GI Malignancies Flashcards
What are some monoclonals for tx of colorectal cancer?
bevacizumab and cetuximab
How common is CRC?
3rd most common cancer and 2nd most deadly with 20% of pts having METs at diagnosis
What is the tx of CRC?
5-FU + leucovorin + oxplatin (aka FOLFOX), or irinotecan instead of oxplatin (aka FOLFIRI)
When are Bevacizumab and cetuximab not helpful in tx of CRC?
in the presence of KRAS mutations (down stream of action)
What does Bevacizumab do?
Bevacizumab is a recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting vascular endothelial growth factor A(VEGF-A)
What is Cetuximab?
Cetuximab (INN) is an epidermal growth factor receptor (EGFR) inhibitor used for the treatment of metastatic colorectal cancer, and others
How is anal cancer tx?
Radiation therpay alone may lead to a 5-yr survival rate in excess of 70%, and added cisplatin, 5-FU, or mitomycin may help
How common is gastric cancer?
4th most deadly cancer with a 5-yr survival of 20%
All gastric cancer pts should be tested for what?
All should be tested for HER-2 (add trastuzumab to the standard 5-FU/cisplatin regimen if positive)
What else can be used to tx gastric cancer?
glutamic acid, which acts as a gatric acidifer to counterbalance deficiencies in HCl
What are three tx options for GI carcinoid tumors?
- octreotide
- methysergide
- IFN-a
Why is octerotide helpful in GI carcinoid tumors?
It acts at somatostatin receptors to inhibit the secretion of serotonin and other peptides, which results in:
increased intestinal absorption of water and electrolytes,
decreased gastric acid secretions, and
increased intestinal transit time
How long can octreotide typically be used to tx GI carcinoid tumors?
12 months due to tachyphylaxis
How does methylsergide help in tx of GI carcinoid tumors?
it is a serotonin antagonist that can be used to inhibit diarrhea arising
IFN-a inhibits disease progression and provides symptom relief in 75% of pts. but is limited by its AEs. Name some
- alopecia
- anorexia
- fatigue and fever
- weight loss
- myelosuppression
What are the main mutational types of GISTs?
80% KIT mutant
5% KIT negative
5-8% PDGFRA mutant
12-15% wild type
Note that for GISTs, conventional cytotoxic chemo is essentially futile, partly due to P-gp overexpression
What are two tx options for GISTs?
- Imatinib mesylate
- Sunitinib malate
What is the 1st line tx of unresectable, metastatis, or recurrent GIST?
Imatinib (Sunitinib is reserved for those unresponsive to Imatinib tx)
What is a TKI used in tx of pancreatic cancer?
Erlotinib
What are the tx options for pacnreatic cancer?
Gemcitabine or 5-FU/folinic acid
Gemcitabine and erlotinib or FLOFIRINOX
80% of cases of liver cancer are associated with what?
HBV or HCV infections, which can directly interact with signaling pathways that promote cellular proliferation
What are some main tx options for liver cancer?
TACE, trans-catheter arterial chemoembolization
-Sorafenib
Describe TACE, trans-catheter arterial chemoembolization
Doxorubicin is injected while the hepatic a. branch feeding the tumor is occluded with an embolic agent (spares normal tissue an limits dispersion)
