Onc- chemo/toxicities etc

Question 1

FOLFOX/CAPOX - what’s in it, MoA & toxicities

Answer 1

Fluropyrimidine (5FU or capecitabine) + oxaliplatin
FOLFOX IV fortnightly 2days infusion,
Capecitabine PO analogue of 5FU
Pyrimidine analoge - stops cell cycle in S
- toxicities: mucositis, BM suppression, Dermatitis (HFS), angina
Platinum - cross linking of DNA
- toxicities: Emetegenic, Nephrotox (Cis), PN (cis, ox), Ototox, BM suppress

Question 2

Most cardiotoxic chemo

Answer 2

Anthracyclines:
- Doxorubicin / Epirubicin / Idarubicin

2nd most common:

• Pyrimidine analogues - 5FU, capecitabine
• mAb/ Transtusumab - reversible

Question 3

Emetogenic chemos

Answer 3

Alkylating : Cyclophosphamide, Ifosfamide

Anthracycline: Doxorubicin, Epirubicin, Idrarubicin, Mitoxantrone

Platinums: Cisplatin, Carboplatin, Oxaliplatin

Question 4

BRAF + MEK toxicity

Answer 4

Fevers

photosensitive rash

(cutaneous new SqCC or new primary melanoma)

Question 5

S/E - VEGF (eg)

Answer 5

Bevacizumab

• HTN
• Thrombosis (arterial)
• Wound healing impaired
• Proteinuria

Question 6

S/E - EGFR (eg)

Answer 6

Cetuximab, Panitumumab

• Acneform rash (Rx - moisturizer, doxy, top steroid)
• Renal salt wasting, hypoMg

Question 7

S/E - oxaliplatin

Answer 7

Peripheral neuropathy - dose dependent (limits cycles)

Question 8

S/E - Fluropyrimidines

Answer 8

5FU + Capecitabine

• Mucositis (whole GIT)
• Hand-foot syndrome
• Vasospasm coronary arteries
• NVD

dihydropyrimidine dehydrogenase def in 5% popn - fatal toxicity w/ myelosuppression, gut perf, usu day 4

Question 9

S/E - Irinotecan

Answer 9

Inhibits topoisomerase-1 (involved in DNA replication)

• Diarrhea (manage w/ atropine) + other cholinergic
• Myelosuppression

UAT181 enzyme def (Gilberts) fatally toxic

Question 10

MoA of anthracycline toxicity

Answer 10

• Inhibits topoisomerase (regulates DNA)
• Topoiso alpa is in cance
• Topoiso beta in cardio myocytes
• Dexrazoxane competitively binds topoiso B (& can use cardiac Rx)
• Ax first with gated heart pool scan, if LVEF low to start - predictive
• Also HFE carrier, females, Tranztuzumab (usu doxo)