Exam 3 - Colorectal Cancer Flashcards
List risk factors for colorectal cancer?
PMH of polyps, IBD (IC, CD), family history, genetics (FAP, HNPCC/Lynch syndrome), smoking, heavy alcohol use (decreases folic acid stores), physical inactivity
List socieconomic/age risk factors for colorectal cancer?
diabetes, obesity, diet (high in red/processed meats), increasing age, race
List signs/symptoms of colorectal cancer?
bright red or dark blood in stool, change in bowel habits, abdominal discomfort, N/V
What is the MOA of leucovorin (folinic acid)?
stabilizes fdUMP binding to thymidylate synthase
What is the MoA of capecitabine (Xeloda)?
prodrug of 5-FU
What is the MoA of 5-fluorouracil?
inhibits thymidylate synthase
What are AEs of capecitabine (Xeloda)?
renal impairment dose adjustments, hyperbilirubinemia, diarrhea, Hand-foot syndrome, mucositis
What is a CI for capecitabine (Xeloda)?
dihydropyrimidine dehydrogenase (DPD) deficiency
What is the MoA of oxaliplatin (Eloxatin)?
platinum analog, non cell-cycle specific alkylating agent
What are AEs of oxaliplatin (Eloxatin)?
peripheral neuropathy, cold intolerance/sensitivity, myelosuppression
What are treatments for oxaliplatin-induced neuropathy? (3)
eating/drinking at room temp, GABA analogues, SNRIs (duloxetine)
What is the MoA of irinotecan (Camptosar)?
topoisomerase-1 inhibitor
What are AEs of irinotecan (Camptosar)?
DIARRHEA, fatigue, alopecia, myelosupression (neutropenia)
What are treatments for acute phase irinotecan-induced diarrhea?
atropine, diphenoxylate/atropine
What is treatment for delayed phase irinotecan-induced diarrhea?
loperamide
What is the MOA of bevacizumab (Avastin)?
recombinant, humanized MoAb to VEGF-A
What is the MOA of Ziv-aflibercept (Zaltrap)?
fusion protein that inhibits VEGF-A/B
What are AEs of bevacizumab (Avastin)?
HTN, delayed wound healing, proteinuria, hemorrhage (epistaxis), VTE
What is a CI for bevacizumab (Avastin)?
uncontrolled HTN
What is the MOA of ramucirumab (Cyramza)?
VEGF-R2 inhibitor
What are AEs of ramucirumab (Cyramza)?
similar to other VEGF inhibitors
List EGFR inhibitors? (2)
cetuximab (Erbitux), panitumumab (Vectibux)
What are AEs of EGFR inhibitors?
infusion-related reactions, hypomagnesemia, paronchyia, aceniform rash
What is the MOA of regorafenib (Stivarga)?
multikinase inhibitor
What are AEs of regorafenib (Stivarga)?
fatigue, weight loss, diarrhea, hand-foot syndrome, HTN, infection
List anti-HER2 therapies?
trastuzumab + pertuzumab or lapatinib
What is the MOA of trifluridine + tipiracil (Lonsurf)?
interferes with DNA synthesis and inhibits cell proliferation by incorporation into DNA
What are AEs of trifluridine + tipiracil (Lonsurf)?
myelosuppression, anemia, fatigue, N/V/D
List immunotherapy options for colorectal cancers? (2)
nivolumab (Opdivo), pembrolizumab (Keytruda)
What are AEs of nivolumab (Opdivo) and pembrolizumab (Keytruda)? (6)
rash, colitis, hepatitis, nephritis, pneumonitis, thyroid disorders
What are treatments used for a BRAF mutation? (2)
cetuximab (Erbitux), encorafenib (Braftovi)
What is treatment for Stage I colorectal cancer?
surveillance
What is treatment for Stage II colorectal cancer?
surgery and consider adjuvant therapy in high risk (FOLFOX, CapeOX, capecitabine, 5-FU/leucovorin)
What is treatment for Stage III colorectal cancers?
surgery with chemotherapy (FOLFOX, CapeOX (preferred); capecitabine, 5-FU/leucovorin)
What is the duration of FOLFOX therapy in high risk Stage III colorectal cancers? Low risk?
6 months; 3-6 months
What should NOT be used in Stage III colorectal cancers? (2)
targeted therapies, irinotecan
What is treatment for Stage IV colorectal cancers?
chemotherapy (FOLFOX or FOLFIRI or CapeOx with additional drugs depending on cytogenetics)
