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Oncology Exam 2 > Growth Factors > Flashcards

Growth Factors Flashcards

1
Q

Anemia is treated with

A

ESA

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2
Q

Neutropenia is treated with

A

CSF

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3
Q

Mucositis/stomatitis is treated with

A

Kerotinocyte GF

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4
Q

Two Lineages of Blood Stem Cells

A

Myeloid

Lymphoid

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5
Q

Myeloid makes

A

erythrocytes, platelets, monocytes, basophils, eosinophils and neutrophils

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6
Q

Lymphoid makes

A

Lymphocytes

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7
Q

Decreased oxygen delivery to kidney leads to

A

→ erythropoietin is generated by the kidneys due to sensing a low O2 level → increased oxygen delivery to tissues

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8
Q

Male Anemia

A

Less than 14

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9
Q

Female Anemia

A

Less than 12

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10
Q

Side effects of anemia

A

headache, dizziness, malabsorption

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11
Q

Moderate Anemia =

A

8-10

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12
Q

Severe Anemia =

A

6.5-7.9

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13
Q

What are the Cancer-Related Causes of Anemia

A 
o	Chemotherapy/radiation therapy
o	Anemia of chronic disease (leukemias, lymphomas, ovarian cancers)
o	Blood loss
o	Bone marrow infiltration
o	Nutritional deficiency
o	Hemolysis
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14
Q

Common cancers that cause Anemia

A

o Gynecological cancers, lymphoma/myeloma, and leukemi

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15
Q

Predisposing Factors for Anemia

A

Chemotherapy
Radiation
Combodities (renal, cancers)

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16
Q

Chemotherapeutic Agents that CAUSE anemia

A

Low grade: 5FU, taxels, CHOP, taxel + anthracycline

High: Toptecan, cisplatin, Ciplatin + etoposide, VIP

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17
Q

Benefits and Risk of RBC transfusions

A 
o	Graft-Versus-Host-Disease
o	Transfusion Related Acute Lung Injury
o	Allergy/anaphylaxis
o	Infections (HIV, HBV, HCV, HTLV, etc)
o	1 Unit of RBC → 1 g/dL increase in 1 hour
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18
Q

ESA main purpose

A

Decrease the need for transfusions

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19
Q

ESA Drugs and Dosing

A

Epoetin alfa: 3 times a week

Barbepoeitin alfa: SC Qweekly

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20
Q

ESA AE

A

 Fever, dehydration, vomiting, pneumonia, fatigue, THROMBOTIC EVENTS

21
Q

ESA Caution

A

OVERALL INCREASE IN THROMBOVASCUALR EVENTS AND DECREASE SURVIVAL RATE

22
Q

Why decreased overall survival rate with ESA

A

 When you give EPO to cure anemia, you may be indirectly stimulating proliferation of cancer cells SO NEVER give EPO when you have a curable cancer because it increases tumor oxidation and growth

23
Q

***WHEN TO USE ESA?

A

 Chronic kidney disease, ESRD due to T2 DM
 Non-myeloid and non-erythoid cancers
 HIV-Induced
 Patients undergoing hip or knee replacement surgery
 Stem cell transplantation and immunosuppressed patients
 Patients treated with chemotherapy and an Hgb level of

24
Q

WHEN TO NOT USE ESA?

A

 Curable cancers
 Cancer-induced anemia
 Hematological cancers (leukemia, lymphomas)

25
Neutropenia + Chemo
Most common dose-limiting toxicity | Between 7-14 days with recovery by day 21-28
26
Consequences of Neutropenia
Increased risk of infection, use of abx, and hospitalization Compromises treatment efficacy QofL impact
27
Prevention of Neutropenia
Dose reduction or delay | G-CSF or GM-CSF hematopoietic growth factors
28
What is G-CSF?
 Glycoprotein + growth factor + cytokine  Presents on precursor cells in bone marrow where it initiates proliferation and differentiation into mature granulocytes to stimulate bone marrow cell release into circulation
29
Filgramstim MOA and Dose
• Regulates the production of neutrophils within the bone marrow and affects neutrophil progenitor proliferation, differentiation and functional activation Dose: daily for 4-14 days and last for 24 hours
30
Pegfilgramstim MOA and Dose
Pegylated form of filgramstim | Dose: one dose Q2weeks
31
Sacramostim MOA and Use
• Stimulates myelopoiesis generally and neutrophils and monocytes specifically Used after BM transplan
32
Use of CSF
 Post chemotherapy febrile neutropenia  When the risk of febrile neutropenia is 20% and no other equally effective regimen is available  Potent inducer of hematopoietic stem cell mobilization for stem cell transplant  Severe chronic neutropenia  Prevention of FN  Peripheral stem cell mobilzation  Accelerate recovery of neutrophils following stem cell transplantation
33
CSF Dosing
Always give 24 hours after starting chemotherapy
34
AE of CSF
 Common: bone pain, elevated uric acid, arthralgia/myalgia |  Serious: splenic rupture, sickle cell crsis, anaphylaxis, respiratory distress
35
Clinical Pearls of CSF
 Begin at least 24 hrs after last dose of chemotherapy  No change in infection-related or overall mortality with treatment  Use for prevention of febrile neutropenia is better than treatment  Higher costs is an issue.
36
Define Mucositis
Inflammation of the mucosal surfaces through the body (esophagus, duodenum, colon, stomach, intestines, rectum)
37
Mucositis Mechanisms
 Characterized by damage to the epithelium of the oropharyngeal cavity and GI tract  Release of cytokines and growth factors → Inflammation → Tissue damage → Ulceration of mucosa
38
Mucositis Symptoms
 Pain  Difficulty eating/talking  Abdominal pain  Diarrhea
39
Complications
 Impaired QofL  Decreased activity  Bacteremia/sepsis  Poor nutrition
40
Grade 1 Mucositis
Painless ulcers, erthema or mild soreness in the absence of lesions
41
Grade 2 Mucositis
Painful erythema, edema or ulcers but eating or swallowing possible
42
Grade 3 Mucositis
Painful erythema, edema, or ulcers requiring IV hydration
43
Grade 4 Mucositis
Severe ulceration or requiring parenteral or enteral nutritional support or prophylactic intubation
44
Phases Of Skin After giving Keratinocyte Growth Factor
o Phase 1: initiation: Reduce DNA damage; Increase levels of detoxifing enzymes to protect against ROS o Phase 2: Signaling: Decrease levels of pro-inflammatory cytokines; Decrease apoptosis o Phase 3: Amplification : Continuation of Phase 1 and 2 o Phase 4: Ulceration: As a result: reduced ulceration and pain o Phase 5: healing
45
Keratinocyte Growth Factor Drug
Kepivance
46
Kepivance MOA
Induces cell proliferation, increases epithelial thickness and upregulates cytoprotective mechanisms
47
Kepivance Indications
Hematologic cancers, high dose chemo + total body irradiation, stem cell transplant
48
Kepivance AE
o Skin erythema o Fatigue o Tongue “feeling thick” or discoloration o Taste disturbances

Oncology Exam 2 (10 decks)

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