Cancer medications

Question 1

Lenvatinib

Answer 1

Multi-target TKI

Uses: Follicular cell thyroid cancer

Question 2

Dabrafenib

Answer 2

BRAF Val600Glu mutation (TKI)
Uses: BRAF mut Melanoma, 60% papillary thyroid cancer

Used in combo with Trametinib (MEK kinase inhibitor)

Question 3

Selpercantinib

Answer 3

Highly selective RET inhibitor

Uses: RET mutated medullary thyroid cancer, RET mutated follicular thyroid cancer

Question 4

Pembrolizumab / Nivolumab

Answer 4

PD-1 Inhibitor

Uses: Multiple cancers!

Question 5

Atezolizumub

Answer 5

PD-L1 inhibitor

Uses: Bladder, SCLC, More

Question 6

Olaparib

Answer 6

PARP Inhibitor
MOA: leads to tumour selective cell death via synthetic lethality
Uses: BRAC positive breast cancer, BRAC positive ovarian,

Question 7

Trastuzumab + Pertuzumab

Answer 7

Anti-HER2
Uses: HER2 positive breast cancer
Given with chemo. 52 weeks standard of care. DUAL - HER2 blockage
AE: cardiotoxic, reversible if stopped

Question 8

T-DM1

Answer 8

Trastuzumab-Emtansine
Use: HER2 positive breast cancer
Antibody drug conjugate
Binds onto HER2 and DM1 internalised and acts as cytotoxic agent
- BYSTANDER EFFECT

Question 9

Tamoxifen

Answer 9

Selective Oestrogen Receptor Modulator (SERM)
ER/PR postive breast cancer
Improves BMD
Slight risk 1 in 1000 extra endometrial cancer
VTE risk

Question 10

Letrozole, Exemestane

Answer 10

Aromatase Inhibitors
MOA: Blocks DHEA
Slightly more effective than Tamoxifen
Reduced BMD
No increase VTE or Uterine Ca
Post-meno only
Arthralgia and vaginal atrophy common

Question 11

Palbociclib, Ribociclib, Abemaciclib

Answer 11

CDK4/6 Inhibitors
Metastatic ER/PR positive breast cancer: First line with endocrine therapy
MOA: reduce phosphorylation of Rb and prevent cell cycle progression at G1
SE: Neutropaenia common, infection rare.., diarrhoea

Question 12

Cetuximab, Panitumimab

Answer 12

Anti-EGFR
CRC - RAS WILD TYPE. LEFT SIDED PRIMARY
Cutaneous acne form rash - predictive of response. Relates to RR and OS

Question 13

Bevacizumab

Answer 13

Anti-VEGF
Uses: CRC (regardless of RAS/RAF)
AE: HTN, Wound breakdown, VTE, GI perf

Question 14

Sorafenib

Answer 14

Multitarget TKI
Use: Was first line for HCC (now overtaken by Atezolizumab + Bevacizumab)
SE: Diarrhoea, Hand-Foot syndrome, HTN

Question 15

Durvalumab

Answer 15

PD-L1 monoclonal Ab
Given post concurrent platinum chemo RTx for lung cancer
Regardless of PDL1 status. Improves OS 0.68. Standard of care

Question 16

Osimertinib

Answer 16

EGFR TKI Inhibitor
Uses: EGFR Mutated NSCLC.
EGFR mutant and T790M mutant (was old acquired resistance mutation)
- Older drugs: Erlotinib/Gefinitib
Excellent CNS penetration
AE: Acneiform rash. PREDICTIVE OF RESPONSE. Diarrhoea, Alopecia, Pulmonary toxicity

Question 17

Alectinib

Answer 17

MOA: TKI - EML4-ALK fusion oncogene
ALK Gene Rearrangement. Chromosomal translation
Older - Crizotinib

Question 18

Crizotinib

Answer 18

ROS1 mutated NSCLC

Question 19

Trametinib

Answer 19

MEK kinase inhibitor

Uses: BRAF mutant metastatic melanoma

Question 20

Vemurafenib + Cobimetinib

Answer 20

BRAF and MEK kinase inhibitors

Uses: Metastatic melanoma

Question 21

Sunitinib

Answer 21

TKI - Inhibits VEGF, PDGF
Uses: Was 1st line for RCC (now Ipi + Nivo if fit)
HTN - PREDICTIVE MARKER

Question 22

Ipilimumab

Answer 22

Anti-CTLA-4
MOA: Binds to CTLA-4 on T cell so CTLA-4 is unable to bind B7 and provide an inhibitory signal. No inhibition = ongoing T cell activity

Question 23

INDICATIONS FOR IPI + NIVO

Answer 23

1) BRAF neg metastatic melanoma - 1st line
2) Mesothelioma - 1st line
3) Metastatic RCC - 1st line

Question 24

Alpelsiib

Answer 24

Alpha specific PI3 kinase inhibitors phosphoinositide-3-kinsae inhibitor

• Inhibit PI3/AKT/mTOR signalling pathway and tumour suppression
• Survival benefit in HR positive, HER2 negative advanced breast cancer in combination with Fulvestrant
• SEs: rash, hyperglycaemia, nausea/vomiting