Common Cancer Types and Treatment Flashcards
Treatment has destroyed all known tumors
complete response or complete remission
At least 30% of the tumor has been eliminated
partial response or partial remission
Given before surgery to shrink the tumor in order to make complete resection more likely
neoadjuvant therapy
Given after surgery in an attempt to eradicate residual disease and decrease recurrence
adjuvant therapy
Which type of cancer is the most common worldwide?
lung cancer
Which type of cancer is the most common in the US?
skin cancer
What medications can increase the risk of skin cancer?
immunosuppressants (post-transplant)
Warning signs of melanoma skin cancer: ABCDE
A = asymmetry (1/2 of the mole doesn’t match the other)
B = border (edges are irregular, notched)
C = color (color isn’t the same all over)
D = diameter (larger than 6 mm, or the size of the tip of a pencil eraser)
E = evolving (mole is changing in size, color, shape, or symptoms)
Modifiable risk factors of breast cancer
- Being overweight (in postmenopausal women)
- Low physical activity
- Poor nutrition
- Tobacco use
These genes normally suppress tumor growth. Inherited mutations in either gene prevents cell repair and causes a dramatic increase in breast cancer incidence.
BRCA1 and BRCA2
Less than __ percent of breast cancer occurs in males.
1
Congenital condition in which males have one Y chromosome and two or more X chromosomes, which leads to an increased production of estrogen.
Klinefelter syndrome
If a tumor expresses a high percentage of estrogen or progesterone, the tumor is referred to as ________-________, and classified as _______________, ______________, or both (____)
- Hormone-sensitive
- Estrogen receptor positive (ER+)
- Progesterone receptor positive (PR+)
- ER+/PR+
Hormone-sensitive cancers will be treated with adjuvant hormone (endocrine) therapy for _________ years to suppress cancer recurrence. The choice of treatment depends on _____________ of the patient.
5-10; menopausal status
First-line treatment for premenopausal females with hormone-sensitive cancer
tamoxifen, a selective estrogen receptor modulator (SERM) and antagonist in breast cells
Which chemotherapy agents are used in postmenopausal women, and why aren’t they effective in premenopausal women?
- Aromatase inhibitors
- Premenopausal females produce estradiol. Postmenopausal females produce very little estradiol and instead get most of their estrogen from the peripheral conversion of androgens. AIs don’t block ovarian estradiol production, which is why they aren’t useful in premenopausal females.
SERM used for breast cancer prophylaxis
raloxifene
What does raloxifene do and what is it indicated for?
increases bone density and is indicated for osteoporosis
Why isn’t raloxifene first line for osteoporosis?
It causes hot flashes and has a risk of blood clots.
Which drug class induces menopause in premenopausal females by decreasing LH and FSH, and makes AI treatment a reasonable option?
Gonadotropin-releasing hormone (GnRH) agonists: Goserelin and leuprolide
Protein that can turn a normal cell into a cancer cell
oncogene
Oncogene that promotes breast tumor growth
HER2
Monoclonal antibody that’s effective in treating tumors that overexpress HER2
Trastuzumab (Herceptin)
Which medication is preferred to treat hot flashes/night sweats caused by SERMs (tamoxifen, raloxifene, and toremifene)?
venlafaxine
Tamoxifen is a prodrug converted via CYP___.
CYP2D6
SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs)
BBW:
- Increases risk of ______ or ___________ cancer (tamoxifen)
- Increases risk of ______________ (tamoxifen, raloxifene)
- QT prolongation (___________)
Side Effects:
- __________ bleeding/spotting
- __________ discharge/dryness/pruritis
- _________ libido
- __________ decreases bone density (supplement with calcium/vitamin D) and is teratogenic
- uterine; endometrial
- thromboembolic events
- toremifene
- vaginal
- vaginal
- decreased
- tamoxifen
SELECTIVE ESTROGEN RECEPTOR DEGRADER (SERD)
Drug: _____________
Administration: ___________
Side effects: _______, injection-site pain, __________
- Fulvestrant
- IM injection
- Increased LFTs; hot flashes
Which drug class has the highest risk of osteoporosis and a higher risk of CVD compared to SERMs?
aromatase inhibitors
Name the main aromatase inhibitor that’s used
anastrozole (Arimidex)
Side effects of aromatase inhibitors
- Hot flashes/night sweats
- Arthralgia/myalgia
- Others: Lethargy/fatigue, N/V, rash, hepatotoxicity, hypertension, dyslipidemia
Cyclin-dependent kinase (CDK4/6) inhibitors
palbociclib (Ibrance), abemaciclib (Verzenio), and ribociclib (Kisqali)
Match the drug class with its MOA:
- Estrogen antagonist in breast tissue __
- Estrogen receptor antagonist that causes receptor degradation and downregulation __
- Block conversion of androgens to estrogens __
- Inhibit downstream signaling and tumor growth __
a. Aromatase inhibitors
b. Serotonin estrogen receptor modulator (SERM)
c. Cyclin-Dependent Kinase (CDK4/6) inhibitors
d. Serotonin estrogen receptor degrader (SERD)
- b
- d
- a
- d
Breast cancer metastases are often located where?
bone, lungs, liver, and brain
Primary chemo agents used for breast cancer
capecitabine, docetaxel, paclitaxel, carboplatin, cyclophosphamide, doxorubicin, methotrexate
What are 2 key counseling points for all patients with breast cancer?
- Don’t take any estrogen-containing medications. Estrogen is contraindicated with an hx of breast cancer.
- Take adequate calcium and vitamin D (unless calcium is high from metastases).
Match the chemo agent with its key counseling points:
- Tamoxifen __
- Raloxifene
- Aromatase inhibitors
a. Can cause hot flashes
b. Can cause hot flashes, night sweats, and muscle damage
c. Avoid in pregnancy (teratogenic); can cause blood clots and endometrial cancer
- c
- a
- b
What is the most common cancer in males in the US?
prostate cancer
Most prostate cancers can be felt with what exam?
digital rectum exam (DRE)
What is produced in the prostate gland by normal and cancerous cells and increases with most prostate cancers as well as in BPH?
prostate-specific antigen (PSA)
A PSA level of 4-10 ng/mL could be indicative of what?
BPH or prostate cancer
PSA level > 10 ng/mL
likely indicates prostate cancer
What are the primary hormones blocked when treating prostate cancer?
testosterone and dihydrotestosterone (DHT)
The hormonal treatment in prostate cancer is called what?
androgen deprivation therapy (chemical castration)
What are the side effects that can be seen with ADT?
impotence, weakness, hot flashes, and loss of bone density
What are the two treatment options for hormonal treatment of prostate cancer?
- Gonadotropin-releasing hormone (GnRH) antagonist alone OR
- GnHR agonist (initially taken with an antiandrogen)
T/F: GnHR antagonists initially causes a tumor flare.
False; GnRH AGONISTS initially cause a tumor flare, which is why an antiandrogen is given with them to block the tumor flare.
Fill in the blanks:
Normally, the hypothalamus releases ______________ hormone, which stimulates the ____ receptor in the pituitary to release ___ and __. These hormones stimulate testosterone (T) production in the testes.
Initially, the GnRH ___________ cause the pituitary to release __ and ___ to increase testosterone, causing a _______________. They are given with an _________ to block this effect by blocking the initial T _______ effect on the cancer cells.
After a few weeks, feedback _________ suppresses FSH and LH output from the pituitary, which ______ T, and the _______________ can be discontinued.
- luteinizing hormone-releasing hormone (LHRH); GnRH; FSH; LH
- agonists; LH; FSH; tumor flare; antiandrogen; surge
- inhibition; decreases; antiandrogen
GnRH agonists are also known as what?
LHRH agonists
Match the hormonal treatments used for prostate cancer with their correct MOA/description:
- GnRH agonists __
- GnRH antagonists __
- 1st generation antiandrogens __
- 2nd generation antiandrogens __
- Androgen biosynthesis inhibitor __
a. Don’t cause upregulation of androgen receptors and can be used as a single treatment
b. Block GnRH receptors directly causing a rapid decrease in testosterone production
c. Interferes with a specific CYP-17 enzyme involved in the synthesis of steroid hormones in the testes and adrenal glands to decrease testosterone production
d. Reduce testosterone through a negative feedback mechanism, causing an initial surge in testosterone, followed by a gradual reduction
e. Competitively inhibit testosterone from binding to prostate cancer cells
- d
- b
- e
- a
- c
Androgen biosynthesis inhibitors must be taken with __________ to cause negative feedback on the production of ________ and prevent symptoms of ________________ (HTN, fluid retention, hypokalemia).
prednisone; aldosterone; hyperaldosteronism
Match the chemo agents used in prostate cancer to their correct drug class:
- Degarelix, relugolix __
- Apalutamide, darolutamide, enzalutamide __
- Leuprolide (Lupron Depot), goserelin (Zoladex), histrelin, triptorelin __
- Bicalutamide, flutamide, nilutamide __
- Abiraterone __
a. GnRH agonists
b. GnRH antagonists
c. 1st generation antiandrogens
d. 2nd generation antiandrogens
e. Androgen biosynthesis inhibitors
- b
- d
- a
- c
- e
Which hormonal treatment for prostate cancer should be taken with calcium/vitamin D supplementation d/t a decrease in bone density?
GnRH agonists (leuprolide, goserelin)
What are the side effects of GnRH agonists?
hot flashes, impotence, gynecomastia, bone pain, QT prolongation
Which drug class used in prostate cancer has an osteoporosis risk?
GnRH antagonists
The 2nd generation antiandrogen, abalutamide, has a side effect of what?
QT prolongation
Why are chemo regimens usually given in combination?
to take advantage of synergistic mechanisms by targeting cells with different resistance mechanisms and at different stages of replication