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Phar 509 > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

T/F: Colorectal cancer is the 3rd most common cancer in the United States

A

True

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2
Q

What are the risk factors for colorectal cancer

A

Age greater than 50 years old, Ulcerative colitis or Chrohn’s disease, polyps, history of colon cancer in a first or second degree relative

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3
Q

What are polyps and why are they a risk factor, prevention

A

Extra tissue that grows in the large intestine, increasing in size increases the likelihood of becoming cancerous, removal

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4
Q

What are the inherited syndromes that increase the risk of colorectal cancer

A

FAP, Lynch Syndrome, MSI

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5
Q

What are protective risk factors against colorectal cancer

A

High fruits and vegetables, regular exercise, regular use of asprin and NSAIDs

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6
Q

What screenings can be done to see if a patient has colorectal cancer

A

Digital rectal exam, colonoscopy, endoscopy, CT colonography

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7
Q

What is the normal pathophysiology from normal tissue to cancer/metastases

A

Normal epithelium -> Early adenoma -> Late adenoma -> carcinoma -> metastatic carcinoma

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8
Q

What is the best way to be diagnose a patient has colorectal cancer

A

A biopsy

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9
Q

What is a tumor marker for colorectal cancer

A

CEA

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10
Q

What are the most common ways to treat colorectal cancer

A

Surgery and Chemotherapy

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11
Q

T/F: Colorectal cancer is one of the few cancer where a patient gets metastes and still be cured

A

True

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12
Q

What is the basic regimen for colorectal cancer and what are the medicatons involved

A

FOLFOX6: Leucovorin 400 mg/m2 over 2 hours day 1, Fluorouracil 400 mg/m2 IVP day 1 then 1200 mg/m2/day for 2 days as a continous infusion, oxaliplatin 85 mg/m2 over 2 hours a day 1 (repeat every 2 weeks for 6 months)

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13
Q

What are side effects of the FOLFOX regimen

A

acute and delyaed neuropathy, moderate emotogenic risk, hypersensitivity (oxaliplatin)/ diarrhea, myelosuppresion (5-FU bolus), Hand-Foot syndrome (infusion)

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14
Q

What are other treatments that can be given

A

Capecitabine (contraindicated if CrCl less than 30), 5-FU PLUS leucovorin

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15
Q

What are the initial therapy for metastaticCRC involving oxiplatin

A

FOLFOX or CAPOX with or without Bevacizumab OR FOLFOX with or without Panitumumab OR FOLFOX with or without Cetuximab

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16
Q

What are the initial therapy options for metastaticCRC involving Irinotecan

A

FOLFIRI with or without Bevacizumab OR FOLFIRI with or without Cetuximab OR FOLFIRI with or without Panitumumab

17
Q

What is the difference between the FOLFOX and FOLFIRI regimens

A

Oxaliplatin 85mg/m2 IV is switched for Irinotecan 180 mg/m2 IV

18
Q

What is in the CapOx regimen and when would it be given

A

Capecitabine 1000 mg/m2 by mouth every 12 hours for 14 days PLUS Oxaliplatin 130 mg/m2 IV day 1 for intervals of 3 weeks, 2nd line after an Oxaliplatin regimen was used

19
Q

What are the EGFR inhibitors, toxicities

A

Cetuximab and Panitumab/ rash (maculopapular), hypomagnesemia, Infusion reactons

20
Q

What are the VEGF inhibitors, toxicities

A

Bevacizumab, Ziv-aflibercept, Regorafenib,Ramucrizumab/ Hypertension, Thrombosis, Bleeding, Proteinuria

21
Q

Which patients should recieve an EGFR inhibitor

A

Only who KRAS wild type patients (non-mutant)

22
Q

Which EGFR needs premedication and with what

A

Cetuximab (chimeric antibody), H1 antagonists (diphenhydramine, loratidine)

23
Q

Which EGFR is most associated with severe diarrhea and ocular toxicities

A

Panitumab

24
Q

T/F: Patient with antibodies to galactose-alpha-1,3 galactose are more likely to have a reaction to Panitumab

A

False: Patient with antibodies to galactose-alpha-1,3 galactose are more likely to have a reaction to Cetuximab

25
Q

T/F: Bevacizumab is medication that patients won’t fail and can be continued throughout a course of metastatic treatment

A

True

26
Q

What are the boxed warning for bevacizumab, adverse effects

A

Hemorrhage. GI perforation, Compromised wound healing/ Hypertension, Arterial thromboembolic events, proteinuria

27
Q

How should Beacizumab be used before and after surgery

A

Hold 28 days before and after surgery

28
Q

What are other drugs that can be used in mCRC

A

Regorafenib (multikinase inhibitor/many adverse effeccts), trifluridine/tipiracil (given monday through friday two weeks in a row every month)

29
Q

What should be given if a patient has high microsatelite Instability or mismatch repair deficiency, what are the medication

A

Immunotherapy/ Pembrolizumab, Nivolumab, Nivolumab and Ipilimumab

Phar 509 (22 decks)

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