Chemotherapy V Flashcards
Tyrosine Kinase Inhibitors
Small molecule (2) Monoclonal Antibodies (3)
Small molecule: Imatinib, Erlotinib
Monoclonal Ab: Trastuzumab, cetuximab, bevacizumab
Imatinib MOA
Binds and blocks BCR-ABL
Where is Imatinib metabolized
LIVER- avoid coadministration with inducers/inhibitors of CYP3A4
Imatinib SE
SUPERFICIAL EDEMA nausea MUSCLE CRAMPS Abdominal pain Rash Diarrhea Anemia Neutropenia, thrombocytopenia
What should you monitor in patients taking Imatinib?
TSH level
Increases clearance of thyroid hormone
Imatinib Indications
CML
GI stromal tumors
Other drugs like Imatinib?
Dasatanib
Nilotinib
Cetuximab MOA
Monoclonal antibody to EGFR (transmembrane TK)
Sensitizes cell to chemo and radiation
Cetuximab Indication
Metastatic lung, colon cancer
Head, neck cancers (+radiation)
Cetuximab SE
Rash Diarrhea HYPOMAGNESEMIA Infusion reaction Skin toxicity Trichomegaly
What must you treat patients taking Cetuximab with?
IV therapy for hypomagnesemia
What type of mutational analysis should you perform on a patient with COLORECTAL cancer to determine if they will respond to Cetuximab?
KRAS
NRAS
Wildtype: respond to Cetuximab
Mutated: no response
Erlotinib MOA
Small molecule inhibitor of the TK associated with EGFR
How is erlotinib metabolized?
CYP3A4
Erlotinib SE
Rash, nausea, anorexia, fatigue, paronchia (nailbed pain)
Perform mutational analysis on non-small cell lung cancers for ____ activating mutations
EGFR
Bevacizumab
Monoclonal Ab, binds to VEGF, prevents signaling for new blood vessel formation
Bevacizumab Indication
Metastatic colorectal cancer
Metastatic lung cancer
*significant prolongation or survival!
Bevacizumab SE
HTN, proteinuria, arterial clots, colon perf, bleeding, reversible posterior leukoencephalopathy syndrome, infusion reactions
Small molecule VEGF receptor TK inhibitors
Sorafenib, Pazopanib, Sunitinib
Small molecule VEGF receptor TK inhibitors metabolism
CYP3A4
Small molecule VEGF receptor TK inhibitors SE
Similar to bevacizumab +
Hand foot syndrome
Congestive heart failure
Small molecule VEGF receptor TK inhibitors Indication
All 3 - renal cell cancer (clear cell)
Sunitnib- pancreatic neuroendocrine cancer, GI stromal tumor
Sorafenib- unresectable hepatocellular cancer
Trastuzumab MOA
Monoclonal Ab to extracellular domain of EGFR receptor, HER-2 Neu
Trastuzumab SE
CARDIAC TOXICITY
fever, n/v/d, cough, HA, SOB, back pain, rash, myalgia
The greatest risk of cardiac toxicity is in patients taking Trastuzumab and this other drug
Anthrcycline
What should you monitor in a patient taking Trastuzumab?
Cardiac ejection fraction
Trastuzumab Indication
Breast cancer (Her2/neu+) Stomach and gastroesophageal junction cancer (Her2/neu+)
When should you use trastuzumab?
when Her2/neu is overexpressed
Crizotinib Indication
Pts with ALK-anaplastic lympoma kinase rearrangements in adenocarcinoma of lung
Vemurafenib Indication
Melanoma with V600E mutation in BRAF (activating mutation)
L-asparaginase MOA
Depletes asparagine pools rapidly
Leukemia cells lack asparagine synthetase and cannot synthesize asparagine
decrease in protein synthesis
L-asparaginase SE
CLOTTING (decreased antithrombin 3)
L-asparaginase Indication
Acute lymphoblastic leukemia
Hydroxyurea MOA
Inhibits DNA synthesis by inhibiting ribonucleotide reductase
Hydroxyurea Indication
Acute myelogenous leukemia
All-trans retinoic acid MOA
Induces terminal differentiation of leukemic cells
All-trans retinoic acid Indication
Acute promyelocytic leukemia (APL)
Arsenic Trioxide Indication
Treatment of relapsed APL
Arsenic Trioxide SE
QT prolongation
