Antineoplastic: Misc

Question 1

Arsenic Trioxide

Answer 1

• mechanism: induces apoptosis through mitochondrial dependent pathway
• kinetics: IV
• clinical: acute promyelocytic leukemia, multiple myeloma, chronic myelogenous leukemia, and acute myelogenous leukemia
• toxicity/interactions: acute (headache and lightheadedness); delayed (fatigue, cardiac dysrhythmias, fever, dyspnea, fluid retention and weight gain)

Question 2

L-Asparaginase

Answer 2

• mechanism: hydrolyzes asparagine to aspartic acid and ammonia (some neoplastic cells require an external source of asparagine–needed for protein synthesis)
• kinetics: IV or intramuscular (destroyed by gastric enzymes)
• clinical: administered with vincristine and prednisone for acute lymphocytic leukemia
• toxicity/interactions: hypersensitivity reactions, decrease in clotting factors, liver abnormalities, pancreatitis, seizures, and coma (due to ammonia toxicity)

Question 3

Imantinib

Answer 3

• mechanism: signal transduction inhibitor (inhibits tumor tyrosinase kinase)
• kinetics: oral
• clinical: chronic myeloid leukemia, GI stromal tumor
• toxicity/interactions: fluid retention and edema, hepatotoxicity, thrombocytopenia or neutropenia, nausea and vomiting

Question 4

Cetuximab

Answer 4

• mechanism: monoclonal antibody (targets epidermal growth factor receptor on the surface of cancer cells)
• kinetics: IV administration; usually combined with irinotecan
• clinical: colorectal cancer
• toxicity/interactions: difficulty breathing, low blood pressure, interstitial lung disease; rash, fever, constipation, and abdominal pain

Question 5

Gefitinib

Answer 5

• mechanism: targets epidermal growth factor receptor
• kinetics: oral
• clinical: non small cell lung cancer (after it has failed to respond to other therapy)
• toxicity/interactions: interstitial lung disease (rare, presents as acute dyspnea with cough); diarrhea, nausea, and acne-like skin rashes

Question 6

Bevacizumab

Answer 6

• mechanism: monoclonal antibody, antiangiogenesis agent (attaches to and stops vascular endothelial growth factor from stimulating the formation of new blood vessels)
• kinetics: IV
• clinical: metastatic colorectal cancer
• toxicity/interactions: most common (hypertension, stomatitis, and diarrhea); less common (intestinal bleeding, protein in urine, and heart failure); rare (bowel perforation, opening of healed wounds, and stroke)