Chapter 9: Med onc Flashcards
Vitamin B ___ can be provided @ ____ - ____ mg, 2-3x/day to reduce hand/foot syndrom
B6
50-100 mg
The American College of Surgeons ________ ___ _________ accredit oncology locations & specifies . They ensure patients have access to a full scope of care including RDN, either onsite or by referral.
Commission on Cancer (CoC)
The American College of Surgeons Commission on Cancer recommends RDNs attend weekly __________ & represent at __________________ meetings
Tumor boards, cancer committee meetings
Antineoplastic therapies include (4):
- Chemotherapy
- Immunotherapy
- Targeted Therapy
- Hormone therapy
An oncologist prescribes cancer treatment according to _______________ OR _______ _____- guidelines
National Comprehensive Cancer Network (NCCN), Clinical trial
3 branches of oncology include
- Medical Oncology
- Radiation Oncology
- Surgical Oncology
Define tumor burden or tumor load
The size of tumor or amount of cancer in the body
T/F: Faster growing tumors respond better to therapy
True. As tumors increase in size the growth rate slows and reduces the effectiveness of cancer treatment
Define tumor growth rate
The proportion of cancer cells within the tumor that are growing/dividing to form new cancer cells. Rapidly growing respond better to treatment
Define Definitive Therapy
Use of radiation as the PRIMARY treatment, with or without chemo
Define Palliation
Use of cancer treatment modalities when disease cure/control is not possible to relieve symptoms/side effects or improve QOL
What is zolendronic acid (aka Reclast)
A type of Bisphosphonate drug used to slow bone breakdown usually d/t bone mets
Prevention versus Prophylactic therapy
Prevention uses medicine, other agents or surgery
Prophylactic uses radiation to relieve symptoms or prevent issues (i.e. prophylactic brain radiation w/ SCLC)
Chemotherapeutic agents interfere with _______________ to ultimately lead to cell death
Cell division, they work at different parts of the cell cycle
Describe the 5 parts of the cell cycle
G0 - rest
G1 - postmitotic phase, synthesis RNA & protein
S - synthesis, make DNA
G2 - premitotic phase, prepare to divide
M - mitotic phase, stop growing and divides into 2 daughter cells
Cell cycle non-specific agents damage drugs in all phases of the cell cycle. 4 classes are:
- Alkalyting agents
- Antitumor Antibiotics
- Hormone Therapies
- Nitrosureas
Cell cycle-specific agents damage cells within specific parts of the cell cycle
- Camptothecins (s)
- Antimetabolites (s)
- Misc (misc)
- Plant alkaloids & taxanes (mitosis)
3 factors used to determine a chemo prescription
- Frequency of cycles
- Length of cycles (minutes, hours, days)
- Number of cycles (per research)
Define personalized or precision medicine
Uses a patients genetic information to prevent, diagnose, or treat cancer. Performed on a sample of the tumor to detect DNA mutations
Define pharmacogenetics
The study of how a person’s genes affect the way the body responds to certain drugs
Looks at small variations within genes to determine of the drug activates or deactivates the gene
Retuximab
What does it treat and what are the side effects?
Monoclonal antibody
C20
B-cell disease
Tumor lysis syndrome
Tumor lysis syndrome is electrolyte and renal abnormalities, what are the defining characteristics?
High phosh
High K+
Low Ca
High uric acid
Which monoclonal antibody causes decreased appetite & hypomagnesium?
Cetuximab
Pertuzumab, Trastuzumab, and Ado-trastuzumab target which gene?
ERBB2
(HER2)
Monoclonal antibodies end in which 2 letters?
“ab”
What are common side effects of monoclonal antibodies?
Skin reaction, infusion reaction, GI, pulmonary, cardiotoxicities
What are common side effects of small molecule drugs?
Cardiotoxicities, skin reactions, GI
Angioneogensis inhibitors fall under which drug category?
Targeted molecules, specifically small molecule drugs
These are the 3 PD-1 targeted monoclonal antibodies
Pembrolizumab
Nivolumab
Impilimumab
Denosumab (Xgeva)
What does it treat?
What class of drugs?
What are side effects?
Bone mets or osteoporosis
Monoclonal antibody
N/V/D
Hypocalcemia, Osteonecrosis of the jaw
Pembrolizumab
What does it treat?
What class of drugs?
What are side effects?
PD-1 Monoclonal antibody
NSCLC, H&N, melanoma
Hyperglycemia, Hyponatremia, Hypoalbuminemia
Nivolumab
What does it treat?
What class of drugs?
What are side effects?
PD-1 Monoclonal antibody
NSCLC, melanoma, renal cell
Colitis, constipation, N/V
Hyponatremia, Hypokalemia, Hymagnesimia
Protein-targeted small molecule drugs end in which 2 letters?
“ib”
What are the 3 small molecule angiogenesis inhibitors?
Bevacizumab
Lenailidomide
Thalidomide
Which chemo drugs requires avoidance of tyramine-rich food/drink?
Procarbazine
Which chemo drug requires avoidance of dairy?
Mercaptopurine
Which small molecule drug must you take with a low fat meal?
Regorafenib
Which supplements should you take with Zoledronic Acid?
calcium & vitamin DC
Can you crush Temozolomide?
No
What should you avoid within 2 hours of taking Tamoxifen?
Antacids
What nutritional considerations should you take with Sipleucel-T? (2)
Drink extra water 2-3 days prior
Avoid caffeine
Which 3 chemo drugs tend to cause hand/foot syndome?
Carboplatin
Fluorouracil
Oxaliplatin
Mensa is given with these 2 chemo drugs d/t bladder toxicities
Cyclophosphamide
Ifosfamide
You should avoid grapefruit juice and excess vitamin A with this chemo drug
Bexarotene
Avoid alcohol with these 2 chemo drugs
Vincristine
Lomustine
Cryotherapy during infusion can help prevent mucositis with boluses of these 2 chemo drugs
Fluorouracil & Melphelan
What are potential side effects of angiogenesis inhibitors?
Hypertension, MI, stroke, nosebleeds, GI perforation
2 specific side effects of Bevacizumab
Proteinuria (1/3 of pts)
Hypothyroidism
Imatinib
What does it treat?
What class of drugs?
What are side effects?
CML
Small molecule tyrosine kinase inhibitor
Fluid retention/edema
Temsirolimus & Everolimus are ___________ agents that treat _____________
Protein-targeted therapy
Renal cancer (and others)
These 2 agents contain lactose, may require lactase enzyme
Deferasiox
Nilotinib
These are the 5 categories of immunotherapy (not including monoclonal antibodies)
- Non-specific
- CAR-T cell
- Cancer vaccines
- Oncolytic viral therapies
- Cadiopharmaceuticals
What are the 2 non-specific immunotherapies
Interferon & interlukin
Create a broad-based immune response rather than targeting certain genes
T-VEC can be used to treat melanoma and is a ________ kind of therapy
Oncolytic viral therapy - genetically modified herpes simplex
What kind of immunotherapy is sipuleucel-T?
Cancer vaccine used in hormone-refractory metastatic prostate cancer
T-cell therapy has been used for treatment of (2)
B-cell lymphoma in adults & ALL in children
How do SERMs work? What are the 3 agents?
Compete with estrogen for binding to receptors
Tamoxifen, Ruloxifen, Toremifene
What are 5 side effects of SERMS?
- Blood clots
- Menstural symptoms
- Fluid retention
- Weight gain
- Increased risk for endometrial cancer
How do aromatase inhibitors work? What are the 3 agents?
Block the conversion of androgen hormones to estogen. Anstrazole, Lestrozole, Exemestane
Which aramotase inhibitor causes high cholesterol?
Lestrozole
How do progresterones work and what is the primary one?
They reduce stability of estrogens, thus limiting their availability
Megestrol acetate -
What are the 5 classes of hormone therapies?
- Serms
- Aromatase inhibitors
- Progesterones
- Anti-androgens
- Luteinizing hormone releasing hormone agonists
How to anti-androgens work? What are the 2 main ones?
Bind to androgen receptors to prevent the effects of testosterone in androgen-sensitive prostate cancer cells
Bicalutamide
Flutamide
Which 2 cancers are leutinizing hormone releasing hormone agaonists used to treat?
Prostate and ovarian
How to lutenizing hormone releasing hormone agonists work?
Stops the pituitary gland to stop producing LH, which results in suppression of testosterone and estrogen
What are the 2 LHRH agonist drugs?
Leuprolide
Goserelin
These 2_______ supplements interfere with Tamoxifen while _________ supplement may improve its use
Sillymarin (Milk Thistle) & Black cohosh
Melatonin
What’s the concern with Quercitin?
May bind with iron and increase risk for deficiency
What makes ibritumomab unique?
Radiopharmaceutical used to treat lymphomas
(Combo of y90 + rituximab)
Most oral chemo drugs should be taken on an empty stomach with the exception of these 3 that should be taken with food
Bexarotene
Imatinib
Capecitabine
