Miscellaneous Agents

Question 1

What is bleomycin classified as?

Answer 1

Antitumor antibiotic

Question 2

How does bleomycin work?

Answer 2

Inhibits DNA synthesis by creating single and double strand breaks (free radical production after binding to metal such as Fe or Cu) - dosed in units rather than milligrams

Question 3

What is the most important toxicity of bleomycin?

Answer 3

Pulmonary fibrosis

Question 4

What enzyme breaks down bleomycin?

Answer 4

Bleomycin hydralase

Question 5

How should pulmonary fibrosis in bleomycin be monitored?

Answer 5

• PFT monitoring (DLCO - diffusion capacity of carbon monoxide)
• Cumulative lifetime exposure tracking - highest risk after 400 units lifetime exposure

Question 6

Which cytotoxic chemotherapy drugs do NOT cause myelosuppression (all the others do!)

Answer 6

Bleomycin and vincristine
- bleomycin is a good option to add on to other therapies (hodkins, testicular cancer)

Question 7

What drug class is procarbazine?

Answer 7

Alkylating agent and weak monoamine oxidase inhibitor

Question 8

Procarbazine is an alkylating agent. What side effect can be expected?

Answer 8

Slightly higher rate of secondary leukemias than some other alkylating agents

Question 9

What formulation is procarbazine available in?

Answer 9

PO

Question 10

What education should be provided to patients taking procarbazine since it is a MAOI?

Answer 10

• Avoiding high tyramine-containing food and drink
• Drug interaction considerations - serotonin syndrome

Question 11

What are the two “forgotten” alkylators?

Answer 11

Dacarabazine and temozolomide

Question 12

What is the brand name of dacarabazine?

Answer 12

DTIC

Question 13

What is the brand name of temozolomide?

Answer 13

Temodar

Question 14

Dacarabazine and temozolomide are pro-drugs of which active metabolite?

Answer 14

MTIC (alkylane inhibitor)

Question 15

What is the main side effect of dacarabazine?

Answer 15

Highly emetogenic (same class as cisplatin)

Question 16

What formulation does temzolomide come in?

Answer 16

PO - great bioavailability and BBB penetration (used in brain tumors!)

Question 17

What does long-term use of temozolomide cause (every day for 6 weeks)?

Answer 17

Lymphopenia - decreased WBCs and lymphocytes (T and B cells that prevent viral infections and pneumocysitis pneumonia)
- PCP prophylaxis is required!!

Question 18

What drug class is hydroxyurea?

Answer 18

Antimetabolite

Question 19

What does hydroxyurea do?

Answer 19

Inhibits ribonucleotide diphosphate reductase (blocks conversion of ribonucleotides to deoxyribonucleotides, leading to G1/S arrest)

Question 20

What is hydroxyurea used for?

Answer 20

• Antineoplastic - reduce WBC in leukemia patients (cytoreduction)
• Most common use is for sickle cell disease (increases production of fetal hemoglobin)

Question 21

What is the unique toxicity of trabectedin?

Answer 21

Hepatotoxicity, rhabdomyolysis

Question 22

What drug class is mitomycin C?

Answer 22

Alkylating agent - creates guanine-cytosine crosslinks

Question 23

What is something unique about mitomycin C?

Answer 23

Long nadir (lowest point of WBC and platelet count) - 4 to 8 weeks (hard to predict)