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Pharmacology Semester II > Exam III Oncology > Flashcards

Exam III Oncology Flashcards

1
Q

Cancer Cell Characteristics

A

Uncontrolled cellular growth

Ability to invade adjacent structures and/or travel to distant areas

Incapable of physiologic functions of the mature tissue of origin

Altered proteins, enzyme systems, membrane characteristics, and cytogenetics

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2
Q

Cancer treatment types

A

Radiation

Surgery

Chemotherapy

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3
Q

Anti-Cancer Therapy

A

Cytotoxic therapies

Anti-hormonal therapies

Targeted therapies

Immunotherapy

Blood and marrow transplant (BMT)

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4
Q

Tumor Staging and treatment terminology

A

TNM Staging (Tumor, Nodal status, Metastasis) for Solid Tumors (Stage I, II, III, IV)

Adjuvant chemotherapy:

-Given after surgery to reduce risk of local and systemic recurrence

Neoadjuvant chemotherapy:

-Given prior to surgical intervention to reduce tumor size or to remove micrometastases

Oncogene

Tumor suppressor gene

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5
Q

Anticancer Drugs

A

Alkylating agents

-Cyclophosphamide, Cisplatin

Protease Inhibitor

-Bortezomib, Carfilzomib

Antimetabolites

-5-Fluorouracil, Methotrexate, Gemcitabine, 6-Mercaptopurine

Natural Products

-Etoposide, Paclitaxel, Vincristine

Antitumor antibiotics

-Bleomycin, Doxorubicin, Mitomycin

Hormonal

-Prednisone, Tamoxifen

Misc

-Imatinib, Cetuximab

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6
Q

Cytotoxic Chemotherapy

A

Traditional

Toxic to all cells, but more specific for rapidly dividing cells

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7
Q

Tumor Growth Kinetics

A

Doubling time

-Time needed for a tumor cell population to double in size

Gomperzian growth

-Early growth is exponential, but as tumor gets bigger, growth slows due to decreased nutrients/blood supply

Log-kill hypothesis

A given dose of chemotherapy kills the same fraction of tumor cells regardless of the size of the tumor at the time of treatment

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8
Q

Principles of Cytotoxic Chemotherapy - Combination chemotherapy or “Regimen”

A

Good single-agent activity against tumor

Different mechanism of action

Different toxicities or different onset of toxicities

Maximum cell kill within toxicity limits

Different mechanisms of action to target a cancer

Decrease drug resistance

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9
Q

Principles of Cytotoxic Chemotherapy - Dosing / Admin

A

Dosing

-Dose usually based on body surface area (BSA)

–Also mg/kg dosing or flat dosing

-Which weight to use

–Ideal, actual, adjusted

Administration

  • Cycles every 14, 21, or 28 days most common
  • Dose intensity and dose density
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10
Q

Alkylating agents - MoA

A

Prevents cell division by cross-linking DNA strands and decreasing DNA synthesis

Cell cycle non-specific

Myelosuppression is generally the dose-limiting toxicity

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11
Q

Alkylating Agents

A

Cyclophosphamide, Ifosfamide

Cisplatin, Oxaliplatin

Carboplatin,

Carmustine, Lomustine

Busulfan, Melphalan

Chlorambucil

Mechlorethamine

Temozolomide/Dacarbazine

Mechlorethamine

Streptozocin

Thiotepa

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12
Q

Alkylating agents: Common Toxicity

A

Nausea/Vomiting

  • Mostly acute - some delay
  • Often moderately to highly emetogenic

Myelosuppression

Alopecia

Sterility/Infertility

Secondary Malignancies

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13
Q

Alkylating Agents: Specific Toxicities

A

Cyclophosphamide/Ifosfamide

-Hemorrhagic cystitis (primarily Ifosfamide) due to acrolein metabolite

–Mesna

Cisplatin

  • Nephrotoxicity
  • N/V (acute and delayed)
  • Ototoxicity

Oxaliplatin

-Neuropathies (exacerbated by cold temperatures)

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14
Q

Antimetabolites

A

Structural analogues of naturally occurring substances necessary for specific biochemical reactions

  • Compete with normal metabolites or
  • Falsely insert themselves for a metabolite normally incorporated into DNA and RNA

Most commonly active in the S phase

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15
Q

DNA and RNA Bases

A

Purine Bases: A and G

Pyrimidine bases: T (DNA), U (RNA), and C

De-Novo base synthesis or salvaged bases used in building DNA and RNA

Continuously dividing cells favor using de novo synthetic pathway

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16
Q

Antimetabolites Most Important

A

Capecitabine

Cytarabine

Fluorouracil

Methotrexate

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17
Q

Antimetabolites Rest

A

Azacitidine

Cladribine

Clofarabine

Decitabine

Fludarabine

Gemcitabine

Methotrexate

Mercaptopurine

Nelarabine

Pentostatin

Pemetrexed

Pralatrexate

Thioguanine

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18
Q

Metabolites that use DHFR

A

Methotrexate

Flourouracil

19
Q

Antimetabolites: Toxicities

A

Common toxicities: myelosuppression, mucositis, mild N/V/D

Methotrexate (MTX)

Renal toxicity

Leucovorin rescue for high dose (>1 gm/m2)

Cytarabine

High dose therapy: nervous system (cerebellar) toxicity

Ocular irritation - eye drops

Fluorouracil (leucovorin)

Capecitabine: Hand-foot syndrome

20
Q

Natural Products

A

Antitumor antibiotics

Plant alkaloids

Vinca alkaloids

Taxanes

Topoisomerase I & II

Marine-based products

Enzymes

21
Q

Antitumor Antibiotics

A

Anthracyclines - block DNA and RNA transcription

Daunorubicin - Lifetime dose Limit

Doxorubicin - Lifetime dose limit

Epirubicin

Idarubicin

Mitoxantrone

Mitomycin - cross-links DNA

Dactinomycin - blocks RNA synthesis

Bleomycin - inhibits DNA synthesis (only cell-cycle specific agent)

Doxorubicin – Streptomyces peucetius

Bleomycin – Streptomyces certicillus

Mitomycin – Streptomyces caespitosus

Dactinomycin – Streptomyces parvulus

22
Q

Antitumor Antibiotics - Toxicities

A

N/V, alopecia, stomatitis, myelosuppression

Bleomycin: lung toxicity - pulmonary fibrosis, interstitial pneumonitis

Lifetime max 400 units

Anthracyclines: cardiotoxicity - CHF

Lifetime max dose (doxorubicin 450 mg/m2 or equivalent)

23
Q

Dose-Dependent Cardiotoxicity of Anthracyclines

A
24
Q

Antitumor Antibiotics - Myocardiotoxicity

A

Myocardiotoxicity (dose-dependent):

Production of toxic free radicals, membrane lipid peroxidation leading to irreversible damage and replacement by fibrous tissue

Risk Factors: Cumulative dose, PT age, concomitant chemotherapy, with known cardiotoxicity, radiation therapy

Early Toxicity: HF can develop within 3 months following completion

Late toxicity: Symptoms may appear one decade following completion

Dexrazoxane MOA: EDTA-like chelating agent, binds intracellular iron releaeed following lipid peroxidation

25
Q

Natural Products - Microtubule agents

A

M-Phase

Synthetic and semi-synthetic

Diffuse mechanisms of action

Vinca alkaloids prevent microtubule assembly

Taxanes prevent microtubule disassembly

26
Q

Plant Alkaloids: Microtubule Toxicities

A

Taxanes

Docetaxel - neuropathies, peripheral edema, hypersensitivity reactions

Paclitaxel - neuropathies, hypersensitivity reactions

-Premedicate with H1 and H2 blocker + steroid

Vinca Alkaloids

Vincristine - neuropathies, constipation, DO NOT give intrathecally

Vinblastine

Vinorelbine - myelosuppression

27
Q

Natural Products and Toxicities

A

Topoisomerase I inhibitors

Irinotecan, Topotecan

Topoisomerase II inhibitors

Etoposide, Teniposide

Enzyme

Asparaginase, Pegaspargase

Irinotecan - diarrhea (2 phases)

Immediate - cholinergic reaction

Delayed - Ioperamide, Diphenoxylate/Atropine

Etoposide - secondary cancers

Asparaginase - hypersensitivity reaction, hyperglycemia, pancreatitis, coagulopathies

E Coli-drevived PEGylated, Erwinia-derived

28
Q

Natural Products-Marine-based products

A

Eribulin - Sea sponge

Microtubule-like Agents

Toxicities: Fatigue, peripheral neuropathy, CINV

Trabectedin - Sea squirt

Mechanism - somewhat like an alkylating agent

Toxicities: fatigue, hand-foot syndrome, CINV, hepatic damage

29
Q

Hormonal Treatment

A

Blocks production of hormones or hormone receptors in the body

Anti-estrogens

Anti-androgens

Luteinizing hormone-releasing hormone (LHRH) analogs

Ex: breast, prostate cancer

30
Q

Hormone Therapy Chart

A
31
Q

Hormonal Therapy: Prostate Cancer

A

LHRH agonists

Inhibit the pituitary (through negative feedback) from releasing LH and FSH which stops stimulation of the testes to produce testosterone (can also be used in breast cancer with same MOA but stops stimulation of ovaries to produce estrogen)

Tumor flare

Leuprolide, Goserelin, Triptorelin

LHRH antagonists

Directly inhibits pituitary from releasing LH and FSH

Degarelix

Antiandrogens

Blocks Androgen receptors

Bicalutamide, Flutamide, Nilutamide, Enzalutamide, Apalutamide

Abiraterone

32
Q

HPT Axis

A
33
Q

Targeted Agents

A

Identifies certain features of a cancer cell that make it different from the normal cell

Prevents Tumor cells from entering cell cycle or target signals that trigger cancer growth, metastasis, and immortality

Monoclonal antibodies

Antibodies that match an antigen on the cancer cell surface

Molecularly targeted therapies

Block signalling inside the cell

34
Q

Targeted Agents names/types

A
35
Q

Targets of targeted agents

A

VEGF signalling pathway (VSP) inhibitors

(VEGF(R) inhibitors - vascular endothelial growth factor (receptor))

HTN, proteinuria, bleeding, impaired wound healing

HTN may indicate effectiveness

Bevacizumab, Sunitinib, Pazopanib, Regorafenib, ETC.

EGFR inhibitors - epidermal growth factor receptor

Acneiform rash

Rash may indicate effectiveness

Erlotinib, Gefitinib, Alectinib, Cetuximab, Panitumumab

36
Q

EGFR Acneform RAsh

A
37
Q

Targets PT-II

A

mTOR inhibitors - mammalian Target of Rapamycin

Hyperglycemia, dyslipidemia, mucosal sensitivity, ulcers

Drug interactions - 3A4

Everolimus, sirolimus, temsirolimus

BCR-ABL mutation inhibition -

Imatinib (edema, N/V), Dasatinib (neutropenia, edema, N/V), Nilotinib (N/V, fatigue), Ponatinib (cardiac), Bosutinib (N/V/D)

CYP3A4 substrates (except ponatinib) so drug interactions possible

Imantinib also a 3A4 inhibitor

38
Q

mTOR inhibitor Toxicities

A
39
Q

Specific Targets

A

CD20 - Rituximab, Ofatumumab, Obinutuzumab - (infusion RXN, myelosuppression)

HER2 inhibition - human epidermal growth factor receptor - 2

Trastuzumab, Pertuzumab - Cardiotoxicity

Lapatinib - N/V/D, fatigue, hand-foot syndrome; drug interactions with strong 3A$ inducers/inhibitors (also cardiotoxicity as it is a HER2 INH)

40
Q

Targeted Agents: Toxicities (MABS)

A

MAB: Brentuximab (neuropathy), Vemurafenib (Colitis), Bortezomab (Neuropathies)

Potential hypersensitivity reactions based on mAB origin

QT prolongation

Nilotinib, Pazopanib, Ponatinib

Fatigue, hair thinning

Low grade (if at all)

N/V

Myelosuppression

41
Q

Targeted Agent Toxicities

A

Hair depigmentation (and repigmentation)

Dysphonia

Hypothyroidism

Sunitinib, Pazopanib, Regorafenib

42
Q

Immunological Therapies

A

INF

Interleukin

Lenalidomide

Thalidomide

CTLA-4 inhibitors

PD-1 inhibitors

Cancer Vaccine

43
Q

PD-1 and PD-L1 Inhibitor

A

Pembrolizumab

??

Big adverse effects

LO

Pharmacology Semester II (21 decks)

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