1-3, for one cycle
- AC: Doxorubicin 60 mg/m2 IVP on Day 1 + Cyclophosphamide 600 mg/m2 IV on Day 1 of every 14-day cycle
- High dose methotrexate (MTX): methotrexate 8000 mg/m2 day 1 + leucovorin q6hr starting day 2 of every 28 day cycle
C.
AC: Doxorubicin 60 mg/m2 IVP on Day 1 + Cyclophosphamide 600 mg/m2 IV on Day 1 of every 14-day cycle
- Dose dense = shortest time between doses
- Dose inteste = more drug given at each dose
I think normal cycles are like 21-28 days? 14 days is pretty short apparently
Which of the following medications is most likely to cause numbness/tingling in a patient’s hands?
A. 5-FU push
B. 5-FU continuous infusion pump
C. Leucovorin
D. Oxaliplatin
E. Palonosetron
F. Dexamethasone
G. Fosaprepitant
D. Oxaliplatin
Cisplatins are known to cause peripheral neuropathy
Which of the following drugs are cell cycle specific for M phase? Select all that apply
- Vincristine
- Fluorouracil
- Busulfan
- Etoposide
- Cytarabine
- Paclitaxel
A. Vincristine
F. Paclitaxel
Vinca alkyloids and taxanes are M-phase specific
- Both mess with microtubules*
- Vincristine prevents polymerization*
- Paclitaxel prevents de-polymerization*
How long after surgery (ex: port placement) should you wait ot give bevacizumab (Avisatatin)?
Why?
7 days
Bevacizumab is a VEGF inhibitor that causes delayed wound healing; Don’t want to mess with wound healing within 1 week after surgery
How does leucovorin affect the toxicity of:
- 5-fluorouracil:
- Methotrexate:
- 5-fluorouracil: Increases toxicity
- Results in increased buildup of toxic metabolite
- Methotrexate: Decreases toxicity
- Reverses action of MTX, thus reducing toxicity
Leucovorin speeds up thymidylate synthase (converts dUMP to dTMP in pyrimidine synthesis)
Leucovorin = folinic acid analog
