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IHO Week 1 > Millikan IHO Week 4 > Flashcards

Millikan IHO Week 4 Flashcards

1
Q

Ways that receptor tyrosine kinase can become over expressed?

A

DNA amplification, increased transcription, decreased degradation (mRNA or protein)

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2
Q

Treatment of Metastatic Colon Cancer

A

5-fluorouracil with irinotecan or oxaliplatin

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3
Q

How long does colon cancer treatment extend survival?

A

2 years on average; 5 years survivors are no longer rare

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4
Q

An established driver of proliferation and survival

A

EGFR in Colon Cancer (epidermal growth factor receptor): to PI3K to Akt or Ras to Raf to MEK to MAPK

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5
Q

What do many cancers have constitutively downstream of EFGR?

A

Ras and Raf

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6
Q

What testing is now universal in patients with metastatic colon cancer?

A

wild-type Ras and Raf

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7
Q

First used for EGFR antibodies

A

Cetuximab

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8
Q

associated with fewer infusion reactions and is active in colon cancer, squamous cancers of the head and neck, squamous (HPV-driven) cancers of cervix and penis

A

Panitumumab

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9
Q

What is commonly mutated in Lung cancer but not in Colon Cancer?

A

EGFR

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10
Q

Two phenotypes of the same disease: Chronic Lymphocytic Leukemia

A

node predominant phenotype (SLL-small lymphocytic lymphoma) and leukemia phenotype (CLL-chronic lymphocytic leukemia)

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11
Q

Do people die of or with CLL

A

with it

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12
Q

Autoimmune Phenomena of Chronic Lymphocytic Leukemia?

A

immune throbocytopenic purpura, auto-immune hemolytic anemia, auto-immune agranulocytosis

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13
Q

What often drives Chronic Lymphocytic Leukemia?

A

Constitutive expression of non-mutated Bruton’s Tyrosine Kinase (BTK)

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14
Q

What CD20 antibody is used to tx CLL?

A

Rituximab

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15
Q

Historical tx for CLL?

A

Chlorambucil

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16
Q

What is the combination tx for CLL that was extremely immunosuppressive?

A

Fludarabine and Cyclophosphamide with Rituximab (FCR)

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17
Q

Latest treatment of CLL?

A

BTK inhibitors

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18
Q

Covalent modifier of ATP binding site (Cysteine 481) on Bruton’s Kinase that is active against CLL with del 17p and del 11q which were largely refractory to existing options

A

Ibrutinib

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19
Q

Causes of Resistance BTK Inhibitors

A

C481S changing from nucleophilic -SH in active site to -OH and PLC-gamma (main substrate for BTK)

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20
Q

Idelalisib

A

blocks downstream of BTK is active

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21
Q

CLL responds to what Bcl-2 modulator to reset apoptotic threshold?

A

Venetoclax

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22
Q

What is Ibrutinib approved to tx?

A

CLL and Mantle Cell Lymphoma; useful in the spectrum of B-cell malignancy

23
Q

Name for Eliminating Growth Promoting Signals?

A

lower concentration of hormone in the blood, block the ability of the hormone to interact with its receptor, block the down-stream signaling between the receptor and the effector apparatus

24
Q

What arises from single translocation like CML and is nearly always cured?

A

Acute Promyelocytic Leukemia (APL)

25
Q

Treatment of Acute Promyelocytic Leukemia

A

all trans retinoic acid, arsenic tri-oxide (induces degradation of chimeric protein and apoptosis at higher doses by uncertain mechanisms)

26
Q

Drugs that can be helpful in in refractory cases (ABCD)

A

ativan, benadryl, compazine (or olanzapine), dexamethasone

27
Q

Cancers well known for thromobotic diathesis

A

pancreas, breast, prostate, bladder, lung and CNS

28
Q

Very high risk of DVT

A

stomach and pancreas

29
Q

High risk of DVT

A

lung, lymphoma, gynecologic, bladder, testicular

30
Q

What two cancers almost universally affect bone

A

Breast and Prostate

31
Q

Bone directed treatment extends survival in what 3 cancers, but not in what cancer?

A

Myeloma, Breast, and Renal Cell but NOT in Prostate

32
Q

What is the most potent and most used bisphosphonate?

A

Zoledronic acid

33
Q

What 2 cancer drugs in particular cause diarrhea?

A

5-FU and Irinotecan

34
Q

Treatment of Constipation in Cancer

A

polyethylene glycol is gentle; mineral oil to prevent tearing

35
Q

Treatment of Diarrhea

A

electrolyte replacement, fiber supplements, tincture of opium and somatostatin analogues for secretory diarrhea that are unresponsive to other measures

36
Q

What do you see in young people on the long-acting myelosuppressive therapy?

A

BAD low back pain

37
Q

2 drugs used for refractory ITP (immune thrombocytopenic purpura)

A

Eltrombopag and Romiplostim

38
Q

Long term side effects of Imatinib

A

muscle cramps, asthenia, edema, skin fragility, diarrhea and tendon/ligament abnormalities

39
Q

Where is Imatinib metabolized? and what can interact with this?

A

CYP3A4, grapefruit juice

40
Q

4 types of resistance to Imatinib

A
  1. altered membrane transport 2. loss of p53 3. over expression of BCR-ABL1 4. point mutations (binding domain)
41
Q

induces ‘deeper’ (lower levels of BCR-ABL transcripts) and faster remissions with a similar sided effect profile to Imatinib

A

Nilotinib

42
Q

active against BCR-ABL1 and Src family at most point mutations (NOT T315I) and can cause fluid retention and HTN

A

Dasatinib

43
Q

active against BCR-ABL1 and Src family and most point mutations (NOT t315I)

A

Bosutinib

44
Q

designed based on crystal structure of T315I mutant and active against this mutation and causes clots and arterial fibrosis that can be fatal

A

Ponitinib

45
Q

chimeric (human/mouse) antibody against CD20, induces antibody-dependent cellular cytotoxicity (ADCC) as well as complement-dependent cytotoxicity (CDC), for B cell malignancies and auto-immune ds (cure in DLBCL and long term, low morbidity control of indolent lymphomas)

A

Rituximab

46
Q

Ofatumumab and Obinutuzumab are humanized antibodies that outperform rituximab on what?

A

low-grade lymphomas

47
Q

Antibody blockade of CTLA-4 permits T cell activation-what drugs do this?

A

Ipilimumab and Tremelilumab

48
Q

AE of CTLA-4 blockade

A

auto-immune phenomena: colitis, rash, endocrinopathies, pulmonary toxicity and a host of odd-ball or severe side effects

49
Q

Response rate of CTLA-4 blockade (Ipilimumab) and best in what cancer?

A

10-20% and best in Melanoma

50
Q

Antibody blockade of PD-1 or one of its ligands permits T-cell activation-what drugs do this?

A

Pembrolizumab or Nivolumab

51
Q

outperformed Ipi as single agent in melanoma

A

PD-1/PD-L1 Blockade (Pembrolizumab or Nivolumab)

52
Q

What is active in cancers with mismatch repair defects and other mechanisms of high genetic variation?

A

PD-1/PD-L1 Blockade

53
Q

Toxicities of PD-1/PD-L1 Blockade (Pembrolizumab or Nivolumab)

A

colitis, rash, thyroid issues

IHO Week 1 (16 decks)

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