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PHRM 864 > E2 Colorectal Cancer > Flashcards

E2 Colorectal Cancer Flashcards

1
Q

all of the risk factors for this one are self explanatory so im not typing them

A

maybe just recognize crohns and colitis and FAP (not that fap)

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2
Q

T or F:
>95% of colorectal cancers are adenocarcinomas

A

true

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3
Q

2 testing-work up options

A

microsatellite instability (MSI)
and
DNA mismatch repair (DNA MMR) (testing for loss of genes involved with that)

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4
Q

T or F:
pts with stage II disease have increased benefit from adjuvant 5-FU compared to stage III

A

false, stage III benefits from 5-FU, stage 2 does not

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5
Q

T or F:
chemo is the gold standard in stage II colon cancer and above

A

false, dont do it in stage II

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6
Q

T or F:
radiation therapy is well established for rectal cancer and not colon cancer

A

true

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7
Q

what stages of colorectal cancer are potentially curable

A

stage I, II, III

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8
Q

T or F:
surgery alone is definitive therapy in stages I and II

A

true

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9
Q

what is FOLFOX

A

5-FU
leucovorin
Oxaliplatin

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10
Q

what is CapeOX

A

capecitabine
oxaliplatin

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11
Q

what is in FOLFIRI

A

5-FU
leucovorin
irinotecan (theres I’s in folfiri) and it ends with iri

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12
Q

T or F:
Capecitabine is = to bolus 5-FU and leucovorin in stage III

A

true

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13
Q

T or F:
Bevacizumab, cetuximab, panitumumab, and irinotecan play a major role in stage III

A

false, they do not play a role at all

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14
Q

what stages do you use FOLFOX or FOLFIRI

A

stage II

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15
Q

T or F:
FOLFOX has more toxicities due to oxaliplatin

A

true (paresthesia and neutropenia) + GI oops

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16
Q

NCCN preferred regimens in low risk

A

capeox 3 months
folfox 3-6 months

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17
Q

NCCN preferred regimens in high risk

A

capeox 3-6 months
FOLFOX 6 months

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18
Q

requires port for administration
A. FOLFOX
B. CapeOX

A

A

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19
Q

hand foot syndrome
A. FOLFOX
B. CapeOX

A

B

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20
Q

which drug used in capeox requires renal dose adjustments *

A

capecitabine

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21
Q

T or F:
capecitabine is IV bolus administered

A

false, oral

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22
Q

what 3 things listed on slide 39 determine which chemo regimen to use?

A

neuropathy
UGT1A1 deficiency (irinotecan)
1 vs 2 vs 3 drugs (?)

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23
Q

T or F:
pembro and nivolumab show benefit in the metastatic setting

A

true

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24
Q

T or F:
pembro and nivolumab are approved for patients before FOLFOX and FOLFIRI

A

false, after

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25
Q

2 predictive biomarkers

A

K-RAS
BRAF

26
Q

Mutations predict lack of response to anti-egfr mabs
A. KRAS
B. BRAF

A

A. KRAS

27
Q

DO NOT USE cetuximab and panitumumab
A. KRAS
B. BRAF

A

A. KRAS

28
Q

when is bevacizumab appropriate in colorectal cancer?

A

in stage IV -> metastatic

29
Q

1st line metastatic disease regimens: no targeted mutations (2 choices)

A

5-FU + leucovorin
OR
capecitabine +/- bevacizumab

30
Q

1st line metastatic disease KRAS wild type, left sided

A

cetuximab
or
panitumumab
(EGFR targets) -> these two are only effective when there are no mutations to KRAS

31
Q

1st line metastatic disease: dMMR/MSI-H

A

nivolumab +/- ipilimumab
or
pembro

32
Q

1st line metastatic disease:
HER2 positive

A

trastuzumab +/- pertuzumab/lapatinib/tucatinib

33
Q

2nd line therapy:
disease progression with prior oxaliplatin based regimens. *

A

FOLFIRI*
OR
irinotecan (this was the first in the list out of 7 so im sure just know this one)

34
Q

2nd line therapy:
disease progression with prior irinotecan-based regimen *

A

FOLFOX or CapeOX
(this was the first in the list out of 5 so im sure just know this one)

35
Q

disease progression with prior oxaliplatin based regimens
A. FOLFIRI
B. FOLFOX

A

A. FOLFIRI

36
Q

disease progression with irinotecan based regimens
A. FOLFIRI
B. FOLFOX

A

B. FOLFOX

37
Q

2 screening tests she told us to know that PRIMARILY detect cancer *

A

fecal occult blood test (FOBT)
and
fecal immunohistochemical test (FIT)

38
Q

detects hemoglobin:
A. FIT
B. FOBT

A

A. FIT

39
Q

2 tests to primarily detect cancer AND advanced lesions

A

endoscopy
and
colonoscopy -> gold standard

40
Q

what age do you get screened if you have a 1st degree relative with colorectal cancer hx

A

40 instead of 45

41
Q

T or F:
calcium-rich diet decreases proliferative response to fatty acids and bile acids

A

true

42
Q

3 things listed under colon cancer prevention (not including diet stuff which is obvious -> high fiber, less fat)

A
  • cyclooxygenase inhibitors -> says FDA indication removed in 2011 so thats odd
  • NSAIDS or aspirin
  • colectomy
43
Q

5-FU:
- converted in vitro to _____ and ____
- FUTP incorporates into ____ and impairs protein synthesis
- ______ binds thymidylate synthase and reduces rate of dna synthesis, replication, and repair

A
  • FUTP, FdUMP
  • RNA
  • FdUMP
44
Q

5-FU extensively metabolized by _____ in the liver

A

DPD (you should remember this)

45
Q

a few common toxicities with 5-FU

A

diarrhea, mucositis, myelosuppression

46
Q

Leucovorin stabilizes the binding of _____ to _______ resulting in enhancement of the toxicity of fDUMP

A

fDUMP to thymidylate synthase (TS)

47
Q

SN-38

A

irinotecan

48
Q

cholinergic symptom of irinotecan that is treated with atropine *

A

early onset diarrhea

49
Q

okay so if you see irinotecan and you’re thinking about side effects and shit what do you think of

A

diarrhea

50
Q

unique toxicities oxaliplatin (3) *

A

neuropathy, COLD INTOLERANCES, sensation of not being able to breathe

51
Q

dose limiting toxicity of Capecitabine *

A

hand-foot syndrome and diarrhea

52
Q

Cetuximab binds to the (intracellular/extracellular) domain of EGFR

A

extracellular

53
Q

2 underlined adverse events for cetuximab * (both of these also had **)

A

acneiform rash
hypomagnesemia

54
Q

pre-medicating with an ___ ___________ is recommended with Cetuximab

A

H1 antagonist

55
Q

Recombinant IgG2 monoclonal antibody and binds specifically to EGFR

A

Panitumumab

56
Q

2 underlined and asterisked toxicities of Panitumumab

A

acneiform rash
hypomagnesemia

57
Q

binds VEGF

A

Bevacizumab

58
Q

T or F:
Bevacizumab is given in combo with 5-FU, leuco, and irino

A

True, not a solo drug

59
Q

significant toxicities (a few but one main one i think) for bevacizumab

A

BLEEDING
htn
proteinuria
thromboembolism
GI perforations
decreased wound healing (bleeding)

60
Q

T or F:
Cetuximab has many black box warnings

A

false, bevacizumab does (i mean the name sounds kind of scary so i guess it makes sense)

PHRM 864 (28 decks)

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