ChemoSH3 Flashcards
Breast cancer
Mammogram to identify lump. Then biopsy to identify if malignant or benign.
Different typers of breast cancers. ER ( estrogen receptors + ) , ( PR ) progesterone receptor + , ( HER2/ ErbB2 ) human epidermal receptor positive. HER2 have a more aggressive disease and higher risk recurrence
Types of Tx for breast cancer
Radiation, surgery, mastectomy, chemo, hormone therapy, target therapy
Chemo
Taxanes ( most common)
- paclitaxel ( taxol ) and docetaxel ( taxotere )
Anthracyclines
-doxorubicin ( adriamycin ) and epirubicin ( ellence )
Platinum agents
- cisplatin, carboplatin ( paraplatin )
Cyclophosphamide ( cytoxan )
-5FU , capecitabine ( xeloda )
Ixabepilone ( ixempra )
Eribulin ( halaven )
Hormone Therapy
: patients that have sensitivity to estrogen
•Tamoxifen , Raloxifene ( SERMS: selective estrogen receptor modulators ; they are sitting on the receptor of estrogen so wont let estrogen sit there. #1 side effect : CLOTS )
•Aromatase inhibitors ( AI ) : used for post menopausal breast cancer
• Fulvestrant ( IM ) : estrogen receptor antagonists : blocks estrogen completely. Increase in bleeding risk
Targeted therapy :
Hormone Receptor- positive ( ER + )
- Palbociclib ( Ibrance ) , Ribociclib ( kisqali ) , Everolimus ( Afinitor )
HER2+ breast cancer
- Trastuzumab ( herceptin ) , Pertuzaumab ( Perjeta ) , Ado-trastuzumab emtansine ( Kadcycla, TDM-1 ) , lapatinib ( tykerb) ( TINIB: tyrosine kinase inhibitor : always PO )
Tamoxifen ; raloxifene ( Evista ) are SERMS. You worry about
Clots!
Aromatase inhibitors:
Hormone therapy
Anastrozole ( armidex)
Letrozole ( Femara )
Stop production of estrogen in ovaries
no clot issues. Dont sit on R of estrogen. If premenopausal then we can only give tamoxifen and if post menopausal then can give evista or Aromatase inhibitors
Faslodex( fulvestrant ) IM estrogen R antagonists
Tamoxifen
non steroidal anti estrogen
SERM: selective estrogen receptor modulator. causes side effects of estrogen. Worry about CLOTS!
Endrogmetrial cancer( tamoxifen stimulates uterine estrogen receptor; evista does not ) , hyper calcemia.
Dose: 20 mg daily.
Clots: swelling of right leg? Go to md asap if any signs or sx
Tamoxifen goes through cyp2d6 to become active. Watch out of ddi. Cyp2d6 inhibitors ( Prozac , Paxil , ) weak but still watch out for Wellbutrin / Zoloft, duloxetine
Recommend venlafaxine
Raloxifene
Evista
Reduce the risk of breast cancer ( POSTMENOPAUSAL )
Osteoporosis prevention
Worry about clots just like tamoxifen
Tamoxifen vs raloxifene : evista does not causes endometrial cancer.
Aromatase inhibitors
: block production of estrogen
It does simulate estrogen so you dont worry about clots, hypercalcemia, or endometrial cancer.
It blocks production of estrogen.
POSTMENOPAUSAL agents.
Anastrozole ( arimidex ) - 1 mg QD
Letrozole ( femara ) - 2.5 mg QD
Exemestane ( aromasin ) - 25 mg QD
Major source of estrogen is derived from peripheral androgen conversion which requires Aromatase
DDI : never give tamoxifen with Aromatase inhibitors. Tamoxifen may decrease serum levels of Aromatase inhibitors
Target therapy for hormone receptor positive breast cancer
Palbociclib ( ibrance ) : CDK 4/6 inhibitor : watch for pulmonary embolism
Ribociclib ( kisqali ) : CDK 4/6 inhibitor. DDI 3a4 sub.
Everlimus ( afinitor , zortress )
Used for
- hormone receptor positive
- HER2 negative breast cancer
- they are used along with Aromatase inhibitors
FULVESTRANT
Faslodex ( IM )
Blocks estrogen completely. MOA: estrogen R antangoist.
IM once a month.
SE: bleeding, thrombocytopenia. Watch if patient on anticoagulants.
Target therapy for HER2 +
Chemo and HER2+ targeted therapy
targeted therapy : trastuzumab ( HERCEPTIN ) 52 weeks 1 year.
Never had herceptin before: give herceptin plus pertuzumab perjeta ( BBW : cardiac failure )
Lapatinib: tyrosine kinase inhibitor
Trastuzumab ( HERCEPTIN )
HErCEPTIN
IV
Dont get this alone, get in combination. With concurrent paclitaxel or docetaxel
Ado trastuzumab ( kadcyla) last line therapy for HEr2 +
T
Last line IV only therapy
Lapatinib
Tykerb
Tyrosine kinase inhibitor ( PO ) - empty stomach
Eribulin mesylate
Halaven
Can be used for triple negative metastatic breast cancer
Megestrol
Megace
Progestin : advanced breast and endometrial cancer
Also used to stimulate appetite
SE: weight gain thromboemolism HF
Prostate cancer
Males only.
Fueled by testosterone
PSA: if high then do biopsy
LH-RH or GnRH analogs
Lutenizing hormone - releasing hormone agonist
Goseriln ( zoladex )
Leuprolide ( Lupron )
Triptorelin ( Trelstar )
Histrelin ( Vantas )
Not just used for prostate cancer. Used for endometriosis and pre menopausal breast cancer patients
LH - RH analogs SEs:
Bc increasing testosterone you can get a tumor flare ( bone pain, increase tumor size, )
- so give an antiandrogen med : Flutamide, biclutamide, nilutamide
LUTAMIDE: start 2 to 4 weeks.
SE: If you decrease testosterone you can get gynecomastia
Pulmonary embolism
LH-RH analogs
Never given daily.
Im q 1 month, q 3 months, or q 4 months
Degarelix
Firmagon
MOA: LHRH antagonists. ( no neg feedback ). Rapid suppression of testosterone.
SUBQ every 28 days
SE: hot flashes weight gain
Ani androgens
Block testosterone production.
Used with LHRH / GnRH analogues
SE: gynecomastia
Salvage Hormone Therapy
Ketoconazole ( nizoral )
Reduces levels of testosterone and cortisol
SE: gynecomastia ( remember sprionlactone, Tagamet and anything that suppress testosterone)
Oral formulation take with food bc want acidic environment to be absorbed
Inhibits cyp3a4
Finasteride ( 5m g
Dutasteride ( avodart ) ( 0.5 mg )
Proscar ( 5 mg ) : can sub for 1 mg propecia
Prevention of prostate cancer: indication.
MOA: inhibit 5 alpha reductase ( enzyme that converts testosterone to the more potent androgen dihydrotestosterone
Studies: these drugs seem to lower the risk of less aggressive prostate cancers while increasing the risk of more aggressive cancers
Provenge
Sipulucel - T
Vaccine : treat advance prostate cancer that is no longer responding to hormone therapy
Colon Cancer Screening
Colonoscopy screen
Start at age 50
Immunotherapy
makes own immune system fight against the cancer
Keytruda ( Pembrolizumab ) : PD-1 Inhibitor monoclonal AB ( PD-1 acts to prevent immune cells from attacking its own cells. By blocking PD1 keytruda allows immune cells to attack own cells / cancer cells
Indication:
-melanoma IV
- Non - small cell lung cancer : metastatic IV
-head and neck cancer IV
SIDE EFFECTS: more tolerable than conventional chemo. GI toxicity, hepatotoxicity, pulmonary toxicity, thyroid disorders
AMES TEST
Test to see if chemical is a mutagen or has mutagenic potential.
If it can change bacterial dna it may also turn out to be a carcinogen that is to cause cancer
