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Heme and Lymph Exam 1 > Cancer Pharm: Immune checkpoint inhibitors + Clinical Application > Flashcards

Cancer Pharm: Immune checkpoint inhibitors + Clinical Application Flashcards

1
Q

What are the 2 immune checkpoint inhibitors that are PD-1 inhibitors?

A

Nivolumab and Pembrolizumab

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2
Q

What are the 3 immune checkpoint inhibitors which are PD-L1 inhibitors?

A

Atezolizumab + Avelumab + Durvalumab

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3
Q

What is the basis for using PD-1 and PD-L1 inhibitors?

A
  • PD-1 is a receptor on T cells
  • Tumors express PD-L1; when activated T-cell binds to this receptor it becomes inactivated
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4
Q

What are 4 mechanisms of resistance to immune checkpoint inhibitors (PD-1 and PD-L1)?

A
  • Primary or acquired
  • Insufficienct generation of anti-tumor T-cells
  • Inadequate function of tumor specific T-cells
  • Impaired formation of T cell memory
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5
Q

What are some common and serious AE’s associated with the immune checkpoint inhibitors?

A
  • Fatigue + nausea + loss of apetite + itching
  • Serious = immune system attacks normal organs i.e., lungs, intestines, liver, kidneys
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6
Q

Discovery and use of which drug dramatically increased the length of survival in ALL?

A

Methotrexate

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7
Q

List 4 drugs other than methotrexate which are active against ALL; which 2 drug combo is added to one of these drugs to induce remission?

A
  • 6-mercaptopurine, Cyclophosphamide, Vincristine and Daunorubicin
  • Combo of Vincristine + Prednisone + one of the agents from above is used to induce remission
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8
Q

Prednisone is added to anti-tumor regimens due to what 4 effects?

A
  • Inhibits cytokine production
  • Alteration of oncogene production
  • Cell cycle arrest
  • Apoptosis
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9
Q

Which drug/route of administration is used as a prophylactic measure to prevent CNS leukemia in ALL?

A

Intrathecal methotrexate

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10
Q

What is the most active agent against AML; best used in combo with what drug?

A

Cytarabine (anti-metabolite) in combo w/ Idarubicin (anthracycline)

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11
Q

After remission is achieved with AML, what is used to maintain durable remission and to induce cure?

A
  • High dose cytarabine

or

  • Hematopoietic cell transplantation
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12
Q

What is the standard 1st-line therapy for CML in previously untreated pt’s in the chronic phase?

A

Imatinib

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13
Q

Which 2 agents are now indicated as 1st-line tx for chronic phase CML, but were originally used in pt’s intolerant/resistant to imatinib?

A

Dasatinib and Nilotinib

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14
Q

Other than the tyrosine kinase inhibitors (-nib’s) what other agents are effective against CML?

A

Busulfan and other oral alkylating agents

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15
Q

What are the 2 most widely used alkylating agents for CLL; which non-classic alkylating agent may also be used?

A
  • Chlorambucil and Cyclophosphamide
  • May also use Bendamustine
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16
Q

In the tx of CLL, Chlorambucil is often combined with what?

A

Prednisone

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17
Q

What are the 2 different combo drugs containing Cyclophosphamide used for tx of CLL?

A
  • COP = Cyclophosphamide + Vincristine + Prednisone
  • CHOP = Cyclophosphamide + Doxorubicin + Vincristine + Prednisone
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18
Q

Which purine antagonist can be used for CLL as a monotherapy or in combo with what?

A
  • Fludarabine as monotherapy
  • Or in combo with cyclophosphamide and with mitoxantrone (anthracycline)
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19
Q

Which 4 drug combo is used in stage I and IIA of Hodgkin’s lymphoma?

A

ABVD = Doxorubicin + Bleomycin + Vinblastine + Dacarbazine

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20
Q

Which combo drug regimen can be used in advanced stage III and IV Hodgkin’s Lymphoma and is less toxic in regards to infertility and 2’ malignancies?

A

ABVD = Doxorubicin + Bleomycin + Vinblastine + Dacarbazine

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21
Q

What are the 7 drugs of Standford V regimen for advanced stage III and IV Hodgkin’s Lymphoma?

A

Doxorubicin + Vinblastine + Mechlorethamine + Vincristine + Bleomycin + Etoposide and prednisone

22
Q

What is the MOPP combo of 4 drugs that can be used for advanced III and IV Hodgkin’s Lymphoma?

A

Mechlorethamine + Vincristine + Procarbazine + prednisone

23
Q

Which 4 combo drug regimen is the best in terms of initial therapy for NHL - diffuse?

A

CHOP = Cyclophosphamide + Doxorubicin + Vincristine + Prednisone

24
Q

Which 2 drug combo is used for NHL - nodular (follicular) at the onset of sx’s?

A

Bendamustine + rituximab

25
What is the standard 2 drug combo for Multiple Myeloma?
**MP protocol** = **Melphalan** (alkylating agent) + prednisone
26
What are the two drug combos which can be used for stage II breast cancer (each contains 3 drugs)?
- **CM****F**=**C**yclophosphamide +**M**ethotrexate +**5-F**luorouracil - **FAC** = **5-F**luorouracil + **Doxorubicin** + **C**yclophosphamide
27
What has become the standard 2 drug regimen for hormone refractory prostate cancer?
**Docetaxel** (works in **M phase**) + prednisone
28
Which 2 combos of 3-drug regimens can be used as adjuvant therapy for high risk stage II and II colorectal cancer?
- **FOLFOX** - **fol**inic acid (**leucovorin**) + **5-FU** + **ox**aliplatin - **XELOX** - **capecitabine** + **ox**aliplatin
29
What is the FOLFIRI regimen for metastatic colorectal cancer; which drug can be added if progression has been observed with oxaliplatin-based chemo?
- **FOL-F-IRI** - **fol**inic acid (**leucovorin**) + **5-FU** + **iri**notecan - **Ziv-afilbercept** added if progression observed w/ oxaliplatin-based
30
Using FOLFOX or FOLFIRI with what other drugs results in significantly improved clinical efficacy against metastatic colorectal cancer?
**Bevacizumab** or **cetuximab/panitumab**
31
Which drug has been approved for chemo-refractory metastatic colorectal cancer but has significant toxicities?
**TAS-102** (**GI toxicity** + **Neutropenia**)
32
Which adjuvant therapy provides survival benefit in NSCLC in pt's with pathologic stage IB, II, and IIIA disease?
**Platinum-based** (-platins)
33
What is the main drug used in NSCLC in pt's with good performance status and non-squamous histology; can add which 2 drugs?
**Bevacizumab** used in combo w/ **carboplatin** and **paclitaxel**
34
If NSCLC pt is not a good candidate for bevacizumab or has a squamous cell histology; which 2 drug combo can be used?
(**C**isplatin or **C**arboplatin) + **C**etuximab
35
Which drug is used as maintenance therapy in NSCLC in pt's who have stabilized after 4 cycles of platinum based 1st-line tx?
**Pemetrexed** (active in **S phase**)
36
What is 1st line drug for **advanced** NSCLC pt's with sensitizing EGFR mutations?
**Erlotinib**
37
What is 1st line drug for metastatic NSCLC pt's with EGFR exon 19 deletions or exon 21 mutations?
**Afatinib**
38
Which drug is used for metastatic NSCLC w/ EGFR T790M-mutant following progression on or after EGFR TKI therapy?
**Osimertinib** (risk of **QTc prolongation** and **cardiomyopathy**)
39
Superior clinical activity against **squamous** cell NSCLC is achieved when what 3 drug combo used?
**Cisplatin** and **Gemcitabine** are combined w/ **necitumumab**
40
Which drug is used for squamous cell NSCLC's that have progressed on or after standard platinum-based chemo?
**Nivolumab**
41
What are the two combos of 2-drug regimens which can be used for SCLC that is initially sensitive to platinum-based regimens?
(**Cisplatin** + **etoposide**) **or** (**Cisplatin** + **irinotecan**)
42
What is the 2nd-line monotherapy for SCLC in pt's that have failed platinum-based regimen?
**Topotecan**
43
Along with whole-abdomen radiotherapy what combination (2-drug) tx is used for stage I ovarian cancer?
**Cisplatin** and **Cyclophosphamide**
44
Which 2-drug combo is tx of choice for stage III and IV ovarian cancer?
**Carboplatin** + **Paclitaxel**
45
Which 2 drugs can be used for recurrent ovarian cancer?
**Topotecan** or liposomal **doxorubicin**
46
What is the 3-drug combo used for testicular cancer?
**PEB** = **Cisplatin** + **Etoposide** + **Bleomycin**
47
List 2 of the most active cytotoxic agents against Malignant Melanoma?
**Dacarbazine** and **Cisplatin**
48
Which 2 biologic agents have greater activity than cytotoxic agents against Malignant Melanoma?
**IFN-**α and **IL-2**
49
Which 2 drugs are approved for unresectable or metastatic Malignant Melanoma?
**Nivolumab** and **Pembrolizumab**
50
Which nitrosourea can be used as a single agent for brain cancer and what is the 3 drug combo regimen which can also be used?
- **Carmustine** as **single** agent - **PCV** regimen = **Procarbazine** + lomustine + **Vincristine**
51
Which single drug can be used alone or in combo for glioblastoma multiforme?
**Bevacizumab**

Heme and Lymph Exam 1 (14 decks)

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