Exam 1 Flashcards
1
Q
difference between cancer and abnormal growth
A
abnormal growth only becomes cancerous when it spreads out to its surrounding environment
2
Q
phases of carcinogenesis
A
- initiation
- promotion
- progression
- metastasis
3
Q
naming cancer: prefixes
A
benign is prefix + “oma”
malignant is prefix + “carcinoma, sarcoma, or blastoma”e
4
Q
exceptions to naming cancer: prefixes
A
lymphoma is malignant tumor from lymphocyte
mesothelioma is malignant tumor from mesothelium
seminoma is malignant germ cell tumor
5
Q
prefix for fat
A
lipo
6
Q
prefix for bone
A
osteo
7
Q
prefix for fibrous tissue
A
fib
8
Q
prefix for cartilage
A
chondro
9
Q
prefix for blood vessel
A
hemangio
10
Q
prefix for smooth muscle
A
leiomyo
11
Q
prefix for striated muscle
A
rhabdomyo
12
Q
prefix for gland
A
adeno
13
Q
what is carcinoma
A
malignant neoplasm of epithelial origin/cancer of the internal or external lining of the bodyw
14
Q
what is sarcoma
A
cancer that originates in supportive & connective tissues such as bones, tendons, cartilage, muscle, fat
15
Q
what is myeloma
A
cancer that originates in the plasma cells of the bone marrow
16
Q
what is blastoma
A
cancer derived from premature precursor cells or embryonic tissue
17
Q
what is leukemia
A
cancer of the bone marrow
18
Q
what is lymphoma
A
solid cancers that develop in the glands or nodes of the lymphatic system
19
Q
TNM stages?
A
T(1-4) the size and extent of the main tumor
N (0-3) the number of nearby lymph nodes that have cancer
m (0-1) metastasis
20
Q
overall stage grouping system
A
stages 0-4
21
Q
stage 0
A
carcinoma in situ, abnormal cells growing in their normal place
22
Q
stage 1
A
tumor is contained within organs
23
Q
stage 2
A
larger tumor within organ, little lymph node involvement
24
Q
stage 3
A
tumor has spread to lymph nodes
25
stage 4
metastasis
26
germline vs somatic genetic variants
germline can be passed on to offspring (present in egg/sperm, all cells carry the variant)
somatic arise during an individual's lifetime, are not passed on (only the tumor carries the variant, occur in non-germline tissue)
27
oncogenes
promote unregulated cell growth
28
types of oncogenes
growth factors
receptor tyrosine kinases
cytoplasmic tyrosine kinases
serine/threonine kinases
GTPase signaling
transcription factors
29
tumor suppressor genes
regulate and inhibit inappropriate cell growth
30
TSP functions
cell cycle arrest/apoptosis
protein phosphatase
inhibit growth-promoting signal transduction
ubiquitin ligase
master brake of cell cycle
cell adhesion & migration
DNA repair
31
difference btwn oncogene and TSP
a single genetic event can activate an oncogene (dominant)
multiple mutations are required to inactivate a TSP (recessive)
32
knudson hypothesis
cancer is the result of accumulated mutations to a cell's DNA
33
cancer cells favor ____>_______
glycolysis > oxidative phosphorylation
34
cancers exhibit increased demand for _____ which can be therapeutic targets
specific amino acids
35
treatment modality that is local and non-targeted
radiation
36
treatment modality that is local and targeted
surgery
37
treatment modality that is systemic and non-targeted
chemotherapy
38
treatment modality that is systemic and targeted
targeted therapies
39
adjuvant therapy
to eradicate residual cancer after primary surgery
40
neoadjuvant therapy
to shrink large, locally advanced disease to enable surgical resection
41
induction therapy
1st treatment for a disease, aims to achieve a rapid reduction in tumor burden or disease activity
42
consolidation therapy
post-remission therapy to eradicate any remaining disease
43
maintenance therapy
to prevent cancer from recurring
44
palliative therapy
to increase survival and improve quality of life by symptom control for advanced, incurable cancer
45
cycle
a period of chemo treatment followed by a period of rest
46
what dictates cycles
cancer, stage, individual, toxicity risk
balance with toxicities (more frequent cycles enhances tumor effects but increases toxicities)
also determined by PK of drug
47
inhibition of HDAC or DNMT does what
restores tumor suppressor gene expression
48
mechanism of CDK4/6 inhibitors
prevent Rb protein phosphorylation which prevents cell transition from G1 to S, leads to cell cycle arrest and apoptosis
49
generic naming formula of targeted therapies
prefix (variable) + substem + stem
50
substem cir
circulatory system is target
51
substem lim
immune system is target
52
substem tu
tumor is target
53
substem ximab
chimeric human mouse
54
substem zumab
humanized mouse
55
substem mumab
fully human
56
stem mAb
monoclonal antibody
57
stem ib
small molecule w/ inhibitory properties
58
tinib
tyrosine kinase inhibitor
59
zomib
proteasome inhibitor
60
ciclib
cyclin-dependent kinase inhibitor
61
parib
poly-ADP-ribose polymerase inhibitor
62
anti CTLA-4 targets _____
CD28 pathway
63
anti PD-1 targets _____
TCR pathway
64
anti-CTLA-4 primarily affects ____
CD4+ T cells
65
anti PD-1 primarily affects _____
CD8+ T cells
66
which (anti-CTLA-4 or PD-1) can move T cells into tumors
anti-CTLA-4
67
which (anti-CTLA-4 or PD-1) expands clonal diversity
anti CTLA-4
68
______ is required before CAR T cell infusion
lymphodepleting conditioning therapy
69
what does lymphodepleting conditioning therapy consist of
fludarabine 30 mg/m2 IV daily x 4 days
cyclophosphamide 500 mg/m2 IV daily x 2 days (starting w/ first dose of fludarabine)
70
what are the common complications of CAR T cell infusion
Cytokine release syndrome (CRS) and neurotoxicity
71
how is prodromal CRS managed
observe, antibiotics per local guidelines if neutropenic, and symptom management
72
how is overt CRS managed
antipyretics, O2, IV fluids, low dose vasopressors
73
how is severe CRS managed
high dose/multiple vasopressors, O2/mechanical ventilation, tocilizumab
74
how is grade 2-3 neurotoxicity managed
dexamethasone 10 mg IV q6h
until grade 1 then taper x 3 days
75
how is grade 4 neurotoxicity managed
methylprednisolone 1000 mg IV x 3 days, then manage as 2/3
76
which classes of cancer drugs work by DNA damage
alkylating agents and antitumor antibiotics
77
which drugs are alkylating agents
cyclophosphamide
carmustine
cisplatin
78
how do alkylating agents work
via crosslinking of guanine bases
79
which drugs are antitumor antibiotics
doxorubicin
daunorubicin
bleomycin
80
how do the antitumor antibiotics work
via DNA intercalation
81
which classes of cancer drugs work by interfering with DNA synthesis
topoisomerase inhibitors and antimetabolites
82
which drugs are topoisomerase inhibitors
irinotecan
topotecan
etoposide
83
how do topoisomerase inhibitors work
by blocking DNA strand re-ligation during DNA synthesis
84
which drugs are antimetabolites
methotrexate
mercaptopurine
5-fluorouracil
cytarabine
capecitabine
gemcitabine
trifluridine and tipiracil
85
how do antimetabolites work
incorporated into DNA/RNA and inhibit nucleic acid synthesis
86
which classes of cancer drugs work on translation/cell division
microtubule inhibitors & nutrient deprivation
87
which drugs are microtubule inhibitors
paclitaxel
cabazitaxel
docetaxel
vincristine
eribulin
88
how do microtubule inhibitors work
inhibit tubulin polymerization or function
89
which drug works by nutrient deprivation
asparaginase
90
how does asparaginase work
inhibition of protein synthesis
91
which drug classes work as targeted therapies on the "go" signals
hormonal agents and epigenetic agents
92
which drug classes fall under hormonal agents
SERMs
aromatase inhibitors
LHRH agonist
LHRH antagonist
antiandrogens
93
which drug is a SERM
tamoxifen
94
which drug is an aromatase inhibitor
anastrazole
95
which drug is a LHRH agonist
leuprolide
96
which drug is a LHRH antagonist
degarelix
97
which drug is an antiandrogen
bicalutamide
98
how do SERMs work
block the effects of estrogen in the breast tissue
99
how do aromatase inhibitors work
inhibiting aromatase, which is an enzyme that converts androgens into estrogens
100
how do LHRH agonists and antagonists work
lower androgen levels by decreasing LH formation or release by the pituitary gland
101
how do antiandrogens work
block androgen receptor
102
which drug classes are epigenetic agents
HDAC inhibitors and DNMT inhibitors
103
which drug is a HDAC inhibitor
vorinostat
104
which drug is a DNMT inhibitor
azacitidine
105
how do HDAC inhibitors work
blocks deacetylation by HDAC and restores expression of tumor suppressor genes
106
how do DNMT inhibitors work
blocks methylation of promoters & restores expression of tumor suppressor genes
107
which drug classes are targeted therapies NOT for "go" signals i.e. other random targets
angiogenesis inhibitors, proteasome inhibitors, CDK4/6 inhibitors, PARP inhibitors
108
which drug is an angiogenesis inhibitor
bevacizumab
109
how do angiogenesis inhibitors work
targeting VEGF
110
which drug is a proteasome inhibitor
carfilzomib
111
how do proteasome inhibitors work
lead to accumulation of misfolded proteins leading to induction of cancer cell apoptosis
112
which drugs are CDK4/6 inhibitors
ribociclib
palbociclib
abemaciclib
113
how do CDK4/6 inhibitors work
prevent phosphorylation of Rb
114
which drugs are PARP inhibitors
olaparib
niraparib
rucaparib
115
how do PARP inhibitors work
prevent double-stranded DNA damage repair in BRCA-deficient cells
116
what are two major classes of immunotherapies
checkpoint inhibitor antibodies
CAR T cell therapy
117
which checkpoint inhibitor targets CTLA-4
ipilimumab
118
which checkpoint inhibitors target PD-1
nivolumab
pembrolizumab
dostarlimab
cemiplimab
119
which checkpoint inhibitors target PD-L1
atezolizumab
avelumab
durvalumab
120
which checkpoint inhibitor targets LAG3
relatlimab
121
which CAR therapy
targets CD19
costimulatory 4-1BB
kymirah
breyanzi
122
which CAR therapy
targets CD19
costimulatory CD28
yescarta
tecartus
123
which CAR therapy
targets BCMA
costimulatory 4-1BB
abecma
124
which CAR therapy
targets BCMAx2
costimulatory 4-1BB
carvykti
125
what are the types of abnormal cell growth
hypertrophy (size)
hyperplasia (number)
metaplasia (change)
dysplasia (disordered)
126
6 cancer hallmarks
1. produce go signals
2. override stop signals
3. angiogenesis
4. evade immune surveillance
5. resist cell death
6. energy metabolism
127
what is the difference between chemotherapy vs targeted therapy target-wise
chemo targets rapidly dividing cells
targeted acts on cancer-specific molecular targets
128
chemo is cyto___ while targeted therapy is cyto___
chemo cytotoxic
targeted cytostatic
129
what is the difference between chemotherapy vs targeted therapy specificity-wise
chemo is specific for rapidly dividing cells
targeted has a higher specificity for cancer cells
130
what is the difference between chemotherapy vs targeted therapy toxicity-wise
chemo is toxic to any fast growing cell
targeted is toxic to normal cells with the specific target
131
anti-CTLA-4 vs anti-PD-1: which one has a significant recurrence after response
PD-1
132
common immune side effects to see with immune checkpoint blockers?
colitis
dermatitis
hepatitis
endocrinopathy
133
how do you monitor dermatitis
exam, biopsy skin
134
first line dermatitis
topical/oral steroids
135
how do you monitor endocrinopathy
signs are fatigue, hypotension, metabolic changes
monitor TSH, T4, cortisol, ACTH
136
first line endocrinopathy
hormone replacement
137
how do you monitor hepatitis
usually asymptomatic, monitor AST/ALT
138
first line hepatitis
oral steroids
139
how do you monitor colitis
clinical, endoscopy
signs are diarrhea, abdominal pain
140
first line colitis
oral steroids
141
BCR-ABL inhibitor
Imatinib
Dasatinib
Ponatinib
Nilotinib
142
BRAF inhibitors
Dabrafenib
Vemurafenib
143
EGFR inhibitors
Erlotinib
Afatinib
Gefitinib
Lapatinib
Cetuximab
Osimertinib
Panitumamib
144
what is micromedex good for
off label indications
dose adjustments
drug interactions
ADME
145
what is NCCN good for
chemo regimen recs
diagnosis & stage specific
tumor marker-directed
evidence-based
frequent updates
146
what is hemonc.org good for
chemo regimen compendium
diagnosis & stage specific
tumor marker directed
evidence based
frequently updated
147
what is NIH daily med good for
package insert PDFs- generic and tradename
boxed warnings
inactive ingredients-- excipients & preservatives
148
when do you need to recalculate BSA
when weight loss or gain of >10%
149
how to calculate % change in weight
change in weight/initial weight x 100%
150
which body weight do you use to calculate BSA for chemo
actual body weight (using ideal/adjusted risks treatment failure)
151
ANC level you want to ensure patients are at for chemotherapy
>1500
152
platelets level you want to ensure patients are at for chemotherapy
>100k
153
calvert formula
dose (mg)= target AUC x (GFR+25)
154
AST upper limit normal
36
155
ALT upper limit normal
56
156
CrCL formula
[(140-age) x IBW]/(SCr x 72) x 0.85 if female
157
IBW
women: 45.5 + 2.3 per every inch >5 feet
men: 50 + 2.3 per every inch >5 feet
158
Adjusted body weight
IBW + 0.4(ABW-IBW)
159
when do you use adjusted body weight
when their actual body weight is 25% or more over IBW
160
BSA
square root of [(cm x kg) / 3600]
