Brain Tumor Chemo

Question 1

Brain metasteses outnumber primary neoplasms by

Answer 1

10:1

Question 2

Most common sites for brain mets to come from

Answer 2

Lung, Breast, Unknown, Melanoma

Question 3

80% of mets go where

Answer 3

hemispheres

Question 4

Management of mets may include more than just anti-tumor treatment

Answer 4

Also managed with steroids to control edema and anticonvulsants for seizures

Question 5

tx of brain mets

Answer 5

Surgery is the mainstay since the BBB is a major issue for traditional chemo

Question 6

Resistance to chemotherapy by the tumor cell may be assisted by communication with astrocytes that lead to upregulation of tumor genes that promote survival and more specifically lower tumor cell apoptosis. The protein products of these genes protect tumor cells from chemo

Answer 6

ok

Question 7

Temozolamide mech

Answer 7

Pro-drug, DNA methylating agent

Labeled for astrocytoma and GBM, Off label for malignant melanoma and glioma

Question 8

AE of temozolomide

Answer 8

myelosuppresion, leukopenia, thrombocytopenia,

Teratogen- CAT X

Question 9

Temozolomide used for

Answer 9

Astrocytoma/ GBM

Question 10

Resistance to Temozolomide

Answer 10

Upregulation of 06- MGMT which repairs the damage done by the methylator

Question 11

Nitrosoureas- mustines

Answer 11

DNA alkylators, high cross resistance with other alkylators, highly lipophilic so CROSS BBB EASY

Question 12

AEsof the mustines

Answer 12

myelosuppresion, N/V, PULM FIBROSIS, endocrine dysfunction, encephalopathy

Question 13

Carmustine

Answer 13

parenteral

Question 14

Lomustine

Answer 14

oral…malignant glioma

Question 15

Which of the mustines not only alkylates but also carbamoylates

Answer 15

Carmustine

Question 16

chemo fog may be from

Answer 16

High TNF-Alpha which may damage mitochondria