ASCO mod - Intro to Common Cancer Tx

Question 1

How do you define stages of DLBCL per the Lugano modified Ann Arbor staging?

Answer 1

• 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)

Question 2

Explain how Rituximab is administered in a rate escalation format:

Answer 2

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.

Question 3

Most important side effects of doxorubicin?

Answer 3

Myelosuppression
Cardiac toxicity (acute arrythmias less common, long term cardiomyopathy is more common)
Nausea/vomiting
Secondary malignancy

Question 4

Recommended lifetime dose of Doxorubicin?

Answer 4

450-550 mg/m2

Question 5

Which drug interaction must be monitored in Vincristine?

Answer 5

Metabolized by CYP 3A4

So avoid concurrent CYP3A4 inhibitors like Clarithromycin/erythromycin, diltizaem, azoles, ritonavir, grapefruit, etc

Question 6

ADverse effects of Vincristine?

Answer 6

Constipation
Neuropathy
liver dysfunction

Question 7

Supportive measures to be considered in conjunction with CHOP therapy?

Answer 7

• Anti-emesis ppx
• TLS prevention
• GCSF for patients >60
• Anti-constipation meds
• Check LVEF and hepatitis B before initiation

Question 8

Common side effects with cyclophosphamide?

Name at least 4

Answer 8

Myelosuppression
N/V, diarrhea
mucositis
Hemorrhagic cystitis (give MESNA)
sterility, teratogenic in 1st trimester
SIADH

Question 9

Common side effects for Taxanes (Paclitaxel, Docetaxel)

Answer 9

Myeosuppression
N/V, mucositis, diarrhea
Increased LFTs
Severe hypersensitivity reactions and anaphylaxis
Total body alopecia
ocular toxicity

Question 10

Common side effects of platinum chemo?

Answer 10

Myelosuppresion
N/V
nephrotoxicity
alopecia
neurotoxicity

Question 11

Common tamoxifen toxicity?

Answer 11

hot flashes
vaginal discharge
cataracts
lipid reduction
2-3x increased risk of endometrial cancer
increased risk of VTE

Question 12

Aromatase inhibitor toxicity?

Answer 12

Hot flashes
vaginal dryness
myalgias
bone loss
lipid elevation

Question 13

Major txicity of Trastuzumab?

Answer 13

Cardiotoxicity (reversible)

Question 14

What adjuvant chemotherapy prescribed for stage 1 colon cancer?

Answer 14

Not indicated, surgery alone

Question 15

What drug interaction is important to know with 5FU or capecitabine?

Answer 15

Strong inhibitor of CYP2C9.

-Drugs metabolized by CYP2C9: warfarin, ARBs, sulfonylureas, statins, NSAIDS, antiepileptics

Question 16

What toxicities are common in the FOLFOX regimen and CAPEOX regimen?

Answer 16

Myelosuppression
Emesis
Alopecia
Mucositis
Palmar erythrodysesthesia
diarrhea
cardiovascular
peripheral neuropathy
infusion reactions

Question 17

Standard chemo tx for NSCLC?

Answer 17

Platinum doublet
-Carboplatin vs Cisplatin
AND
-Etoposide, paclitaxel, pemetrexed, gemcitabine, or vinorelbine

Can also consider adding Bevacizumab as 3rd agent

Question 18

Which targeted drugs are approved in NSCLC with EGFR mutations?

Answer 18

Erlotinib, afatinib, osemertinib

Question 19

What scenario could Pembrolizumab be given in a patient with Stage III NSCLC?

Answer 19

Histology shows >50% PD-L1 staining

Question 20

Whatkind of lung cancer does Pemetrexed as part of platinum doublet likely have survival benefit?

Answer 20

NSCLC - Adenocarcinoma

Question 21

What drug is always given with abiraterone during prostate cancer treatment

Answer 21

prednisone

Question 22

Side effects of LHRH?

Answer 22

hot flashes
impotence
gyecomastia
tumor flare in first two weeks of therapy
osteoporosis
cardiac risks

Question 23

Which medicine are given in the first month of initiation of LHRH treatment for prostate cancer?
Why is it given?

Answer 23

Antiandrogen: Bicalutamide, Flutamide, Nilutamide

-given in first month due to tumor flare effect that occurs in first two weeks of initiation of LHRH treatment

Question 24

Alternative therapy for castration-resistant prostate cancer where mets are to bone only?

Answer 24

Radium 223