Cancer drugs Flashcards
Bevacizumab
Cancers treated:
MOA:
Issues
Colorectal
MOA: rhuMAB-VEGF
issues: BBW: Bleeding, GI performation, wound dehisence
ADE: HTN, hypersensitivity
Capecitabine
cancer?
MOA?
Issues
colorectal
MOA: oral produrug metabolized to 5FU
Issues: BBW: dihydropyrimidine dehydrogenase (DPD) deficiency(familial pyrimidinemia) prevents metabolic activation. C/I in renal dysfunction; adverse CV events, Neurologic and hematologic tox
ADE: interacts with oral anticoagulant, coumarin
Cetuximab
cancer:
MOA:
Issues
cancer: colorectal
MOA: rh/mMAB-EGFR
Issues: BBW: caridac and respiratory arrest, +/- sudden death
ADE: infusion reactions. acneiform rash common (76-88%), severe in up to 17% of patients
**Cisplatin **
cancers(3)
MOA
Issues
cancers: anal, esophageal, gastric
MOA: forms DNA intrastand crosslinks and adducts
Issues:
- BM suppression and platinum hypersensitivity
- hearing impairment and renal failure/impairment
**Docetaxel **
Cancer
MOA
Issues
Cancer: Esophageal, gastric
MOA: microtubule stabilizer inhibiitng depolymerization
Issues: **BBW: Increases tx related mortality in NSCLC; edema, C/I in hepatic disease **
ADE: neutropenia = dose limiting tox
Doxorubicin
cancer(s)
MOA
Issues
cancers: gastric and liver
MOA: intercalator, free radical generator, topo II inhibitor (dexrazoxane - reduces cardio tox of doxo via decreased free radical formation)
BBW: ** 1. BW suppression and heart disease**
**2. hepatic disease **
**3. secondary malignancies and extravasational necrosis **
Erlotinib (No BBW)
cancer
MOA
Issues
cancer: pancreas
MOA: EGFR-TKI
ADE: 1. GI tox: N/V diarrhea
- prolonged bleeding
- elevated LFTS
- ocular tox and rarely interstitial lung disease
**Fluorouracil **
cancers
MOA
issues
cancers: esophageal, gastric, pancreas and liver, colorectal and anal
MOA: pyrimidine antimetabolite that inhibits thymidylate synthase (TS) and interferes with RNA synthesis and function. also some effects on DNA
BBW: **Dihyropyrimidien dehydrogenage(DPD) deficiency (familiar pyrimidinemia) lead to enhanced neurotox; enzyme necessary for degrading fluorouracil to an inactive compound (enzyme needed for degrading fluorouracil to an inactive compund) **
ADE: severe hematological tox incluidng BM suppression
**Gemcitabine **
cancer
MOA
issues
cancer: pancrease
MOA: DNA polymerase inhibitor via incorporation of triphosphate form during DNA synthesis
ADE: 1. BM suppression and infection
- sensory peripheral neuropathy, arhtralgia, drowsiness, and fatigue
- N/V, diarrhea, anorexia commonplace - resolve in 2-3 days
glutamic acid
cancer
MOA
issues
cancer: gastric
MOA: nutritional supplement; used to counterbalance deficiencies of HCl in gastric juice
issues: taken orally before meals
**imatinib **
cancer
MOA
issues
cancer: GIST only
MOA: oral TKI as adjuvant tx following complete resection of Kit (CD1117) positive GIST
ADE: 1.GI tox (pain, bloating, N/V, constipation, stomatitis, dyspepsia, etc) common.
- CHF reported in some pts.
- neurologic tox
- fluid retention and edema
interferon-alpha
Cancer
MOA
ISSUES
cancer: GI carcinoid
MOA: enzyme activation follwoing cell surface receptor binding and tyrosine kinase activation
BBW: Neuropsychiatric events: aggression, deppression, and suicice
ADE: flu-like sympotms: fatigue, fever, malaise, myalgia, arthralgia, chills, headache, and weight loss
**irinotecan **
cancer
MOA
issues
cancer(s): colorectal, gastric, pancreas
MOA: Topo I inhibitor
**BBW: BM suppression, diarrhea **
ADE: asthenia, fever, pain, weight loss
Leucovorin
cancers
MOA
issues
cancers: colorectal and pancrease
MOA: redcued folate; modulates the effects of 5-FU
Issues: diarrhea and dehydration
**Methysergide **
not for cancers
MOA
issues
MOA: serotonin inhibitor in GI tract
ADE: vasoconstrictor of large and small arteries; used for migraine therapy
mitomycin
cancer:
MOA
issues (all BBWs)
cancer: anal cancer
MOA: mono or bifunctional alkylating agen
BBW(4): **BM suppression, thrombocytopenia, leukopenia, hemolytic-uremic syndrome(microangiopathic hemolytic anemia, thrombocytopenia/irreversible renal failure) , **
**octreotide **
cancer
MOA
issues
cancer: GI carcinoid
MOA: somatostatin analong:
- reduces duodenal bicarbonate, amylase,
- reduces gastric acidity
- inhibits gallbladder contractility and bile secretion, 4.inhibits meal-induced increases in SMA and portal venous blood
ADE: monitor blood glucose, inhibits insulin and glucagon. dose-related diarrhea
oxaliplatin
cancer
MOA
issues (5)
cancers: colorectal, pancrease
MOA: more potent than cisplatin. the **1,2 diaminocyclohexane **carrier though to contribute to enchanced **cytotoxicty and lack of cross-resistance btw oxaliplatin and cisplatin **
**BBW: dose-limiting neurotoxicity. **
ADE: thrombocytopenia if used with 5-FU + leucovorin. Diarrhea, N/V, stomatitis
sorafenib
cancer
MOA
Issues
cancer(s): liver
MOA: oral multi-kinase inibitor targeting serine/threonine and receptor tyrosine kinase in both tumor and vasculature.
targeted kinases: Raf, VEGFR2,3, PDGFR-beta, KIT, FLT-3, RET
ADE: hand-foot skin rxn characterized by redness, pain, swelling, or blisters onthe palms of the hands/soles of the feet. appears in first 6weeks of tx.
sunitinib
cancer
MOA
ADE
cancer: GIST
MOA: inhibitor of >80 receptor tyrosine kinase(RTKs) including: PDGFRalpha, beta, VEGFR1,2,3, stem cell factor receptor KIT, FLT-3, CSR-1R, and RET
ADE: thrombocytopenia and bleeidng, QT prolongation (fatal) GI complications: GI perforation (have occured rarely in pt w/intraabdominal malignancies)
Trastuzumab
cancer:
MOA
issues
cancer: gastric
MOA: HER-2/neu anitbody; HER2 is downregulated, cyclin-dependent kinase inhibitor p27 accumulates, and cell cycle arrest occurs. also inhibits constitutive HER2 cleavage/shedding mediated by metalloproteases which may correlate with clinical activity.
ADE: LVEF dysfunction and cardiomyopathy. severe infusion related rxns including: anaphylaxis, angioedema, and pulmonary tox; pulmonary tox worse in pts with intrinsic lung disease: **COPD, asthma, resp insufficiency **
