Chapter 61: Oncology I: Overview and Side Effect Management

Question 1

Screening: Breast Cancer

Answer 1

Age 45-54 begin yearly mammograms

Age >= 55 begin mammograms every 2 years of continue yearly

Question 2

Screening: Cervical

Answer 2

Age 21-29 pap smear every 3 years

Age 30-65 pap smear + HPV test every 5 years

Question 3

Screening: Colon

Answer 3

Age >= 45 stool based test (fecal occult blood test every year) or (stool DNA test every 3 years)
Colonoscopy every 10 years
Sigmoidoscopy every 5 years

Question 4

Screening: Lung

Answer 4

Age 55-74 annual CT scan of chest if all of the following:
in good health
have at least a 30 pack-year smoking history
still smoking or quitting smoking within the last 15 years

Question 5

Screening: Prostate

Answer 5

Age >=50 If patient chooses to be tested it involves:
prostate specific antigen (PSA) blood test
+/- a digital rectal exam (DRE)

Question 6

Maximum Doses for Hight Toxic Drugs: Bleomycin

Answer 6

Max: lifetime cumulative dose of 400 units
Reason: Pulmonary toxicity

Question 7

Maximum Doses for Hight Toxic Drugs: Doxorubicin

Answer 7

Max: lifetime cumulative dose of 450-550mg/m2
Reason: Cardiotoxicity

Question 8

Maximum Doses for Hight Toxic Drugs: Cisplatin

Answer 8

Max: Dose per cycle not to exceed 100mg/m2
Reason: Nephrotoxicity

Question 9

Maximum Doses for Hight Toxic Drugs: Vincristine

Answer 9

Max: single dose “capped” at 2mg
Reason: neuropathy

Question 10

Common Toxicities, Drugs, and Management: Myelosuppression

Answer 10

Drugs: All chemotherapy drug except: asparaginase, bleomycin, vincristine
Management: Neutropenia: colony stimulating factors
Anemia: RBC
Thrombocytopenia: platelet transfusion

Question 11

Common Toxicities, Drugs, and Management: Nausea and Vomiting

Answer 11

Drugs: Cisplatin, cyclophosphamide, ifosfamide
Management: Neurokinin-1 receptor antagonists (NK1-RA)
Serotonin-3 receptor antagonists (5HT3-RA)
Dexamethasone
IV/PO fluid hydration

Question 12

Common Toxicities, Drugs, and Management: Mucositis

Answer 12

Drugs: Fluorouracil, methotrexate
Management: symptomatic treatment (mucosal coating agents, local topical anesthetics)

Question 13

Common Toxicities, Drugs, and Management: Diarrhea

Answer 13

Drugs: Irenotecan, capecitabine, fluorouracil, methotrexate
Management: IV/PO fluid hydration, antimotility agents (loperamide).
Irenotecan: atropine for early onset diarrhea

Question 14

Common Toxicities, Drugs, and Management: Constipation

Answer 14

Drugs: Vincristine
Management: Stimulant laxatives, polyethylene glycol

Question 15

Common Toxicities, Drugs, and Management: Xerostomia

Answer 15

Drugs: caused by radiation to head or neck regions
Management: Artificial saliva substitutes, pilocarpine

Question 16

Common Toxicities, Drugs, and Management: Cardiotoxicity (Cardiomyopathy)

Answer 16

Drugs: anthracyclines
Management: DNE lifetime dose of 450-550 for doxorubicin; give dexrazoxane prophylactically in select patients

Question 17

Common Toxicities, Drugs, and Management: Cardiotoxicity (QT Prolongation)

Answer 17

Drugs: arsenic trioxide, many TKIs
Management: Keep K, Mg, and Ca within normal limits. consider holding if QTc >500

Question 18

Common Toxicities, Drugs, and Management: Pulmonary Toxicity

Answer 18

Fibrosis: bleomycin, busulfan, carmustine
Pneumonitis: Immune therapy Mabs
Management: symptom management, steroids if autoimmune suspected

Question 19

Common Toxicities, Drugs, and Management: Hepatotoxicity

Answer 19

Drugs: antiandrogens (bicalutamide, flutamide, nilutamide)
Management: Steroids if autoimmune mechanism suspected

Question 20

Common Toxicities, Drugs, and Management: Nephrotoxicity

Answer 20

Drugs: cisplatin, methotrexate
Management: Amifostine (ethyol) can be given prophylactically with cisplatin
Adequate hydration
DNE max dose of 100mg/m2/cycle for cisplatin

Question 21

Common Toxicities, Drugs, and Management: Hemorrhagic Cystits

Answer 21

Drugs: ifosamide, cyclophosphamide
Management: Mesna always given prophylactically with ifosamide and sometime cyclophosphamide
Adequate hydration

Question 22

Common Toxicities, Drugs, and Management: Neuropathy

Answer 22

Peripheral: vinca alkaloids, platinums, taxanes
Autonomic: vinca alkaloids
Management: Vincristine: limit dose to 2mg/week
Oxaliplatin: avoid cold temperatures and cold beverages

Question 23

Common Toxicities, Drugs, and Management: Thromboembolic Risk

Answer 23

Drugs: aromatase inhibitors (anastazole, letrozole), SERMs (tamoxifen, raloxifene)
Management: Consider thromboprophylaxis based on risk factors

Question 24

Adjunctive Treatment: Cisplatin

Answer 24

AT: amifostine and hydration
Indication: prophylaxis to prevent nephrotoxicity

Question 25

Adjunctive Treatment: Doxorubicin

Answer 25

AT: dexrazoxane
Indication: prophylaxis to prevent cardiomyopathy

Question 26

Adjunctive Treatment: Fluorouracil

Answer 26

AT: Leucovorin or levoleucovorin
Indication: Given to enhance efficacy

Question 27

Adjunctive Treatment: Fluorouracil or capecitabine

Answer 27

AT: Uridine triacetate
Indication: Antidote: use with in 48 hrs for an overdose or to treat severe life threatening or early onset toxicity

Question 28

Adjunctive Treatment: Ifosfamide

Answer 28

AT: Mesna and hydration
Indication: Prophylaxis to prevent hemorrhagic systitis

Question 29

Adjunctive Treatment: Irinotecan

Answer 29

AT: Atropine and loperamide
Indication: To prevent or treat acute diarrhea and treat delayed diarrhea

Question 30

Adjunctive Treatment: Methotrexate

Answer 30

AT: leucovorin or levoleucovorin and glucarpidase
Indication: given prophylactically to decrease myelosuppression and mucositis.
Antidote to decrease excessive methotrexate levels due to acute renal failure