Cancer Flashcards
10 questions
what drives the cancer progression?
oncogenes
what inhibits cancer progression?
tumor suppressors
what is cancer caused by?
DNA alterations
what is critical in the prevention of cancer?
DNA proofreading and repair
tumor suppressor proteins that are important for DNA repair; a mutation in these genes predisposes patients to cancer
BRCA 1 and 2
what is the most effective treatment for localized disease?
surgery
radiation that is done prior to surgery
neoadjuvant therapy
radiation that is done after surgery for residual disease
adjuvant therapy
what is chemotherapy dosing based on?
toxicities - the Maximal Tolerated Dose (MTD)
what helps to prevent cancer resistance to drugs?
combination therapy
what 2 kinds of cancer treatments are given orally?
hormonal-based therapy
kinase inhibitors
drugs that inhibit DNA synthesis
antimetabolites
drugs that inhibit mitosis
microtubule targeted agents
MOA of doxorubicin and adriamycin?
inserts into DNA to disrupt topoisomerase II-mediated replication
what 10 cancers is Doxorubicin/Adriamycin used in?
bladder
breast
leukemia
lung
lymphoma
myeloma
ovarian
sarcoma
stomach
thyroid
ADR of doxorubicin/adriamycin?
cardiotoxicity
in which patients should we not use doxorubicin/adriamycin?
patients with heart disease
liposomal formulated doxorubicin that has altered distribution; more goes to skin and less goes to heart - leading to skin rashes
doxil
-platin
and MOA?
platinum agents
crosslink DNA
in which 7 cancers are platinum agents used in?
brain
breast
bladder
cervical
head/neck
lung
testicular
which cancer is carboplatin used for?
ovarian
which cancer is oxaliplatin used for?
colorectal
2 ADR of cisplatin?
neurotoxicity
nephrotoxicity
ADR of carboplatin?
myelosuppression
ADR of all platinum agents?
hearing loss
antimetabolite that is a thymidine synthase inhibitor; prevents DNA synthesis
5-FU
what 6 cancers is 5-FU used for?
breast
basal cell carcinoma
colon
rectum
stomach
pancreas
3 ADR of 5-FU?
inflammation of mouth/skin
CNS damage
diarrhea
what is it called when one pathway is lost in cancer cells, and they become dependent on other pathways that normal cells are not dependent on?
synthetic lethality
collateral DNA damage as a result of cancer treatment can give rise to _____ _____
secondary cancers
what patients are at a high risk for secondary cancers over time?
pediatric patients
antimitotics against rapidly dividing tumors, hematological malignancies slow-growing tumors (prostate) and in non-dividing cells due to trafficking and signaling defects
microtubule targeted drugs
name the 3 microtubule destabilizers
“on the EVV on an exam, I’m destabilized”
eribulin
vinblastine
vincristine
what are the 6 uses for microtubule destabilizers?
lung cancer
leukemia
lymphoma
neuroblastoma
sarcoma
testicular
name the 3 microtubule stabilizers
paclitaxel
docetaxel
ixabepilone
what are the 8 uses for microtubule stabilizers?
breast
cervical
head/neck
lung
ovarian
pancreas
prostate
stomach
what are the 4 ADR of microtubule targeting agents / antimitotic chemotherapies?
“M for marrow dysfunction, T for (neuro)toxicity/peripheral neuropathy, and A for abdominal disturbance/alopecia”
bone marrow dysfunction
GI disturbance
alopecia
peripheral neuropathy
what is the defining marker of lymphoma?
CD30
microtubule destabilizer that is combined with CD30, which is then separated when inside the cancer cell by cathepsin cleavage
MMAE
what is the use for MMAE?
lymphoma
2 ADR of MMAE?
peripheral neuropathy
neutropenia
what is the most likely mechanism of drug resistance in cancer?
innate resistance
what cancer cells lead to relapse/resistance? (3)
slow growing
can pump out drug
can evade immune system
what are the 3 mechanisms of drug resistance in cancer?
specific (binding site change)
upregulation of complementary pathways (oncogene inhibited)
multidrug resistance (efflux pump)
what is a strategy to avoid drug resistance in cancer?
combination chemotherapy
luteinizing hormone releasing hormone agonist that upregulates the release of androgen, leading to feedback inhibition, eventually inhibiting the release of FSH and LH
leuprolide (lupron)
luteinizing hormone antagonist that prevents LHRH from binding to receptors in the pituitary gland
degarelix (firmagon)
what are the uses for LHRH agonists and LH antagonists?
androgen-depending prostate cancer
8 ADR of LHRH agonists and LH antagonists?
associated with androgen deprivation
hot flashes
decreased bone density
loss of muscle mass
weight gain
insulin resistance
ED
low libido
cognitive impairments
inhibitors of androgen receptor activity that directly bind and inhibit activity of testosterone receptors at multiple levels (2)
bicalutamide (cased)
enzalutamide (xtandi)
-lutamide
inhibitors of androgen receptor activity
what are the uses for inhibitors of androgen receptor activity? (2)
hormone-responsive prostate cancer
castration resistant prostate cancer
prostate cancer that continues to grow despite low levels of androgen
castration resistant prostate cancer
GnRh/LHRH agonists that stop the ovaries from making estrogen (2)
leuprolide (lupron)
goserelin (zoladex)
what is the use for GnRH/LHRH agonists?
hormone-positive breast cancer in premenopausal women
aromatase inhibitors that inhibit conversion of androgens into estrogens (3)
anastrozole (arimidex)
letrozole (femara)
exemestane (aromasin)
“Ana Let’s her Ex do whatever he wants” = postmenopausal
what is the use for aromatase inhibitors?
hormone-positive breast cancer in postmenopausal women
selective estrogen receptor modulator that is an antagonist in breasts and an agonist in uterus and bone
tamoxifen (novadex)
what is the use for selective estrogen receptor modulators?
estrogen-positive breast cancer in premenopausal women
estrogen receptor antagonist that is used for hormone-positive breast cancer in postmenopausal women
fulvestrant (faslodex)
antibody that binds to HER2 receptors on tumor cells, preventing activation of HER2, blocking tumor growth and survival
Herceptin (trastuzumab)
what is the use for trastuzumab?
HER2 positive breast cancer
what is the most effective treatment option for triple negative breast cancer?
chemotherapy
kinase inhibitor that inhibits ABL tyrosine kinase activity, used for CML
gleevec (imatinib)
caused by a single chromosomal translocation event that generates a hybrid gene/fusion protein known as BCR-ABL
CML
molecularly targeted kinase inhibitors can be effective in _____ _____ molecular settings when the main pathway driving the tumor can be _____
well defined
inhibited
why aren’t kinase inhibitors a good long-term treatment for other cancers, besides CML?
resistance occurs by upregulating complementary pathways
VEGF inhibitory antibody that inhibits the growth of vasculature in cancer
bevacizumab (avastin)
VAS for vasculature
what are the 5 uses of VEGF inhibitory antibody?
cervical
colorectal
glioblastoma
ovarian
renal
VEGF kinase inhibitors that inhibit the growth of vasculature in cancer (2)
sorafenib (nexavar)
sunitinib (sutent)
what are the 3 uses of sorafenib?
hepatocellular (liver)
renal
thyroid
“sora like sorry = HRT (hurt)”
what are the 3 uses of sunitinib?
GI
pancreas
renal
8 ADR of chemotherapies that block angiogenesis?
hemorrhage
clots
GI perforation
hypertension
healing defects
fatigue
diarrhea
cardiac failure
what anticancer drugs can promote long-term survival advantages in 30% of patients with high mutational burden?
checkpoint inhibitors
work by inhibiting mechanisms that cancer cells use to evade detection by the immune system / “take the brake off the immune system”
checkpoint inhibitors
name the 4 PD-1 inhibitors that block signaling of the T cell immune checkpoint (PD-1)
keytruda
opdivo
tecentriq
imfinzi
which 2 checkpoint inhibitors can be used for melanoma and lung cancer?
keytruda
opdivo
besides melanoma and lung cancer, what can keytruda be used for? (2)
head/neck
high mutational burden
besides melanoma and lung cancer, what can opdivo be used for? (2)
renal
lymphoma
2 uses for tecentriq and imfinzi?
urothelial (bladder)
lung
CTLA-4 inhibitor - (CTLA-4 usually regulates antitumor immune response initiation)
yervoy
what is the use for yervoy?
melanoma
what are the ADR for checkpoint inhibitors (PD-1 inhibitors and CTLA-4 inhibitors)?
autoimmune effects months after treatment
