GI Cancer Rx Flashcards
Agents used in Rx of Anal Cancer? (3)
“Clears My Feces”
- Cisplatin
- Mitomycin
- Fluorouracil (5-FU)
Anal Cancer incidence and prognosis?
Incidence→Uncommon; 4% of lower alimentary tract tumors
Prognosis→Usually curable
Anal cancer treatment regimens? (2)
a. Radiation alone→5 yr survival is 70%
b. Radiation + Cisplatin, Mitomycin, 5-FU→this combo leads to improved outcomes
Agents used in Rx of Colorectal Cancer (CRC)? (7)
Fiery Colon Cancer BOIL
- Fluorouracil (5-FU)
- Capecitabine
- Cetuximab
- Bevacizumab
- Oxaliplatin
- Irinotecan
- Leucovorin
CRC incidence and prognosis?
Incidence: 3rd mc cancer; 2nd most deadly cancer
Prognosis: 20% have metastases at time of diagnosis
Standard treatment regimens for CRC? (2)
- FOLFOX→5-FU + Leucovorin + Oxaliplatin
- FOLFIRI→5-FU + Leucovorin + Irinotecan
Capecitabine can be substituted for 5-FU.
What are the targeted agents (2) used for CRC? When are they not effective (1)?
Bevacizumab or Cetuximab
They appear to improve outcomes, except in pt;s with KRAS mutations
First line therapy for CRC?
Bevacizumab or Cetuximab + FOLFOX or FOLFIRI
Agents used in the Rx of Esophageal Cancer? (3)
esophageal “Cancer Frustrates Digestion” in my throat
- Cisplatin
- Fluorouracil (5-FU)
- Docetaxel
When esophageal cancer becomes symptomatic (dysphagia) what does that tell the physician?
Once symptomatic (usually dysphagia), the esophageal cancer has invaded into the muscularis propria (externa) and metastasized.
Rx Recommendations for Esophageal cancers?
a. Endoscopic stents for palliation of dysphagia
b. Radiation and Chemotherapy for metastatic disease
1st and 2nd line chemotherapy treatments in Rx of metastatic esophageal cancer?
a. 1st line = Cisplatin + 5-FU
b. 2nd line (for those whose ds progresses after 1st line Rx and can tolerate 2nd line) = Docetaxel (taxanes)
Agents used in Rx of Gastric Cancers? (7)
“Carl’s Irritated Gastric Tract Doesn’t Digest Food”
- Cisplatin
- Docetaxel
- Doxorubicin
- Fluorouracil (5-FU)
- Glutamic Acid
- Irinotecan
- Trastuzumab
Incidence and prognosis of gastric cancer?
4th most deadly cancer; 5-yr survival is 20%
Treatment regimen for gastric cancers? (2)
Test ALL gastric cancer pt’s HER2 Status→if positive add trastuzumab
1. HER2-Positive Regimen: (2→T+FC)
Trastuzumab + 5-FU and Cisplatin
- HER2-Negative Regimen: (FCDID)
a. 5-FU/Cisplatin Combo
b. +/- Doxorubicin
c. + Irinotecan or Docetaxel
What is the use of Glutamic acid in the Rx of gastric cancers?
It is an ancillary agent employed as a GASTRIC ACIDIFIER to counterbalance deficiencies of HCl in the gastric juice.
Two Agents used in the Rx of GI carcinoid tumors?
“Car(cinoid)s Irk Octopi”
- Interferon-alpja
- Octreotide
What are GI carcinoid tumors and where do they originate from?
GI Carcinoids are rare malignancies arising from cells linking the endocrine and central nervous systems. They originate in cells responsible for the production of key neurosecretory hormones.
Octreotide MoA and effects (3) in Rx of GI carcinoids?
MoA: Somatostatin analog→activates somatostatin receptors→inhibition of the secretion of serotonin and other gastroentero-pancreatic peptides.
Effects: this results in:
1. Increased intestinal transit time
2. Increased intestinal absorption of water/electrolytes
3. Decreased gastric acid secretions
Duration of Octreotide treatment? Why?
Treatment duration is ~12 months b/c of TACHYPHYLAXIS (less frequent w/ long-acting formulations) and/or disease progression
Effects of IFN-alpha in Rx of GI carcinoids? (2)
- Inhibits disease progression
- Provides symptom relief
Greater anti-tumor effect than octreotide, but it has substantial ADE’s
ADEs of IFN-alpha (5)
My AA Friend-likes Suicides
- Myelosuppression
- Alopecia
- Anorexia/weight loss
- Flu-like symptoms (fever, fatigue)
- Suicidal Ideation
Two agents used in the Rx of Gastrointestinal Stromal Tumors (GIST’s)?
gISt
1. Imatinib
2. Sunitinib
These are TKI’s
Incidence and Epidemiology of GIST’s?
Incidence: s 50-80 y.o.
b. Equally distributed across both sexes and all geographic/ethnic groups
4 Subgroups of GIST’s?
GIST’s can fall into one or more of the following groups:
- KIT-mutant (CD117-positive) (80%)
- KIT negative (5%)
- PDGFRA-mutant (5-8%)
- Wild-type (12-15%)
Is conventional chemotherapy useful in Rx of GIST?
No, conventional chemo is essentially futile, partly due to P-gp overexpression
What class of drugs has revolutionized the Rx of GIST’s?
Tyrosine Kinase Inhibitors (TKI’s)
1st line agent for Rx of unresectable, metastatic, or recurrent GIST?
Imatinib (TKI that targets KIT???)
Why do the majority of pt’s with GIST’s experience delayed resistance to Imatinib?
It is often due to the development of secondary mutations in a separate portion of the KIT-coding sequence.
What is the second line agent for GIST’s? When is it used?
Sunitinib is given to patients w/ unresectable disease who progress on higher-dose imatinib.
Agents used in the Rx of Pancreatic Cancers? (6)
"OLE FIG" in the Pancreas Oxaliplatin Leucovorin Erlotinib Flurouracil (5-FU) Irinotecan Gemcitabine
Incidence and Prognosis of Pancreatic Cancer?
Pancreatic cancer is a poorly understood cancer of increasing incidence.
Rarely Curable
<20% are organ-confined at diagnosis