Clinical Workshops

Question 1

If somebodies tumour is T2 N1 M0…do they have metastatic cancer?

Answer 1

No as M=0

They do have one lymph node that is involved however

Question 2

What is the FEC-T regime?

And what it is used to treat?

Answer 2

5-FU (TS inhibitor)

Epirubicin (anthracycline)

Chyclophosphomide (Mustard)

• All for 3 weeks, with 3-4 cycles

Docetaxol (anti-microtubule)

• Given for 3 weeks after FEC, with 3-4 cycles

Used to treat breast cancer

Question 3

What is the MHRA advice on giving IV Ondansetron?

Answer 3

Can get potential QT prolongation

Under 75 –> Not exceed 16mg

Over 75 –> Not exceed 8mg

Over 65 and diluted –> All doses should be diluted in 50-100mL of saline

Question 4

Why can dexamethasome be problemactic in diabetics?

Answer 4

Will increase glucose levels

Question 5

Define the following….

Acute CINV

Delayed CINV

Anticipatory CINV

Answer 5

Acute –> Occurs quickly (less than 24hrs) after chemo is given

Delayed –> Occurs more than 24 hours after chemo

Anticipatory –> Occurs before the next cycle of chemo after already having a cycle (as they know what to expect)

Question 6

What are the common visible effects of a low platelet count (eg, 38)?

Answer 6

Bleeding from the gums

More bleeding in general

More bruising

Question 7

Why is Folinic Acid included in the FOLFOX chemotherapy regime?

And what is this used to treat?

Answer 7

To improve the clinical outcome by proloning the inhibition of TS (for 5-FU)

Treats colorectal cancer

Question 8

What is a common syndrome that occurs as a result of capecitabine (5-FU pro-drug)?

And what OTC drug would interact with this

Answer 8

Hand-foot syndrome

Often results in delays of treatments

Interacts with folic acid –> Possibly increasing its toxicity

Question 9

Name 4 pre-medications that should be given when a patient is given the pemetrexed (antimetabolite), pembrolizumab and carboplatin regimen?

Answer 9

Folic acid –> 5 doses per week

Hydroxycobalabin injection (1000mg) before first pemetrexed dose

Dexamethasone 4mg BD for 3 days –> For N+V

Steroids –> to prevent pemetrexed rashes

Question 10

At what GFR is Pemetrexed not allowed to be given?

Answer 10

<45ml/min

Question 11

In patients starting of Afatinib (an EGFR inhibitor), what advice should be given to prevent rashes/acne?

Answer 11

Moisturise with urea/aqueous based moisturisers (not alcohol based)

Avoid sunlight –> Use SPF 30 if subjected to it

Use soap substitutes

Question 12

How does Palbociclib function?

Answer 12

A selective inhibitor of cyclin-dependent kinases (CDK4/6)

Prevents the phosphorylation of Rb, meaning that mitosis cannot occur

Question 13

Why is there a maximum lifetime dose of anthracyclins (like doxorubicin/epirubicin)

Answer 13

To prevent cardiac side effects

Question 14

What 3 types of pre-meds would be given to prevent hypersenstivity reactions in people taking paclitaxol?

Answer 14

Corticosteroid –> Dexamethasone

Antihistamine –> Chloramphenamine

H2 Antagonist –> Ranitidine

Question 15

Why is bicalutamide taken with/after the single dose of goserlin?

Answer 15

To cover the period of time where the tumour may flare and symptoms worsen after taking goserlin

This is because goserlin is an LHRH agonist, and so will stimulate LH/androgen production….however after a few weeks the receptors become desensitised, so LH isn’t stimulated and we dont need to give bicalutamide anymore

Question 16

Why must prednisolone always be given with Abiraterone?

Answer 16

As abiraterone is a CYP17A1 inhibitor, which is vital for the production of cortisol

So we need prednisolone to compensate

Question 17

What are some of the side effects of enzalutamide?

Answer 17

Headache

Memory impairment

Anxiety

Restless legs

Fatigue

Risk of seziures (1%)