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PT 2 > Block 10 - L6-L7 > Flashcards

Block 10 - L6-L7 Flashcards

1
Q

What is targeted therapy?

A

Cancer drugs designed to interfere with a specific molecular target (typically a protein) that is believed to have a critical role in tumor growth or progression

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2
Q

What are the two types of tyrosine kinase?

A
  1. Transmembrane protein with a ligand binding extracellular domain and a catalytic intracellular kinase domain (receptor)
  2. Non-membrane tyrosine kinase (non-receptor)
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3
Q

What is the common mechanism of TK dysregulation?

A

Fusion of a partner protein with TK due to chromosomal translocation, causing TK oligomerization and activation in the absence of ligand binding or other signals; this can increase cell surivival, proliferation, and drug resistance

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4
Q

What is the MOA of imatinib mesylate?

A

Inhibits critical signaling pathways in the cancer cell that are constitutively active due to the Bcr-Abl fusion protein; occupies the ATP binding site, stopping phosphorylation

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5
Q

What are the AE of imatinib mesylate?

A

Superficial edema, nausea, muscle cramps, abdominal pain, musculoskeletal pain, rash, diarrhea, anemia, neutropenia, thrombocytopenia, CHF (rare)

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6
Q

Why should TSH levels be monitored in patients with hypothyroidism who are taking imatinib mesylate?

A

Imatinib may increase clearance of TH, requiring the thyroid replacement therapy to be increased

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7
Q

What are the indications of imatinib mesylate?

A

Chronic myelogenous leukemia

GI stromal tumor

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8
Q

What is the MOA of cetuximab?

A

EGFR receptor inhibitor (overexpression of EGFR receptors leads to increased signaling and affects cell growth)

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9
Q

What are the AE of cetuximab?

A

Rash, hypersensitivity reactions, diarrhea, hypomagnesemia, trichomegaly

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10
Q

What are the indications of cetuximab?

A

Lung cancer
Head and neck cancer
Colorectal cancer

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11
Q

Why should a KRAS mutation analysis be done before treating colorectal cancer with cetuximab?

A

If KRAS is mutated, the drug will not work

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12
Q

What is the MOA of erlotinib?

A

Inhibition of critical cell signaling pathways by inhibiting the TK domain associated with EGFR

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13
Q

What are the AE of erlotinib?

A

Rash, nausea, anorexia, fatigue

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14
Q

What are the indications of erlotinib?

A

Lung cancer

Head and neck cancer

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15
Q

Why should patients with non-small cell lung cancer have a mutational analysis done before treatment with erlotinib?

A

If there are EGFR activating mutations, this makes the cancer cell more sensitive to TKIs.

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16
Q

What types of patients tend to have EGFR activating mutations?

A

Women
Asians
Never smokers
Adenocarcinoma, bronchoalveolar

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17
Q

What is the MOA of bevacizumab?

A

Ab binds to VEGF ligand, prevents signaling for new blood vessel formation in tumors

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18
Q

What are the AE of bevacizumab?

A

Infusion reactions, proteinuria, HTN, arterial clots, bleeding, colon perforation, reversible posterior leukoencephalopathy syndrome (rare)

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19
Q

What are the indications of bevacizumab?

A

Lung cancer

Metastatic colorectal cancer

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20
Q

What are three oral VEGF inhibitors?

A
  1. Sorafenib
  2. Sunitinib
  3. Pazopanib
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21
Q

What are the AE of the oral VEGF inhibitors?

A

Same as bevacizumab, plus hand-foot syndrome, rashes, and CHF

22
Q

What are the indications for all of the oral VEGF inhibitors?

A

Renal clear cell cancer

23
Q

What are the other indications for Sorafenib?

A

Hepatocellular cancer

24
Q

What are the other indications for Sunitinib?

A

Pancreatic neuroendocrine cancer

GI stromal tumors

25
Q

What is the MOA of trastuzumab?

A

Ab that binds to the extracellular domain of EGFR and decreases signaling pathways

26
Q

What are the AE of trastuzmab?

A

Fever, N/V, infusion, reactions, diarrhea, cough, headache, fatigue, shortness of breath, back pain, rash, muscle pain, heart failure

27
Q

Discuss the heart failure seen in patients taking trastuzumab.

A

Risk is highest in patients receiving concurrent anthracycline; not dose dependent, can be reverse; EF should be monitored

28
Q

What are the indications of trastuzumab?

A 
Breast cancer (w/chemo, Her-2/Neu overexpression)
Stomach and GEJ cancer (w/chemo, Her-2/Neu overexpression)
29
Q

When is critzotinib indicated?

A

Non-small cell lung cancer with ALK-anaplastic lymphoma kinase rearrangements

30
Q

When is vemurafenib indicated?

A

Melanoma w/BRAF activating mutation

31
Q

What is the indication of L-asparaginase and what is its MOA?

A

Acute lymphoblastic leukemia; depletes asparagine pools - leukemia cells lack asparagine synthetase and cannot synthesize asparagine

32
Q

What are the AE of L-asparaginase?

A

Allergic reactions, elevated liver enzymes, clotting, pancreatitis, elevated glucose

33
Q

What is the indication of Hydroxyurea and what is its MOA?

A

Acute myelogenous leukemia; inhibits DNA synthesis by inhibiting ribonucleotide reductase; used to initially control the high white cell count

34
Q

What is the indication of All-trans-retinoic acid and what is its MOA?

A

Acute promyelocytic leukemia; induces terminal differentiation of leukemic cells

35
Q

What are the AE of all-trans-retinoic acid?

A

Mucocutaneous toxicity; retinoic acid syndrome (fever, weight gain, lung infiltrates, pleural or pericardial effusions)

36
Q

What is the indication of arsenic trioxide?

A

Relapsed acute promyelocytic leukemia

37
Q

What are the AE of arsenic trioxide?

A

Fatigue, weight gain, retinoic acid syndrome, QT prolongation

38
Q

What are the general principles of cancer treatment?

A
  1. Establish the diagnosis (biopsy)
  2. Determine the stage (extent of disease at time of diagnosis)
  3. Determine the prognosis and treatment (determined by stage)
  4. Educate the patient
  5. Clearly define the goals of therapy
  6. Evaluate the patient to make sure the patient can tolerate the potential AE
39
Q

___ are drugs given orally or parenterally in an attempt to control or eradicate a malignant process.

A

Chemotherapy

40
Q

What is adjuvant chemotherapy?

A

Chemotherapy given to patients who have had a cancer removed but who are believed to be at risk of having micrometastatic disease

41
Q

What is neoadjuvant chemotherapy?

A

Chemotherapy given to achieve cytoreduction prior to surgery

42
Q

What are the possible goals of chemotherapy in patients who have clinically apparent metastatic disease?

A

Curative or palliative

43
Q

What is patient performance status?

A

Measure of tolerance of chemotherapy (0 = fully active to 5 = death)

44
Q

List the chemocurable cancers.

A

Advanced cancers:

  1. Hodgkin’s disease
  2. Diffuse large B-cell lymphoma
  3. Childhood leukemia
  4. Metastatic testicular cancer
  5. Burkitt’s lymphoma
  6. Choriocarcinoma (F)
45
Q

The killing of cancer cells by chemotherapy drugs follows first order kinetics. What does this mean?

A

The same fraction of cancer cells is killed with each administration of chemotherapy. Thus, in order to achieve a cure with chemo, multiple courses will have to be given.

46
Q

The treatment of cancers with single drugs was unable to produce significant remissions or cures. Thus, how do we treat cancer?

A

Combination chemo

47
Q

Why are drug combinations more effective than single agents?

A

Combinations provide maximal cell kill within the range of toxicity tolerated by the host for each drug (fractional cell kill or log cell kill is increased in combinations compared to single agents) + combining drugs with different MOA provides a broader range of coverage of de novo resistant cell lines

48
Q

List the rules for creating a combination chemotherapy drug program.

A
  1. Drugs chosen should possess activity against the disease when utilized as a single agent
  2. Drugs chosen should have non-overlapping toxicities (except for hair loss, myelosuppression, N/V)
  3. Different MOAs
  4. Cell cycle specific and non-specific drugs
  5. Optimal dose and optimal schedule
49
Q

When is adjuvant therapy indicated?

A
  1. Node positive and selected node negative breast cancer
  2. Stomach cancer
  3. Pancreatic cancer
  4. Selected patients with malignant melanoma
  5. Node positive colon and rectal cancer
  6. Osteogenic sarcoma
  7. Non-small cell lung cancer
  8. Testicular cancer
50
Q

State the single cause of the failure of chemotherapy to cure a patient with cancer.

A

Chemoresistant cancer cells (??)

PT 2 (15 decks)

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