Heme onc

Question 1

ras

Answer 1

protooncogene; lung, colon, pancreas, bladder

Question 2

n-myc

Answer 2

protooncogene; neuroblastoma, small cell cancer of the lung

Question 3

ERB-B1

Answer 3

protooncogene; squamous cell carcinoma of the lung

Question 4

ERB-B2

Answer 4

protooncogene; breast, ovarian cancer

Question 5

TGF- alpha

Answer 5

protooncogene; astrocytoma, HCC

Question 6

sis

Answer 6

protooncogene; astrocytoma, osteosarcoma

Question 7

abl

Answer 7

protooncogene; CML, ALL

Question 8

BRCA 1,2

Answer 8

anti-oncogene; breast, ovarian cancer

Question 9

NF-1

Answer 9

antioncogene; neuroblastoma, neurofibramatosis 1, sarcoma

Question 10

APC

Answer 10

antioncogene; colon (familial adenomatous polyposis)

Question 11

DCC

Answer 11

antioncogene; colon

Question 12

p53

Answer 12

antioncogene; most cancers, li-fraumeni

Question 13

RB

Answer 13

antioncogene; retinoblastoma, osteosarcoma

Question 14

WT-1

Answer 14

Wilm’s tumor

Question 15

Azathioprine, 6-mercaptopurine, 6-thioguanine

Answer 15

Antimetabolite: Purine analog, decrease purine synthesis, activated by HGPRT; immunosuppresant, RA, IBD, SLE; used to wean off steriod therapy; myelosuppression, GI, liver, metabolized by xanthine oxidase, so increased toxicity with allopurinol

Question 16

Cladribine

Answer 16

Antimetabolite: Purine analog; hairy cell leukemia; myelosuppression, nephrotoxicity, neurotoxicity

Question 17

Cytarabine

Answer 17

Antimetabolite: Pyrimidine analog/inhibition of DNA polymerase; leukemias (AML), lymphomas; pancytopenia

Question 18

5-FU

Answer 18

Antimetabolite: Pyrimidine analog (activated by 5F-dUMP), inhibits thymidylate synthase, lowers dTMP, lowers DNA synthesis; colon cancer, pancreatic cancer, BCC (topical); myelosuppression (not reversible with leucovorin)

Question 19

Methotrexate

Answer 19

Antimetabolite: FA analog, competitve inhibitor of DHF, lowers dTMP, lowers DNA synthesis; cancers ((leukemia, ALL esp), lymphoma, choriocarcinoma, sarcoma), non-cancer (ectopic, abortion, RA, IBD, psoriasis, vasculitis); myelosuppression (reversible with leucovorin), hepatotoxicity, mucositis, pulmonary fibrosis

Question 20

Bleomycin

Answer 20

Antitumor antibiotic: Induces free radical formation that breaks DNA strands; testicular cancer, Hodgkin lymphoma; pulmonary fibrosis, skin hyperpigmentation, mucositis, minimal myelosuppression

Question 21

Dactinomycin

Answer 21

Antitumor antibiotic: Intercalates in DNA; children’s tumors (wilms, ewing, rhabdomyosarcoma); myelosuppression

Question 22

Doxorubicin, daunorubicin

Answer 22

Antitumor antibiotic: generates free radicals, intercalate in DNA; solid tumor, leukemia, lymphoma; cardiotoxicity (DCM) - can be prevented with dexrazosane the iron chelator, myelosuppression, alopecia

Question 23

Busulfan

Answer 23

Alkylating agent: cross-links DNA; CML. Also used to ablate BM before BM transplantation; severe myelosuppression, pulmonary fibrosis, hyperpignmentation

Question 24

Cyclophosphamide

Answer 24

Alylating agent: cross-link DNA at guanine N-7 (requires liver bioactivation); solid tumor, leukemia, lymphoma; myelosuppression, hemorrhagic cystitis (partially prevented with mesna)

Question 25

Nitrosoureas

Answer 25

Alkylating agent: cross-link DNA, can cross BBB, requires bioactivation; brain tumor (inc GBM); CNX toxicity (convulsion, dizziness, ataxia)

Question 26

Paclitaxel

Answer 26

Microtubule inhibitor: hyperstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down and anaphase cannot occur; ovarian and breast carcinomas; myelosuppression, alopecia, hypersensitivity reactions

Question 27

Vincristine, vinblastine

Answer 27

Microtubule inhibitor: vinca alkaloids that bind beta-tubulin and inhibit polymerization into microtubules - prevent mitotic spinde formation (arrest M-phase); solid tumors, leukemias, Hodgkin (vinblast), non-Hodgkin (vincristine); Vincristine (neurotoxicity), vinblastine (BM suppression)

Question 28

Cisplatin

Answer 28

Cross-link DNA; testicular, bladder, ovary, lung carcinoma; nephrotoxicity (prevent with amifostine (free radical scavenger and saline diuresis), ototoxicity

Question 29

Etoposide, teniposide

Answer 29

Inhibits topoisomerase II, increases DNA degradation; testicular and small cell lung cancer, leukemias, lymphomas; myelosuppression, GI upset, alopecia

Question 30

Irinotecan, topotecan

Answer 30

Inhibit topoisomerase I, prevent DNA unwinding and replication; irinotecan = colon cancer, topotecan = ovarian and small cell lung cancer; severe myelosuppression, diarrhea

Question 31

Hydroxyurea

Answer 31

Inhibit ribonucleotide reductase, inhibit DNA synthesis in the S phase; melanoma, CML, SCD; severe myelosuppression, GI upset

Question 32

Prednisone, prenisolone

Answer 32

Bind intracytoplasmic receptor; CLL, non-Hodgkin lymphoma; Cushing-like symptoms

Question 33

Bevacizumab

Answer 33

Monoclonal anti-VEGF antibody, inhibits angiogenesis; colon cancer, RCC; hemorrhage, blood clots, impaired wound healing

Question 34

Erlotinib

Answer 34

EGFR tyrosine kinase inhibitor; non-small cell lung carcinoma; rash

Question 35

Imatinib

Answer 35

Tyrosine kinase inhibitor of BCR-ABL and c-kit; CML, GI stromal tumors; fluid retention

Question 36

Rituximab

Answer 36

Anti-Cd20 monoclonal antibody; Non-Hodgkin lymphoma, CLL, IBD, RA; risk of PML

Question 37

Tamoxifen, raloxifene

Answer 37

Selective estrogen receptor modulators (antagonist at breast, agonist at bone); tamoxifen = breast cancer, raloxifene = osteoporosis; tamoxifen - endometrial cancer, hot flashes

Question 38

Trastuzumab (Herceptin)

Answer 38

Her2 (tyrosine kinase receptor) monoclonal antibody; inhibition of Her2-initiated cellular signalling and antibody-dependent cytotoxicity; Her2 positive breast cancer and gastric cancer; cardiotoxicity

Question 39

Vemurafenib

Answer 39

Small molecule inhibitor of BRAF oncogene positive melanoma; metastatic melanoma