Anti-neoplastic focus

Question 1

Alkylating Agents

Answer 1

MOA: prevents cell division by cross linking DNA strands and decreasing DNA synthesis

Cell cycle non specific

Myelosuppresion is the dose limiting toxicity

Other common toxicity

• N/V
• Alopecia
• Secondary malignancies
• inferititly

Question 2

Ifosfamide / Cyclophosphamide

Answer 2

Alkylating Agents

Hemorrhagic cystitis due to acrolein metabolite

Give mesna

Question 3

Cisplatin

Answer 3

Alkylating Agent

Nephrotoxicity
N/V
Ototoxicity

Question 4

Oxaliplatin

Answer 4

Neuropathy exacerbated by cold temperatures

Question 5

Antimetabolites

Answer 5

MOA:
structural analogs of naturally occurring substances necessary for specific biochemical reactions

Compete with normal metabolites or falsely insert themselves for a metabolite normally incorporated into DNA and RNA

Most commonly active in the S phase

Common toxicity
- Myelosuppression, mucositis, mild N/V, diarrhea

Capecitabine - hand - foot syndrome
Cytarabine - high dose therapy ; NS toxicity, ocular irritation

Question 6

Methotrexate

Answer 6

Antimetabolites

Renal toxicity
Folic acid suppressor
chemo protection - leukovorin - timing is important, leukovorin increases efficacy / toxicity of fluorouracil

Question 7

Anthracyclines

Answer 7

Antitumor antibiotic

MOA: block RNA and DNA transcription

ADR: cardiotoxicity - congestive heart failure

lifetime max dose (doxorubicin 450)

Free radicals from Fe – fibrosis of myocardium

esp w/ doxorubicin - risk of CHF

chemo-protection: dexrazoxane binds/removes Fe

Question 8

Bleomycin

Answer 8

antitumor antibiotic

MOA: cell cycle specific DNA inhibition (testicular cancer)

ADR: pulmonary toxicity - fibrosis and pneumonia

life time max 400 units

Question 9

Biggest Antitumor Antibiotics ADR

Answer 9

Myocardiotoxicity (dose dependent)
- production of free radicals, membrane lipid per oxidation leading to irreversible damage and replacement by fibrous tissue

Dexrazoxane: MOA chelating agent, binds intracellular iron released following lipid per oxidation

Question 10

Microtubule agents main ADR

Answer 10

Natural products

Significant neuropathy / loss of fine motor control

Question 11

Texans

Answer 11

Microtubule agents -Natural products

MOA: prevent microtubule dissemble

ADRs: neuropathies, peripheral edema, hypersensitivity reactions

Paclitaxel - premeditate with H1 + H2 blocker + steroid

Question 12

Vinca alkaloids

Answer 12

MOA: prevent microtubule assembly

ADR: neuropathy, constipation

Vincristine - DO NOT GIVE INTRATHECALLY

Question 13

Topoisomerase I inhibitors

Irinotecan

Answer 13

Diarrhea in 2 phases

immediate - anti cholinergic ; treat w/ atropine

delayed - treat with ioperamide

Question 14

Topoisomerase II inhibitors

Etoposide

Answer 14

Secondary cancers (AML)

Question 15

Enzyme

Asparaginase
Pegasparigase

Answer 15

Hypersensitivity reactions
hyperglycemia
Pancreatitis
Coagulopathies

Question 16

Eribulin

Answer 16

Marine based - natural
microtubule like
Fatigue, peripheral neuropathy, CINV

Question 17

Trabectedin

Answer 17

Marine based - natural

alkylating like

toxicity - hand food syndrome, CINV, hepatic damage

Question 18

SERM - Tamoxafen

Answer 18

MOA: inhibits estrogen-R in breast tissue

used in pre-menopause (or post)

ADRs: VTE (blood clots > stroke), endometrial cancer, cataracts, hot flashes

Question 19

Aromatase inhibitors

Answer 19

MOA: inhibits aromatase enzyme that converts androgen to estrogen

used in post - menopause (preferred over SERM)

ADRs: osteoporosis, fractures, arthralgia, CV disease, hot flashes

Question 20

LHRH Agonist

Answer 20

Prostate cancer

MOA: inhibit pituitary from releasing LH and FSH which stops stimulation of testes to produce testosterone

ADR: tumor flare initial growth

Question 21

LHRH antagonist

Answer 21

MOA: directly inhibits pituitary from release LH and FSH

Question 22

Antiandrogens

Answer 22

MOA: block androgen receptor

Question 23

Monoclonal antibodies

Answer 23

Targeted Agent

Antibodies that match an antigen on the cancer cell surface

-mabs

ADRs: hypersensitivity reactions

Question 24

Molecularly targeted therapies

Answer 24

Block signal inside cancer cell

ADRs: hypothyroidism, QT prolongation, fatigue, hair thinning, CYP3A4 interactions

Question 25

VEGF signalling pathway inhibitors

Answer 25

ADR: hypertension**, proteinuria, bleeding

Hypertension may indicate effectiveness

Question 26

EGFR inhibitors

Answer 26

Acneiform rash

treat w/ clindamycin and by hydrating

rash may indicate effectiveness

tetracyclines, topical antibiotics

Question 27

mTOR inhibitors

Answer 27

hyperglycemia, dyslipidemia, mucosal sensitivity, ulcers

DDI 3A4

caution in diabetics

Mucosalulcers - dexamethasone

Question 28

BCR-ABL mutation

Answer 28

edema, N/V, neutropenia, cardiac, diarrhea

3A4 DDI

Question 29

CD20

Answer 29

infusion reactions

myelosuppresion

Question 30

HER2 inhibition

Answer 30

breast cancer

cardiotoxicity
hand food syndrome

Question 31

Targeted Agents Toxicities

Mainly

Answer 31

Monoclonal AB - potential hypersensitivity reactions
QT prolongation

Fatigue, hair thinning, low grade N/V & myelosuppresion

Hair depigmentation
Dysphonia
Hypothyroidism

Question 32

Immunological Therapies

Answer 32

activate immune system to help kill disease, at low tumor burden

ADR: fatigue

Question 33

PD1 and PD2 inhibitors

Pembrolizumab
Nivolumab

Answer 33

Pembrolizumab - melanoma

Nivolumab - melanoma, lung cancer