Chapter 62: Oncology II - Common Cancers & Cancer Treatment Flashcards
When treatment has destroyed all known tumors
Complete response
When at least 30% of the tumor was eliminated
Partial response
The majority of adverse effects are due to damaging effects on non-cancerous, rapidly-dividing cells in the:
GI tract, hair follicles and bone marrow, where the production of blood cells take place
Which drugs can increase the risk of skin cancer
Immunosuppressants (including many transplant drugs)
What does each letter stand for in ABCDE for educating patients on suspicious skin spots?
Asymmetry Border Color Diameter Evolving
What is the top risk factor for breast cancer
Being female
What are the modifiable RF for breast cancer
Being overweight (in postmenopausal women)
Low physical activity
Poor nutrition
Tobacco use
Which genes normally suppress tumor growth in breast cancer
BRCA1 and BRCA2
Inherited mutations in BRCA1 and BRCA2 prevent:
cell repair and causes dramatic increase in breast cancer incidence
What is Klinefelter Syndrome
A congenital condition in which males have one Y chromosome and two or more X chromosomes (normally, they only have one X and one Y)
They produce more estrogen than is typical for males & have higher risk of breast cancer
For breast cancer, hormone sensitive (e.g., ER+) cancer for premenopausal women is treated with
Tamoxifen
For breast cancer, hormone sensitive (e.g., ER+) cancer for postmenopausal women is treated with
Aromatase Inhibitor
What drug class does tamoxifen fall under
SERM
Is tamoxifen an estrogen agonist or antagonist in breast cells?
Antagonist
MOA of aromatase inhibitors
Reduce estrogen production by blocking the aromatase enzyme that catalyzes the conversion of androgens to estrogens
Which SERM is used for breast cancer prevention (NOT treatment)
Raloxifene
What is another use of raloxifene & it’s benefit
Used for osteoporosis prevention and treatment in postmenopausal women
Increases bone density
Raloxifene is not first-line for osteoporosis because of what SE/risks
Hot flashes
Clotting risk
In some circumstances, a premenopausal woman will be put into menopause by taking a GnRH agonist. What is the MOA of GnRH agonists
Decrease LH and FSH, which suppresses ovarian estradiol production. This makes aromatase inhibitors a reasonable option
The HER2 oncogene promotes:
Breast tumor growth
What formulation does fulvestrant come in
IM injection
Tamoxifen should not be used with
2D6 inhibitors, such as fluoxetine and paroxetine
What drug can be used with tamoxifen to treat hot flashes
Venlafaxine
Tamoxifene boxed warnings
Increased risk of uterine or endometrial cancer and thrombotic events (also raloxifene)
Side effects of tamoxifene and fulvestrant
hot flashes/night sweats, vaginal bleeding/spotting, vaginal discharge/dryness/pruritis, decreased libido, decreased bone density (premenopausal women) - supplement with calcium/vitamin D
Which SERM drug is teratogenic
Tamoxifen
Anastrozole brand name
Arimidex
Which drug class has a higher risk of CVD: SERMs or Aromatase Inhibitors
AIs
Which drug class has a higher risk of osteoporosis: SERMs or Aromatase Inhibitors
AIs
Side effects of aromatase inhibitors
Hot flashes/night sweats, arthralgia/myalgia
What drugs are contraindicated with any history of breast cancer
Estrogen-containing meds
Androgen deprivation therapy (ADT) for prostate cancer is also called
Chemical castration
Androgen deprivation therapy is achieved with either:
GnRH antagonist alone or a GnRH agonist (initially taken with an antiandrogen)
Another name for GnRH agonists
LHRH agonists
The initial surge of testosterone caused by GnRH agonists is called
Tumor flare
Symptoms include bone pain and difficulty urinating
To prevent tumor flares with GnRH agonists, what can be given in combination
Antiandrogens for several weeks at the start of a GnRH agonist
Leuprolide brand name
Lupron Depot
Goserelin brand name
Zoladex
Concerns with GnRH agonists
Decrease bone density; supplement with calcium/vitamin D
Tumor flares
GnRH agonist side effects
Hot flashes, impotence, gynecomastia, bone pain
Degarelix, a GnRH antagonist, has what concerns
Osteoporosis risk
No tumor flares
How to calculate BSA using Mosteller Equation
BSA (m2) = √ Ht (cm) x Wt (kg) / 3600
Cyclophosphamide and ifosfamide produce a metabolite called ____ that concentrated in the bladder and can cause hemorrhagic cystitis
Acrolein
Which chemoprotectant inactivates acrolein in the bladder without interfering with the cyctotoxic efficacy of cyclophosphamide and ifosfamide
Mesna
Between cyclophosphamide and ifosfamide, which drug is ALWAYS given with mesna
Ifoafamide
cyclophosphamide is only used with mesna at high doses
Busulfan has a side effect of
Pulmonary toxicity
Dacarbazine turns what color when decomposed
pink
Mitomycin has a concern for
Vesicant
Which platinum chemotherapy is associated with the highest incidence of nephrotoxicity
Cisplatin
Besides nephrotoxicity and CINV, what other concern does cisplatin have
Ototoxicity
Which chemoprotectant is given prophylactically to prevent cisplatin-induced nephrotoxicity
Amifostene (Ethyol)
What is the Calvert formula used to dose carboplatin in adults
Total carboplatin dose (mg) = Target AUC x (GFR + 25)
Using the Calvert formula to dose carboplatin, what is the GFR usually capped at
125 mL/min
Doses of cisplatin > ____ mg/m2/cycle must be confirmed with a prescriber
100
Which chemoprotectant is indicated for prevention of doxorubicin-induced cardiotoxicity
Dexrazoxane (Zinecard)
remember this brand name bc it has the word “card” in it for cardio
What is the antidote for accidental doxorubicin extravasation
Dexrazoxane (Totect)
Zinecard may be considered when the doxorubicin cumulative dose > ___ mg/m2
300
What color does doxorubicin turn urine, tears, sweat and saliva
Red
Mitoxantrone is an anthracendione related to the anthracyclines that turns urine, sclera and other body fluids which color
Blue
Irinotecan causes acute cholinergic symptoms such as diarrhea, which should be treated with ____. Delayed diarrhea should be treated with ___
Atropine
Loperamide
Etoposide IV causes:
Infusion-rate hypotension: infuse over 30-60 min
Etoposide capsules should be
Refrigerated
T/F: Bleomycin causes myelosuppression
False
Which vinca alkaloid when given intrathecally will cause progressive paralysis and death
Vincristine
Which two vinca alkaloids are associated with more bone marrow suppression
Vinblastine and vinorelbine
VInca alkaloids are potent vesicants and should be treated with _____ if extravasation occurs
Warm compresses and hyaluronidase
T/F: vinca alkaloids can be given via IV administration
True
What can occur with all taxanes
Severe infusion-related hypersensitivity reactions and fatal anaphylaxis: premedicate
Docetaxel can cause severe ___
fluid retention
All taxanes except paclitaxel should use _____
non-PVC bag and tubing
Which taxane does not require premedication
Paclitaxel
Paclitaxel and cabazitaxel should use _____
0.22-micron filter
What is given with fluorouracil to increase its efficacy
Leucovorin
Capecitabine brand name
Xeloda
What increases the risk of severe fluorouracil toxicity
DPD deficiency
Side effects of 5-FU and capecitabine
Hand-foot syndrome, diarrhea, mucositis
Methotrexate brand name
Trexall
Methotrexate doses used for RA/psoriasis are given
weekly, not daily
High-dose MTX requires
Leucovorin rescue
Folate antimetabolites interfere with the enzymes involved in the folic acid cycle, blocking purine and pyrimidine biosynthesis during which phase of the cell cycle
S phase
What antidote will rapidly decrease MTX levels that remain high despite hydration and urinary alkilinazation
Glucarpidase
Drug interactions with MTX
NSAIDs, salicylates
Boxed warnings for MTX
Myelosuppression, renal damage, hepatotoxicity, GI toxicity, teratogenicity
Side effects of the mTOR inhibitor everolimus
Mouth ulcers/stomatitis, rash, interstitial lung disease, peripheral edema, dyslipidemia, increased BP
Bevacizumab brand name
Avastin
Concern with bevacizumab (VGEF inhibitor)
Impairs wound healing: do not administer for 28 days before or after surgery
Bevacizumab boxed warnings
Severe/fatal bleeding, GI perforation
Trastuzumb brand name
Herceptin
Monitoring for trastuzumab
LVEF (using echo or MUGA scan)
Persons using cetuximab need to have what gene
KRAS wild type
Side effect of cetuximab
Acneiform rash - indicates that a patient is expected to have a better response to the drug.
Advise pts to avoid sunlight, use sunscreen. Topical steroids and antibiotics can be given prophylactically
Rituximab brand name
Rituxan
Must premedicate with what drugs when using Rituximab
APAP, steroids, diphenhydramine
What must be done before giving a patient a TKI
PG testing
Oral bioavailability may be altered if taken with food
Imatinib brand name
Gleevec
Someone using imatinib must be positive for which chromosome
Philedelphia chromosome (BCR-ABL)
Side effect of imatinib
Fluid retention
To use vemurafenic and dabrafenib in melanoma, patients must be positive for what mutations
BRAF V600E or V600K mutation
To use afatinib, erlotinib and gefitinib for NSCLC, patients must be positive for what mutation
EGFR
Side effect for EGFR inhibitors
Aceniform rash, which indicates patient is expected to have a better response to the drug
To use alectinib, brigatinib, ceritinib, and crizotinib, patients must be positive for which mutation
ALK
Which chemo agents must be taken with food
Imatinib and capcitabine
Which chemo agents can be taken without regard to food
Tamoxifen and Anastrozole
Which chemo agents are teratogens
Thalidomide, pomalidomide, and lenalidomide
