Chemotherapy and Targeted Agents

Question 1

What are the side effects of VEGF monoclonal antibodies (Bevacizumab)?

Answer 1

Hypertension (responds to CCB/ACEi)
Bleeding/thrombosis
GI perforations
Nephrotic syndrome
Hand-foot syndrome

Question 2

What is the mechanism of Sunitinib/Sorafenib?

Answer 2

Tyrosine kinase inhibitors that also block VEGF, raf and PDGFR

Used in renal, GIST and HCC

Question 3

What are the side effects of tyrosine kinase inhibitors (Sunitinib/Sorafenib)?

Answer 3

Hypertension
Acneiform rash on face, scalp and trunk
Thrombosis
Cardiotoxocity
Hypothyroidism

Question 4

What is the mechanism of Ceruximab/Panitumumab?

Answer 4

EGFR monoclonal antibody

Used in K-Ras wildtype colon, lung and head & neck cancers

Question 5

What are the side effects of EGFR monoclonal antibodies (Cetuximab)?

Answer 5

Rash
Fatigue
Hypersensitivity
Hypomagnesaemia & cramps

Question 6

What is the mechanism of Imatinib/Gefitinib?

Answer 6

EGFR tyrosine kinase inhibitors

Used in CML, lung, GIST and pancreatic cancer

Question 7

What are the side effects of EGFR tyrosine kinase inhibitors (Imatinib/Gefitinib)?

Answer 7

Rash
Oedema
Fatigue
Diarrhoea
Cytopaenia

Question 8

What is the mechanism of Bevacizumab?

Answer 8

VEGF monoclonal antibody

Used in colon, lung, brain, ovarian and breast cancer

Question 9

What is the response rate of EGFR tyrosine kinase inhibitor, Erlotinib, in NSCLC adenocarcinoma?

Answer 9

70-80%

Typically EGFR mutations in NSCLC are found in young women who have never smoked.
This rate is higher and more sustained than standard chemotherapy

Question 10

What is the mechanism of Trastuzumab?

Answer 10

Monoclonal antibody to HER-2 receptor

Question 11

What is the major side added of Bleomycin?

Answer 11

Bleomycin-induced pneumonitis (BIP) and late toxic effects of pulmonary fibrosis

• related to total cumulative life time dose
• cease Bleomycin if >25% rejection in DLCO on PFTs

BIP should be recognised early, so Bleomycin can be ceased and corticosteroids commended

Question 12

What is the most significant side effect of Metoclopromide in young patients (

Answer 12

Metoclopromide-induced dystonia resulting in oculogyric crisis and rigidity.

Treat with IV Benztropine

Increased risk in the young

Question 13

What are the main haematological side effects of Temozolamide?

Answer 13

Temozolamide is an oral, alkylating agent used in the treatment of GBM and other gliomas.

It causes:
- thrombocytopenia (10-20%) -> cease drug if plt