Naplex Oncology Notes Flashcards
Positive Reed-Sternberg cells in the lymph node biopsy indicates what kind of diagnosis?
Hodgkin’s Lymphoma
Epstein Barr virus acquired thru HIV also increases risk of HD
Good recommendations to prevent colorectal cancer
Increase calcium intake, as well as fiber and antioxidants, and decrease fats
What are indications for a poor prognosis of breast cancer
Young (<35 yo); premenopausal, African American, and
HER2/neu overexpression
Primary side effects of Cyclophosphamide?
Hemorrhagic cystitis (inflammation of bladder - may see blood in urine); high N/V; mucositis
What can be used to help minimize the side effects of Cyclophosphamide?
Maintain adequate hydration to avoid inflammation of bladder, and Mensa
What is the side effect profile of Chlorambucil (Leukeran)?
Bone marrow suppression, infertility, secondary leukemias, SJS, hepatotoxicity
Should Leukeran be taken with food or on an empty stomach?
Empty stomach
Side effect profile of Carmustine?
Severe N/V profile, pulmonary fibrosis, HoTN, secondary leukemias (w/ long term use), reversible increase in LFTs
What is the side effect profile for the -Platin’s: cisplatin, carboplatin, oxaliplatin (Eloxin)
Dose-related myelosuppression, Nephrotoxicity!, peripheral neuropathy, rhabdomyolysis (oxaliplatin)
What a side effect special for cisplatin? And Level of emetogenic potential
Ototoxicity, high emetogenic potential
What is the max dose for cisplatin?
Do not administer doses exceeding 100mg/m^2 every 3 weeks
Of the 3 platin chemotherapies (cisplatin, carboplatin, and oxaliplatin) which 2 are renally dose adjusted?
Carboplatin and oxaliplatin
What is the MOA of Cyclophosphamide, Chlorambucil, and Carmustine? Hint all are in the same class.
Alkylate DNA, make it more prone to breakage, most effective against rapidly dividing cells
What is the MOA of the platin drugs? (Cisplatin, carboplatin, oxaliplatin)
Crosslink DNA, causing it to break
What is the MOA of Irinotecan and Etoposide? (Same drug class)
Target enzymes responsible for DNA replication and repair
What is the brand name for Irinotecan and Irinotecan liposomal?
Irinotecan = Camptosar
Irinotecan liposomal = Onivyde
What is the major side effect of Irinotecan?
Diarrhea, severe and life-threatening
How would you treat the major side effect of Irinotecan?
Atropine in early-onset OR loperamide for late-onset diarrhea
How should you administer Etoposide?
IV, NOT IV push!
and NOT IM - cases NECROSIS!
What is the MOA of Vincristine, Vinblastine, Paclitaxel, Paclitaxel, and Docetaxel? (Same drug class)
Spindle poisons; interfere with mitotic spindle; prevent chromosome segregation and lead to cell death
What are major side effects of Vincristine?
Constipation!, Peripheral neuropathy
How do you administer Vincristine?
IV, do NOT give intrathecally, AVOID extravasation (vesicant)
Pt should be on a prophylactic bowel management regimen (SE: constipation)
What are major side effects of Paclitaxel (protein bound particles) [Abraxane]?
Bone marrow suppression (dose-limiting), peripheral neuropathy, cardiac rhythm abnormalities, MUCOSITIS, STOMATITIS (SEVERE!!)
Max dose for Vincristine?
do NOT exceed 2mg/dose
Max dose for Docetaxel?
AVOID doses > 100 mg/m^2
Taxotere and Docefrez are the brand names for what chemo-drug?
Docetaxel
What is the MOA of antimetabolites (Cytarabine and 5FU)
Nucleoside analogs
MOA of Trexall (MTX)?
Folic acid antagonist
What can be used as a rescue for patients treated with MTX?
Leucovorin - can be highly toxic
Give 24hrs after MTX to limit toxicities;
Can enhance 5FU effects
What is the side effect profile of Methotrexate (MTX)
Nephrotoxicity, BMS, SJS, severe diarrhea and ulcerative stomatitis, neurotoxicity, hepatotoxicity, pneumonitis, TLS
Side effects of Daunorubicin (Cerubidine) and Doxorubicin (liposomal - Doxil)
Cardiotoxicity!! (Dose-related), severe bone marrow suppression, secondary leukemias, red colorations of body fluids!!! Vesicant
What is the MOA of anthracyclines? (Daunorubicin and Doxorubicin)
Intercalated DNA and desecrate reactive oxygen species
What is the life-time cumulative dose of anthracyclines? And why is there a life-time max?
Greatest risk of irreversible myocardial damage at cumulative dose > 550 mg/m^2
What can be used to prevent doxorubicin induced cardiotoxicity or to treat anthracycline-induced extravasation?
Dexrazoxane
What 3 types of cancers can Liposomal doxorubicin be used for?
- Kaposi’s sarcoma, 2. multiple myeloma, and 3. ovarian cancer
Which 3 anti-hormonal drugs can be used for postmenopausal women?
Anastrozole (Arimidex), Exmestane (Aromasin), Letrozole (Femara)
What are the major contraindications for Tamoxifen anti-cancer therapy?
Concurrent warfarin therapy, Hx of DVT or PE
What are the major side effects of Leuprolide (Eligard, Lupron Depot)?
Abnormal menses, exacerbation of endometriosis, hot flashes/sweats, decreased BMD (if used > 6 mon), tumor flare, depression, mood disturbances!!
How do you administer Lupron aka Eligard?
SQ inj daily or IM injection Q 1-6 mon depending on dosage
Rotate inj sites!!
What may seem like a side effect, but may be an indication of a good therapeutic response of Tamoxifen?
And how can it be managed?
Bone pain,
Can be managed with mild analgesic
What is the side effect profile of tamoxifen?
Thromboembolic events, increased risk of endometrial cancer (duration dep on menopausal status), hot flashes, altered menses, mood disturbances/depression, decreased BMD
Which chemotherapy drugs have the common side effect of Cardiotoxicity? (7)
Doxorubicin, Daunorubicin, Idarubicin, Lapatinib, Mitoxantrone, Pertuzumab, Trastuzumab
Which chemotherapy drugs have the common side effect of N/V? (5)
Cisplatin, Carboplatin, Cytarabine, Doxorubicin, Cyclophosphamide
Which chemotherapy drugs have the common side effect of Mucositis? (4)
Cytarabine, Cyclophosphamide, 5FU, MTX
Which chemotherapy drugs have the common side effect of Neuropathy? (4)
Vincristine, Vinblastine, Oxaliplatin, Paclitaxel
Which chemotherapy drugs have the common side effect of renal impairment? (3)
Cisplatin, Cyclophosphamide, Ifosfamide
Which chemotherapy drugs have the common side effect of pulmonary fibrosis? (2)
Cleomycin, Busulfan
Which chemotherapy drugs have the common side effect of Infusion reactions? (2)
Monoclonal antibodies and Paclitaxel
Which 4 chemo drugs have a MOA/Target of the CD20 antigen?
Ibritumomab tiuxetan (Zevalin), Obinutuzumab (Gazyva), Ofatumumab (Arzerra), and Rituximab (Rituxan)
Do NOT administer live vaccines in these patients!!
Which monoclonal antibody chemo drugs would you want to pre-treat with antihyperuricemics and hydration in patients at high risk of TLS?
As well as screen for HBV prior to treatment?
*Same drugs
Gazyva, Arzerra, and Rituxan
What are the major EGFR inhibitors used for chemotherapy? (11)
Afatinib (Gilotrif), Cetuximab (Erbitux), Erlotinib (Tarceva), Gefitinib (Iressa), Lapatinib (Tykerb), Necitumumab (Portrazza), Osimertinib (Tagrisso), Panitumumab (Vectibix), Pertuzumab (Perjeta), Trastuzumab (Herceptin), and Ado-Trastuzumab emtansine (Kadcyla)
Of the 11 EGFR inhibitors, which ones are PO? (5)
Gilotrif, Tarceva, Iressa, Tykerb, and Tagrisso
Which EGFR inhibitors are used for HER2 positive metastatic breast cancer? (4)
Lapatinib (Tykerb), Pertuzumab (Perjeta), Trastuzumab (Herceptin - also used for gastric cancer), and Ado-Trastuzumab emtansine (Kadcyla)
What are major side effects specific for Cetuximab (Erbitux)?
Sudden cardiac death, electrolyte abnormalities
Major side effects specific for Erlotinib (Tarceva)?
Renal failure, GI perforation, MI, Rash
Which chemo drugs are VEGF inhibitors? (6)
Axitinib (Inlyta), Bevacizumab (Avastin), Cabozantinib (Cabometyx), Ramucirumab (Cyramza), Sorafenib (Nexavar), Sunitinib (Sutent)
Which of the VEGF inhibitors are Oral?
Inlyta, Nexavar, and Sutent
What are common side effects of EGFRs?
Diarrhea, Rash, Interstitial Lung Disease (ILD), Hepatotoxicity
What are common side effects for VEGF inhibitors?
Thromboembolic events (except Sorafenib and Sunitinib), Hemorrhage, Diarrhea, increased LFTs, Rash, impaired healing, HTN
Which VEGF inhibitor can affect thyroid function?
Axitinib (Inlyta)
Which VEGF inhibitor can be used for metastatic colorectal cancer?
Bevacizumab (Avastin) - infusion related rxns
Which chemo drugs are Tyrosine Kinase Inhibitors? (5)
MOA: halt proliferation of tumor cells by inhibiting TK
Bosutinib (Bosulif), Dasatinib (Sprycel), Imatinib (Gleevec), Lenvatinib (Lenvima), Nilotinib (Tasigna)
Of all the Oral Tyrosine Kinase Inhibitors, which ones are used for Philadelphia-positive CML and ALL? (4)
Bosulif, Sprycel, Gleevec, and Tasigna
All TKI’s are oral
What are common side effects of Tyrosine Kinase Inhibitors?
Myelosuppression, rash, TLS, HTN,hemorrhage
Which TKI’s can cause Hypothyroidism? (2)
Gleevec and Lenvima
Which TKI's are 3A4 substrates? (4) 3A4 Inhibitors (3)?
Bosutinib, Sprycel (inhibitor), Gleevec (inhibitor), Tasigna (inhibitor)
Which TKI increases risk of TdP with other drugs that prolong QT interval?
Lenvatinib (Lenvima)
Which chemo drugs are Anaplastic Lymphoma Kinase inhibitors? (3)
ALK inhibitors - and which are PO?
Alectinib (Alecensa), Ceritinib (Zykadia, Crizotinib (Xalkori)
ALL are PO!
What are ALK inhibitors used in cancer therapy?
Mainly for ALK-positive metastatic NSCLC
Which chemo drug contains radioactive isotopes which require handling?
Zevalin
Which anti-nausea drugs would you use for anticipatory nausea?
Benzodiazepines
Which anti-emetic would you use for delayed (N/V)? - such seen with cisplatin, Cyclophosphamide, and doxorubicin
Aprepitant
Which anti-emetics would you use for less severe cases of N/V with chemotherapy?
Prochlorperazine or metoclopramide
Which CYP enzyme is use by Aprepitant?
3A4, substrate and inhibitor
Which anti-emetic class should be avoided with serotonergic agents due to increased risk of serotonin syndrome?
5HT3 antagonists such as ondansetron (Zofran), other brand names of 5HT3 antags are Sancuso, Anzemet, Suplenz, Aloxi
Which 5HT3 antagonist can be effective in preventing acute and delayed N/V?
Palonosetron (Aloxi)
What is a major contraindication of Metoclopramide?
Seizure disorders
What is a major side effect specific for Reglan?
Extrapyramidal Symptoms (EPS)
What are the 3 CSFs?
Filgrastim (Grantix, Neupogen, Zarxio), PEG-Filgrastim (longer t1/2) (Neulasta), and Sargramostim (Leukine)
