Antineoplastic drugs CIS Flashcards
Differential Diagnosis of Eosinophilia
Infectious diseases (most common worldwide) - Helminths: Toxocara canis (dog roundworms), trichinella
Disorders of the immune system (2nd most common US)
- Allergy, lupus, rheumatoid arthritis, ulcerative colitis
Toxins, drugs, and environmental factors
- Phenytoin, carbamazepine, phenobarbital, sulfonamide antibiotics, filgrastim, pegfilgrastim, ingestion of aniline (C6H7N)
Endocrine abnormalities – adrenal insufficiency
Inherited disorders – familial eosinophilia
Hypereosinophilic syndromes
- Churg-Strauss syndrome, Kimura disease, Well syndrome, Castleman disease
Cancer
Acute lymphoblastic leukemia (ALL)
Main form of leukemia in childhood and the most common form of cancer in children
Generally, children with this disease have a relatively good prognosis
The combination of drugs currently utilized to induce remission does so in over 90% of patients with minimal toxicity
Circulating leukemic cells often migrate to sanctuary sites located in the brain and testes; prophylactic intrathecal methotrexate chemotherapy is often considered a standard component of the induction regimen to prevent CNS leukemia, a major mechanism of relapse
Agents from which drug class listed below act in a cell cycle specific manner?
Alkylating agents Anthracyclines Antimetabolites Glucocorticoids Monoclonal antibodies
antimetabolites
Cell Cycle Specific classes
Antimetabolites- S phase
Antitumor antibiotics- bleomycin (S-G2 phase)
Taxanes (M phase)
Vinca (M phase)
Topoisomerase I and II inhibitors (S-G2 phase)
Cell cycle non-specific classes
alkylating agents
anthracyclins
antitumor antibiotics (dactinomycin, mitomycin)
platinum agents
An agent known to cause delayed cardiotoxicity was added to this patient’s chemotherapy regimen due to his high-risk status. Which drug class best fits this description?
Alkylating agents Anthracyclines Enzymes Glucocorticoids Pyrimidine analogs
What is thought to be the mechanism of cardiotoxicity?
anthracyclines (doxorubicin)
free radicals that accumulate over a lifetime are thought to be the cardiotoxic effect
What agent is most likely administered in conjunction with systemic high-dose methotrexate to rescue healthy cells in this patient?
Bleomycin Hydrocortisone Interferon alpha Leucovorin Mesna
Leucovorin
What is the main advantage to high-dose intermittent administration?
permits recovery of normal cells
Which agent in this patient’s regimen is a cell-cycle inhibitor of mitosis?
Asparaginase Cisplatin Doxorubicin Tretinoin Vincristine
Vincristine (inhibits microtubule assembly)
Taxanes also work against M phase– inhibit microtubule disassembly (stabilize them)
Tretinoin
differentiating agent
used in leukemias with RARa translocation (retinoic acid receptor)
headache, fever, dry skin and mucus membranes, skin rash, pruritis, conjunctivitis
why is aspariginase added to an ALL pt’s regimen?
ALL tumor cells lack asparagine synthetase.
Asparaginase
MOA: hydrolyzes circulating L-asparagine into aspartic acid and ammonia, effectively inhibiting protein synthesis
Cell cycle specific (G1)
Acute lymphoblastic leukemia tumor cells lack the enzyme asparagine synthetase adn require an exogenous source of L-asparagine, rendering them selective to and vulnerable to asparaginase
Which of the following cytogenetic aberrations is most likely given the diagnosis of CML? inv(16) t(5;14) t(8;13) t(9;22) t(15;17)
t(9;22)- philadelphia chromosome
What protein is newly created in patients with the Philadelphia chromosome translocation?
BCR-ABL CBFβ-MYH11 FGFR1-ZNF198 IL3-IgH PML-RARα
BCR-ABL
Which chemotherapeutic agent is the first choice for this patient and acts by inhibiting the BCR-ABL fusion protein?
Erlotinib Gefitinib Imatinib Lapatanib Sorafenib
Imatinib
Molecular testing reveals that a mutation has occurred in the BCR-ABL fusion protein. Which agent is most appropriate in this situation?
Bevacizumab Bortezomib Dasatinib Erlotinib Trastuzumab
Dasatinib
Why is chemotherapy recommended after surgery?
Micrometastases may be present in distant tissues
Small populations of tumor cells may remain within the tissue
Surgery and radiation have only reduced her tumor burden
Surgery can stimulate dormant cells into the cell cycle
All of the above are possible reasons
all of the above
Based on the fact that the tumor sample expresses the HER-2/neu epidermal growth factor receptor, which drug class listed may be used to target this receptor and is an appropriate choice to treat this patient?
Anthracyclines Antifolates Monoclonal antibodies Platinum compounds Taxanes
monoclonal antibodies
Which agent below is a monoclonal antibody used to treat HER2/neu+ breast cancer?
Alemtuzumab Erlotinib Imatinib Lapatinib Trastuzumab
trastuzumab
A patient is treated with a combination of cyclophosphamide, doxorubicin, paclitaxel, and trastuzumab over the course of 6 months. Following treatment, a PET scan shows she is in remission. At a one-year follow-up appointment, a bone scan reveals metastatic disease in the brain, liver, and lungs. Which is the most likely explanation for continued cancer growth during this time?
Drug-drug interactions Drug resistance Increased CYP450 enzyme activity Pharmacological sanctuary Poor patient compliance
Drug resistance
After treatment, a pulmonary function test indicates decreased pulmonary function compared to pre-treatment ability. Which treatment most likely accounts for the observed decrease in function?
Bleomycin Cisplatin Etoposide Orchiectomy Radiation
Bleomycin, the only anti-tumor cell antibiotic that is cell cycle specific. It has pulmonary toxicity
Which of these agents is cell cycle nonspecific?
Bleomycin
Cisplatin
Etoposide
Cisplatin
What is the major dose-limiting toxicity of cisplatin?
Cardiotoxicity Hemorrhagic cystitis Nephrotoxicity Hepatotoxicity Pulmonary toxicity
Nophrotoxicity- also ototoxicity.
Antitode for cyclopohosphamide-induced hemorrhagic cystitis?
mesna
Vincristine is administered to a patient with a tumor that is likely to be responsive to the drug. Which is the most likely adverse effect?
Nephrotoxicity Neutropenia Peripheral sensory and motor neuropathy Pulmonary damage Thrombocytopenia
Peripheral sensory and motor neuropathy
Which drugs from the same class as vincristine would be likely to cause neutropenia and thrombocytopenia
vinblastine
A 65 y/o male develops severe, irreversible cardiomyopathy because the maximum lifetime dose of an anticancer drug was exceeded. Which agent is most likely responsible for this patient’s symptoms?
Asparaginase Bleomycin Cisplatin Cyclophosphamide Daunorubicin
daunorubicin
class: anthracyclins
mechanism: free radicals
A 5 y/o male presents with Wilms tumor and is prescribed an agent that acts by intercalating into DNA strands. The drug is efficacious regardless of which stage of the cell cycle the tumor cells are in. Which of the following drugs best fits this description?
Cytarabine Doxorubicin Fluorouracil Ifosfamide Vinblastine
doxorubicin.
DNA intercalation does not involve covalent bonds between the drug and DNA
A 55 y/o female recently diagnosed with chronic myelogenous leukemia (CML) is being treated with imatinib. Which of the following effects are anticipated in response to imatinib therapy?
A high rate of therapeutic failure, and the need to switch to interferon α2a and α2b
Hypotension and hypovolemia due to drug-induced diuresis
Interactions with other drugs that induce the CYP450 system
Significant toxicity to normal host cells due to profound inhibition of tyrosine kinase
Thrombocytosis with a high risk of intravascular clotting
INteractions with other drugs that induce the CYP450 system
As a general rule, large solid tumors are more difficult to eradicate when chemotherapy is initiated. Which of the following tumor-based properties explains best the reason for this chemotherapeutic limitation?
Growth fraction slows, more cells enter G0
A Hodgkin disease patient received mechlorethamine as part of his treatment plan. Which best describes the anticancer mechanism of action of this agent?
Alkylates DNA, causing cross-links between parallel DNA strands
Blocks microtubule assembly and mitosis during M-phase
Inhibits topoisomerase, preventing repair of DNA strand breaks
Intercalates in DNA strands
Stabilizes microtubules, thereby preventing mitosis
Alkylates DNA, causing cross-links between parallel DNA strands
