Chapter 62: Oncology II - Common Cancers & Cancer Treatment Flashcards by Emily Jansen

When treatment has destroyed all known tumors

Complete response

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A partial response in cancer is when

at least 30% of the tumor was eliminated

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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

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Which drugs can increase the risk of skin cancer

Immunosuppressants (including many transplant drugs)

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What does each letter stand for in ABCDE for educating patients on suspicious skin spots?

Asymmetry
Border
Color
Diameter
Evolving

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What is the top risk factor for breast cancer

female gender

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What are the modifiable RF for breast cancer

Being overweight (in postmenopausal women)
Low physical activity
Poor nutrition
Tobacco use

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Which genes normally suppress tumor growth in breast cancer

BRCA1 and BRCA2

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Inherited mutations in BRCA1 and BRCA2 prevent:

cell repair and causes dramatic increase in breast cancer incidence

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What is Klinefelter Syndrome?
how does it relate to breast cancer?

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

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For breast cancer, hormone sensitive (e.g., ER+) cancer for PREmenopausal women is treated with

Tamoxifen

antagonist in breast tissue

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For breast cancer, hormone sensitive (e.g., ER+) cancer for POSTmenopausal women is treated with

why?

Aromatase Inhibitor

majority of estrogen is produced outside ovaries by AI

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What drug class does tamoxifen fall under

Selective Estrogen Receptor Modulator (SERM)

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Is tamoxifen an estrogen agonist or antagonist in breast cells?

Antagonist

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MOA of aromatase inhibitors

Reduce estrogen production by blocking the aromatase enzyme that catalyzes the conversion of androgens to estrogens

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Which SERM is used for breast cancer prevention (NOT treatment)

Raloxifene

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What is another use of raloxifene (besides breast cancer prevention) & it’s benefit

Used for osteoporosis prevention and treatment in postmenopausal women
Increases bone density

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Raloxifene is not first-line for osteoporosis because of what SE/risks

Hot flashes
Clotting risk

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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

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The HER2 oncogene promotes:

Breast tumor growth

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breast cancer therapy that targets HER2

trastuzumab (Herceptin)

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What formulation does fulvestrant come in

IM injection

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Tamoxifen should not be used with

2D6 inhibitors, such as fluoxetine and paroxetine

tamoxifen is a prodrug converted via 2D6

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What drug can be used with tamoxifen to treat hot flashes

Venlafaxine

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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 | also raloxifene but only used in POST menopausal women

Anastrozole brand name

Arimidex

Which drug class has a higher risk of CVD: SERMs or Aromatase Inhibitors

AIs | androgens have negative impact on CV health

Which drug class has a higher risk of osteoporosis: SERMs or Aromatase Inhibitors

AIs (tamoxifen decreases bone density in PREmenopausal women, raloxifene incr bone density)

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

Luteinizing hormone releasing hormone (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 ("lutamides") 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 QT prolongation

Name drugs in the following drug classes: 1. GnRH agonists 2. GnRH antagonists 3. antiandrogens (1st or 2nd gen) 4. androgen biosynthesis inhibitor (interferes with CYP17 enzyme)

1. leuprolide, goserelin 2. degarelix, relugolix (relics are antiques) 3. bicalutamide, enzalutamide 4. abiraterone

Degarelix, a GnRH antagonist, has what concerns

Osteoporosis risk | No tumor flares

1st antiandrogen SEs

hot flashes, gynecomastia | lutamides

How to calculate BSA using Mosteller Equation

BSA (m2) = √ Ht (cm) x Wt (kg) / 3600 | use acutal BW

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

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 formula is used to dose carboplatin in adults?

Calvert Uses target AUC and eGFR

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 | renal and ototoxicity

Which chemoprotectant is indicated for prevention of doxorubicin-induced cardiotoxicity

Dexrazoxane (Totect)

What is the antidote for accidental doxorubicin extravasation

Dexrazoxane (Totect)

dexrazoxane may be considered when the doxorubicin cumulative dose > ___ mg/m2

300

What color does doxorubicin turn urine, tears, sweat and saliva

Red

T/F: Doxorubicin is a highly emetic drug

True - give antiemetics

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-related hypotension: infuse over ≥ 30-60 min

Etoposide capsules should be stored

in the refrigerated

T/F: Bleomycin causes myelosuppression

False

anthracyclines MOA

inhibit topoisomerase II and create free radicals

ironotecan MOA

topoisomerase I inhibitor - block coiling and uncoiling of DNA

etoposide and bleomycin MOA

inhibit Top II - block coiling and uncoiling of DNA

Which vinca alkaloid when given intrathecally will cause progressive paralysis and death

Vincristine | do not put in syringe, put in small IV piggyback bag

Which two vinca alkaloids are associated with more bone marrow suppression

Vinblastine and vinorelbine | both have B for bone marrow suppression

vincristine max dose

2mg per dose | prevent neuropathies

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 | only IV

What can occur with all taxanes

Severe infusion-related hypersensitivity reactions and fatal anaphylaxis: premedicate (steroid, diphenhdyramine, and H2RA)

Docetaxel can cause severe ___

fluid retention

All taxanes except paclitaxel should use ____

non-PVC bag and tubing | LATTIN

Which taxane does not require premedication

Paclitaxel bound to albumin (Abraxane)

Paclitaxel and cabazitaxel should use ____

0.22-micron filter | GAl, PLAT

What is given with fluorouracil to increase its efficacy

Leucovorin | helps bind tightly to its target enzymes

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

vinca alkaloids MOA

inhibit function of microtubules

taxanes MOA

inhibit microtubuels during M phase

5-FU and capecitabine MOA

inhibit pyrimidine synthesis during S phase

MTX MOA

inhibits purine and pyrimidine biosynthesis during **S phase**

What antidote will rapidly decrease MTX levels that remain high despite hydration and urinary alkalinization

Glucarpidase

Drug interactions with MTX + effect

NSAIDs, salicylates decrease clearance

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

name the protease inhibitors used as chemo

bortezomib - use antiviral to prevent herpes reactivation carfilzomib - peripheral neuropathy

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 | KRAS mutation will have poor response

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 | what must be checked prior to use

APAP, steroids, diphenhydramine | hep B panel

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, QT prolongation

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 mutation + (exon 19 or 21)

Side effect for EGFR inhibitors (afatinib, erlotinib)

Aceniform rash, which indicates patient is expected to have a better response to the drug

To use alectinib and brigatinib patients must be positive for which mutation

ALK

common toxicities of TKIs

hypothyroidism QT prolongation hepatic metabolism/toxicity diarrhea skin rash (acneiform, SJS/TEN) HTN hand-foot syndrome

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