Chemotherapy

Question 1

MCC of CA death in women and men
MC CA in women
MC CA in men

Answer 1

MCC of CA death in women and men = lung
MC CA in women = breast
MC CA in men = prostate

Question 2

Cisplatin

Answer 2

Ototoxic, nephrotoxic

Question 3

Carboplatin

Answer 3

B myeloid suppression

Question 4

Cyclophosphamide

Answer 4

Acrolein is the active metabolite. Mesna can help with hemorrhagic cystitis

Question 5

Methotrexate

Answer 5

– inhibits dihydrofolate reductase  inhibits purine synthesis. Renal toxicity. Leucovorin rescue reverses effects of MTX

Question 6

5FU

Answer 6

– SE: Myeloid suppression. inhibits thymidylate synthetase  inhibits purine synthesis. Leucovorin increases 5FU toxicity

Question 7

Leucovorin

Answer 7

Leucovorin = folinic acid

Question 8

Oxaliplatin

Answer 8

Oxaliplatin – SE Nephrotoxic, neurotoxic, ototoxic, (less than cisplatin)

Question 9

Gemcitabine

Answer 9

Inhibits thymidylate synthetase

Question 10

Vincristine

Answer 10

Vincristine – inhibits microtubule synthesis – peripheral neuropathy

Question 11

Etopisode

Answer 11

S/E: Bone marrow suppression

Question 12

Taxanes

Answer 12

Taxanes – Promote microtubule formation! S/E: cause neuropathy

Question 13

Bevacizumab (Avastin)

Answer 13

Bevacizumab (Avastin) – VEGF inhibitor. Used in lung CA and metastatic colorectal CA

Question 14

Esophageal CA

Answer 14

Esophageal CA – Carboplatin and paclitaxel

Question 15

ENT chemo

Answer 15

ENT chemo – Cisplatin and 5FU

Question 16

Squamous cell CA in Anal margin lesions (below the dentate line)

Answer 16

Squamous cell CA in Anal margin lesions (below the dentate line) – Cisplatin and 5FU

Question 17

Colorectal adenocarcinoma

Answer 17

• First line = 5FU, leucovorin, and irinotecan (FOLFIRI). Add Bevacizumab (Avastin) if metastatic cancer
• 2nd line: 5FU, leucovorin, oxaliplatin (FOLFOX).

For metastatic cancer 
- Cetuximab only if EGFR positive and metastatic
- Bevacizumab if metastatic (VEGF inhibitor)

Question 18

Anal canal (above dentate line) squamous cell CA

Answer 18

5FU and mitomycin with XRT (Nigro protocol)

Question 19

Small cell lung CA

Answer 19

Small cell lung CA – cisplatin and etoposide (VP16)

Question 20

Non-seminoma and Seminoma (germ cell tumors)

Answer 20

Non-seminoma and Seminoma (germ cell tumors) – cisplatin, bleomycin, etoposide

Question 21

Bladder CA

Answer 21

Bladder CA –MVAC; Methotrexate, vinblastine, Adriamycin, cisplatin

Question 22

Gallbladder

Answer 22

Gallbladder – Gemcitabine + cisplatin or Gemcitabine + capecitabine

Cholangiocarcinoma – Gemcitabine + cisplatin

Question 23

Pancreatic CA

Answer 23

FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or gemcitabine

Question 24

GIST

Answer 24

Imatinib

Question 25

Carcinoid (used for unresectable disease)

Answer 25

Carcinoid (used for unresectable disease) – streptozocin and 5FU, octreotide

Question 26

Insulinoma

Answer 26

5FU and streptozocin, diazoxide

Question 27

Ovarian CA Cervical CA

Answer 27

Cisplatin and paclitaxel

Question 28

Breast CA

Answer 28

TAC  Taxanes (docetaxel pacletaxal), doxurubicin, and cyclophosphamide

Question 29

Nephroblastoma (Wilm’s) – Actinomycin and vincristine

Question 30

Neuroblastoma - (DECC) doxorubicin, etoposide, cisplatin and cyclophosphamide

Question 31

Non-small cell lung CA (squamous or adenocarcinoma) - carboplatin, taxol (paclitaxel)

Question 32

Hodgkin’s - (ABVD – Adriamycin, bleomycin, vinblastine, dacarbazine)

Question 33

Radiation therapy XRT

Answer 33

M phase (mitosis) – most vulnerable stage of cell cycle for XRT. Targets this Damage done by formation of oxygen radicals  maximal effect with high oxygen level Main target is DNA – XRT and oxygen radicals damage DNA Higher energy radiation has skin preserving effect (Maximal ionizing potential not reached until deeper structures) Fractionate XRT doses allows: - Repair of normal cells - Re-oxygenation of tumor - Redistribution of tumor cells in cell cycle Very radiosensitive tumors (high mitotic rate) – Seminoma, lymphoma Very radioresistant – epithelial, sarcoma

Question 34

Antibodies

Answer 34