ASCO mod - Intro to Common Cancer Tx Flashcards
How do you define stages of DLBCL per the Lugano modified Ann Arbor staging?
- Stage 1: 1 nod or group of adjacent nodes or a single extranodal lesion without nodal involvement
- Stage 2: Two or more nodal groups on same side of diaphragm. Or stage 1 or 2 by LN involvement, with limited contiguous extanodal involvement
- Stage 3: Lymph nodes on both sides of the diaphragm. Or nodes above diaphragm and spleen involvement
- Stage 4: Additional non-contiguous extra-lymphatic involvement (like bone marrow)
Explain how Rituximab is administered in a rate escalation format:
First dose takes 4-6 hours.
Start at 50mg/hr then increase by increments of 50mg/hr every 30 minutes as long as there is no reaction. Maximum rate 400mg/hr
If first dose is well-tolerated the 2nd dose can be given faster. 20% of dose in first 30 minutes and then 80% over the next 60 minutes.
Most important side effects of doxorubicin?
Myelosuppression
Cardiac toxicity (acute arrythmias less common, long term cardiomyopathy is more common)
Nausea/vomiting
Secondary malignancy
Recommended lifetime dose of Doxorubicin?
450-550 mg/m2
Which drug interaction must be monitored in Vincristine?
Metabolized by CYP 3A4
So avoid concurrent CYP3A4 inhibitors like Clarithromycin/erythromycin, diltizaem, azoles, ritonavir, grapefruit, etc
ADverse effects of Vincristine?
Constipation
Neuropathy
liver dysfunction
Supportive measures to be considered in conjunction with CHOP therapy?
- Anti-emesis ppx
- TLS prevention
- GCSF for patients >60
- Anti-constipation meds
- Check LVEF and hepatitis B before initiation
Common side effects with cyclophosphamide?
Name at least 4
Myelosuppression N/V, diarrhea mucositis Hemorrhagic cystitis (give MESNA) sterility, teratogenic in 1st trimester SIADH
Common side effects for Taxanes (Paclitaxel, Docetaxel)
Myeosuppression N/V, mucositis, diarrhea Increased LFTs Severe hypersensitivity reactions and anaphylaxis Total body alopecia ocular toxicity
Common side effects of platinum chemo?
Myelosuppresion N/V nephrotoxicity alopecia neurotoxicity
Common tamoxifen toxicity?
hot flashes vaginal discharge cataracts lipid reduction 2-3x increased risk of endometrial cancer increased risk of VTE
Aromatase inhibitor toxicity?
Hot flashes vaginal dryness myalgias bone loss lipid elevation
Major txicity of Trastuzumab?
Cardiotoxicity (reversible)
What adjuvant chemotherapy prescribed for stage 1 colon cancer?
Not indicated, surgery alone
What drug interaction is important to know with 5FU or capecitabine?
Strong inhibitor of CYP2C9.
-Drugs metabolized by CYP2C9: warfarin, ARBs, sulfonylureas, statins, NSAIDS, antiepileptics
What toxicities are common in the FOLFOX regimen and CAPEOX regimen?
Myelosuppression Emesis Alopecia Mucositis Palmar erythrodysesthesia diarrhea cardiovascular peripheral neuropathy infusion reactions
Standard chemo tx for NSCLC?
Platinum doublet
-Carboplatin vs Cisplatin
AND
-Etoposide, paclitaxel, pemetrexed, gemcitabine, or vinorelbine
Can also consider adding Bevacizumab as 3rd agent
Which targeted drugs are approved in NSCLC with EGFR mutations?
Erlotinib, afatinib, osemertinib
What scenario could Pembrolizumab be given in a patient with Stage III NSCLC?
Histology shows >50% PD-L1 staining
Whatkind of lung cancer does Pemetrexed as part of platinum doublet likely have survival benefit?
NSCLC - Adenocarcinoma
What drug is always given with abiraterone during prostate cancer treatment
prednisone
Side effects of LHRH?
hot flashes impotence gyecomastia tumor flare in first two weeks of therapy osteoporosis cardiac risks
Which medicine are given in the first month of initiation of LHRH treatment for prostate cancer?
Why is it given?
Antiandrogen: Bicalutamide, Flutamide, Nilutamide
-given in first month due to tumor flare effect that occurs in first two weeks of initiation of LHRH treatment
Alternative therapy for castration-resistant prostate cancer where mets are to bone only?
Radium 223
