5. Cancer Pharmacology Part 2 Flashcards
What is the MC form of cancer in children, whose treatment with MTX dramatically increased length of survival, MTX is an antimetabolite/folate and is rescued by follinic acid/ leucovorin with SE including myelosuppression, D/N/V and causes secondary cancer such as AML?
Acute Lymphoblastic Leukemia
6-mercaptopurine, cyclophosphamide, vincristine, and daunorubicin are all active against Acute Lymphoblastic Leukemia ALL, a combination of what two drugs plus one of the other agents listed is used to induce remission- 90% do with minimal toxicity?
Vincristine, Prednisone and one other agent listed
Note: predinose causes inhibition of cytokine production, alteration of oncogene expression, cell cycle arrest and APOPTOSIS so it is GOOD to kill tumor cells and proliferation
HAHAH
Circulating leukemic cells migrate to sanctuary sites located in the brain and testes, prophylaxis with what intrathecally is used to prevent CNS leukemia which is associated with a major mechanism of relapse?
Methotrexate
What leukemia is the most common in adults, need intensive support care during the period of chem induction- such as platelet transfusions to prevent bleeding, granulocyte colony stimulating factor, filgrastim*, to shorten periods of neutropenia and abx to combat infections?
Acute Myelogenous Leukemia AML
Acute Myelogenous Leukemia AML is best treated with what agent which is most active for AML, and is best used in combination with an athracycline such as idarubicin, in which we seen complete remission in 70% of patients?
Cytarabine** + Idarubicin
Acute Myelogenous Leukemia AML remission is achieved by allogenic bone marrow transplantation preceded by high dose chemo and total body irradiation followed by immunosuppression- cures 35%, pts over 60 respond less well to chemo, after remission is acheived, consolidation chemo (after tx) is required to maintain remission and induce a cure, using cytarabine OR what?
Hematopoeitic cell transplantation
What leukemia is due to Bcr-Abl fusion oncoprotein aka philadelphia chr t(9:22) - seen in 90-90% of cases, the translocation results in constant expression of bcr-abl oncoprotein = growth, goals of tx include reduce granulocytes to NL levels, raise hemoglobin [] to NL, and relieve disease sx?
Chronic Myelogenous Leukemia CML
What is the standard first line therapy in previously untreated patients with Chronic Myelogenous Leukemia CML, in which nearly all pts treated with it exhibit a complete hematologic response and 50% pts show a COMPLETE cytogenetic resopnse?
Imatinib
Dasatinib and Nilotinib were initially approved for pts who were intolerant or resistant to imatinib but now both are indicated as first line treatment of CML, what drug specifically mentioned, along with other oral alkylating agents are effective in tx this disease?
Busulfan
Chronic Lymphocytic Leukemia (CLL) is MC treated with chlorambucil and cyclophosphamide alkylating agents, chlorambucil is usually combined with prednisone, bendamustine is also approved as a monotherapy or in combo with prednisone. Dr Sheehy wants us to know COP and CHOP tx for CLL, what drugs are they?
COP: Cyclophosphamide/vincristine/prednisone
CHOP: Cyclophosphamide/doxorubicin/vincristine/prednisone
In COP: O=vincristine= Oncovin
in CHOP: H = doxorubicin
CLL is also effectively treated with what monotherapy, or in combinationg with cyclophosphamide and mitoxantrone or it is combined with rituximab which enhances chemo when there is resisitance?
Fludarabine
Hodkin’s Lymphoma treatment involves a complete staging evaluation before treatment can be formulated, for Stage I and IIA, tx includes combination therapy with chemo and field radiation to LN, the chemo used is ABVD, which are what 4 agents in which 60% are cured?
A-doxorubicin Bleomycin Vinblastine Dacarbazine ***more effective, less toxic than MOPP - infertility and 2nd malig
Hodkin’s Lymphoma for advanced stage III and IV, ABVD treatment is first line followed by sanford V which includes doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, eoposide and prednisone followed by radiation, and 3rd line is MOPP?
Mechlorethamine Vincristine Procarbazine Prednisone -high complete responses (80%), but more toxic--> infertility and 2ndary malignancies
Non-Hodgkin’s Lymphoma (diffuse) is tx with combination chemotherapy CHOP (cyclophosphamide-doxorubicin-vincristine-prednisone) is the best initial treatment, what agent is added for BEST tx, shows increased response rate, disease free survival and overall survival versus CHOP alone?
R-CHOP w/ Rituximab
Non-Hodgkin’s Lymphoma nodular (follicular) is treated with initiation of chemotherapy at the onset of symptoms, ‘watchful waiting’ and can use either bendamustine + rituximab or?
R-CHOP
Multiple myeloma- most pts are symptomatic at time of initial diagnosis- requires cytotoxic chemotherapy by using MP protocol known as what two drugs, which is the standard regimen for 30 years- 40% respond?
Melphalan + Prednisone
Stage I breast cancer is small primary tumor and negative LN so treated with sx alone. StageII breast cancer is node positive (1-3nodes), high risk of both local and systemic recurrence so post sx use adjuvant chemo to reduce relapse/prolong survival— CMF = cyclophosphamide, MTX, 5-fluorouracil or FAC which consists of?
5-Fluorouracil
doxorubicin
cyclophosphamide
Prostate cancer is first treated with hormone therapy, advanced prostate cancer becomes refractory to it, mitoxantrone and prednisone is approved for this situation, provides palliation in those experiencing bone pain… What two drugs are the standard of care for hormone refractory prostate cancer*****?2
Docetaxel + Prednisone
High risk stage II and II colorectal cancer are candidates for adjuvant chemo, either with XELOX = capecitabine (xeloda) + oxaliplatin or FOLFOX which is what 3, these are used q 6 months following surgical resection, reduces recurrence rate by 35%, improves pt survival?
FOLFOX= Folinic acid (leucovorin) + 5FU (which is metabolized to fdUMP, FUTP, FdUTP), and oxaliplatin
NOTE: Capecitabine is a prodrug metabolized to 5FU
For metastatic colorectal cancer FOLFIRI is used which is folinic acid, +5FU + irinotecan, ziv-aflibercept added if progression has been observed with oxaliplatin, the most effective treatment is FOLFOX or FOLFIRI plus bevacizumab, or panitumumab/ ?
Cetuximab
TAS-102 approved from chemo refractory disease - limited by sig toxicities, clinical efficacy and low response rates
Adjuvant platinum-based chemotherapy provides survival benefit in patients with pathologic non-small cell lung cancer NSCLC stage Ib, II, IIIA, Bevacizumab in combo with carboplatin and paclitaxel are used in pts with good performance status and what histology?
Non-squamous histology
In patients with NSCLC who are not good candidates for bevacizumab or a squamous cell histology is present, treat with cisplatin or carboplatin + cetuximab, maintenance chemo is what agent, which is used in patients that have stabilized after four cycles of platinum-based first line chemo?
Premetrexed
If molecular testing is done on NSCLC, there are certain agents used for different situations, for example, which is first line therapy in advanced NSCLC patients with sensitizing EGFR mutations- exon 19 deletions or exon 21 (L858R) substitution mutations?
Erlotinib
