Colon Cancer Flashcards
What is the class of 5-Fluorouracil?
Antimetabolite
What is the MOA of 5-Fluorouracil?
- Prodrug metabolized to 5-fluorouridine-5’-triphosphate (FUTP) and 5-fluorodeoxyuridine-5’-monophosphate (FdUMP)
- FUTP incorporated in RNA—impairs protein synthesis
- FdUMP binds to thymidylate synthase (TS) in presence of methylenetetrahydrofolate (CH2-THF), reducing rate of DNA synthesis
What are the adverse effects of 5-Fluorouracil?
- Alopecia
- Hand-foot syndrome
- Nausea/vomiting – low emetogenicity
- Mucositis/stomatitis
- Myelosuppression – neutropenia, thrombocytopenia, anemia
What is the class of Leucovorin?
Folinic acid
What is the MOA of Leucovorin?
- Reduced form of folinic acid enhances inhibition of thymidylate synthase
- Increases the effects of 5FU
What are the side effects of Leucovorin?
- Rash/pruritis
- Nausea/diarrhea
What is the class of Oxaplatin?
Alkylating agent
What is the MOA of Oxaplatin?
Binds to DNA, forms crosslinks
What are the side effects of Oxaplatin?
- Neuropathy (76%)—acute and persistent
- Nausea/vomiting (65%)—highly emetogenic
- Diarrhea (46%)
- Fatigue (41%)
- Myelosuppression—anemia (64%), thrombocytopenia (30%)
- Elevated AST (36%)/ALT (54%)
- Hypersensitivity reactions
Acute Oxaplatin-Induced Neuropathy
- Onset: hours to days
- Resolution: within 2 weeks
- Frequently recurs with further dosing
- Symptoms: Paresthesia/dysesthesia/hypoesthesia in the hands, feet, perioral area, or throat
- Exposure to cold temperatures or cold objects can precipitate or exacerbate symptoms
Persistent Oxaplatin-Induced Neuropathy
- Paresthesia, dysesthesia, hypoesthesia, and possibly proprioception
- May occur without prior acute neuropathy
- Longer than 2 weeks
What is the administration and monitoring of Oxaplatin?
Administration: IV infusion over 2-6 hours
Monitoring:
-CBC w/ differential
-Liver function tests
-Serum creatinine
-Signs/symptoms of neuropathy
-Signs/symptoms of hypersensitivity
What is the class of Irinotecan?
Topoisomerase I inhibitor
What is the MOA of Irinotecan?
Prevents repair of single-stranded breaks by binding to the topoisomerase 1-DNA complex
What are the side effects of Irinotecan?
- Diarrhea (90%)—acute (50%) vs. late (85%)
- Nausea/vomiting—highly emetogenic
- Myelosuppression—anemia (60-90%), neutropenia (30-96%), anemia (60-97%)
- Alopecia (46-72%)
- Electrolyte abnormalities (hypocalcemia, hyponatremia)
- Fever (45%)
- Mucositis (30%)
- Elevated bilirubin (84%)
What is the administration of Irinotecan?
IV infusion over 90 minutes
What is the class of Capecitabine?
Antimetabolite
What is the MOA of Capecitabine?
Oral prodrug of 5-FU
What are the side effects of Capecitabine?
- Nausea/vomiting—moderately emetogenic
- Diarrhea (47-57%)
- Mucositis (25%)
- Hand-foot syndrome (54-60%)
- Myelosuppression—anemia (72%), neutropenia (26%), thrombocytopenia (24%)
- Elevated bilirubin (22-48%)
What are the monitoring parameters of Capecitabine?
- CBC w/ differential
- Liver function tests
- Renal function tests
- Diarrhea
- Hand-foot syndrome
Drug interaction: May increase levels of phenytoin and warfarin
What are the classes of Trifluridine and Tipiracil?
Antimetabolite (pyrimidine analog)
What is the MOA of Trifluridine and Tipiracil?
- Trifluridine is incorporated into DNA and interferes w/ DNA synthesis
- Tipiracil prevents rapid degradation of trifluridine, allowing increased exposure
What are the adverse effects of Trifluridine and Tipiracil?
- Fatigue (<= 52%)
- GI: Nausea (48%), decreased appetite (39%), diarrhea (32%), vomiting (28%), abdominal pain (21%)
- Heme: Hgb (77%), WBC (67%), platelets (42%)
- Weakness (<= 52%)
- Fever (19%)
What is the dosing of trifluridine?
35 mg/m2 twice daily on days 1 to 5 and days 8 to 12 of a 28-day cycle
