Oncology Flashcards
1
Q
What do the letters in TNM staging stand for?
A
T - tumor size and extent
N - spread of cancer to lymph nodes
M - metastasis
2
Q
What are the CAUTION warning signs for cancer?
A
C - Change in bowel/bladder habits
A - A sore that does not heal
U - Unusual bleeding/discharge
T - Thickening or lump in breast or elsewhere
I - Indigestion or difficulty swallowing
O - Obvious change in wart/mole
N - Nagging cough or hoarseness
3
Q
What drug is recommended for prevention of colorectal cancer?
A
Low dose ASA
4
Q
What is the maximum lifetime dose for bleomycin?
A
400 units
5
Q
What is the maximum lifetime dose for doxorubicin?
A
450-550 mg/m2
6
Q
What is the maximum cycle dose for cisplatin?
A
Not to exceed 100 mg/m2 per cycle
7
Q
What is the maximum single dose for vincristine?
A
2 mg
8
Q
What is the major toxicity of bleomycin?
A
Pulmonary toxicity
9
Q
What is the major toxicity of doxorubicin?
A
Cardiotoxicity
10
Q
What is the major toxicity of cisplatin?
A
Nephrotoxicity
11
Q
What is the major toxicity of vincristine?
A
Neuropathy
12
Q
Which chemo agents do not cause myelosuppression?
Hint - 5
A
Asparaginase
Bleomycin
Vincristine
MABs
TKIs
13
Q
Which chemo agents cause severe N/V
Hint - 5
A
Cisplatin
Cyclophosphamide
Ifosfamide
Doxorubicin
Epirubicin
14
Q
Which chemo agents cause mucositis?
Hint - 5
A
Methotrexate
Fluorouracil
Capecitabine
Irinotecan
TKIs
15
Q
Which chemo agents cause diarrhea?
Hint - 5
A
Irinotecan
Methotrexate
Fluorouracil
Capecitabine
TKIs
16
Q
Which chemo agents cause constipation?
Hint - 3
A
Vincristine
Thalidomide
Pomalidomide
17
Q
Which chemo agents cause cardiomyopathy?
Hint - 3
A
Anthracyclines
HER2 inhibitors
Fluorouracil
18
Q
Which chemo agents cause QT prolongation?
Hint - 3
A
Arsenic trioxide
TKIs
Leuprolide
19
Q
What drug can be given alongside an anthracycline to prevent toxicity?
A
Dexrazoxane
20
Q
Which chemo agents cause pulmonary fibrosis?
Hint - 4
A
Bleomycin
Busulfan
Carmustine
Lomustine
21
Q
Which chemo agents cause pneumonitis?
Hint- 2
A
Methotrexate (long term use)
MABs targeting CLTA-4 or PD-1
22
Q
Which chemo agents cause hepatotoxicity?
Hint - 5
A
Antiandrogens (bicalutamide)
Folate antimetabolites (methotrexate)
Pyrimidine analogs (cytarabine)
TKIs
Some MABs
23
Q
Which chemo agents cause nephrotoxicity?
Hint - 5
A
Cisplatin
Methotrexate (high doses)
Pemetrexed
Pralatrexate
Some MABs
24
Q
What drug can be given with cisplatin to reduce toxicity?
A
Amifostine
25
Which chemo agents cause hemorrhagic cystitis?
Hint - 2
Ifosfamide
Cyclophosphamide (high doses)
26
What drug can be given with isosfamide/cyclophosphamide to reduce toxicity?
Mesna (Mesnex)
27
Which chemo agents cause neuropathy?
Hint - 7
Vinca alkaloids
Platinums
Taxanes
Proteasome inhibitors (-zomibs)
Thalidomide
Cytarabine
Brentuximab
28
What type of neuropathy occurs with oxaplatin?
Cold-mediated sensory neuropathy
Counsel pts to avoid cold temps/beverages
29
Which chemo agents have an increased risk of thromboembolic/clotting events?
Hint - 3
Aromatase inhibitors (anastrozole)
SERMs (tamoxifen)
Immunomodulators (-lidomides)
30
What drug(s) are given with fluorouracil to enhance efficacy?
Leucovorin or levoleucovorin
31
What drug is an antidote to fluorouracil and capecitabine?
Uridine triacetate
To be used within 96 hrs of OD/toxicity
32
What drug can be used to prevent/treat acute diarrhea associated with irinotecan?
Atropine
33
What drug can be used to treat delayed diarrhea associated with irinotecan?
Loperamide
34
What drug can be given prophylactically with high dose methotrexate to decrease myelosuppression and mucositis?
Leucovorin or levoleucovorin
35
What drug is an antidote to methotrexate?
Glucarpidase
36
What drugs can be used to treat neutropenia?
Colony-stimulating factors
(Filgrastim and Pegfilgrastim)
Given prophylactically after chemotherapy
37
What is the lowest point that WBCs and platelets reach called?
Nadir
38
How long does it take for WBCs/platelets to recover post treatment?
3-4 weeks
Must wait for cells to recover before giving next round of treatment
39
When does the nadir occur for platelets/WBCs?
~7-14 days post treatment
40
What are the cell counts for neutropenia?
Neutropenia: ANC <1,000
Severe neutropenia: ANC <500
Profound neutropenia: ANC <100
41
Key points for CSFs
Main SE: Bone pain
Filgrastim = qd
Pegfilgrastim = once per cycle, at least 12 days before next cycle
Must store in fridge
Administered 24-96 hrs after chemo
Must monitor for enlarged spleen and resp distress syndrome
42
Febrile neutropenia diagnosis criteria
Temp >38.3 C x1 reading OR >38.0 C sustained for 1 hr
PLUS
ANC <500 (or expected to be <500 within next 48 hrs)
43
What bug must be covered when empirically treating febrile neutropenia?
Pseudomonas
44
When is it acceptable to use an ESA for anemia in a cancer pt?
Only if it is being used with palliative intent and Hgb <10
ESAs can increase tumor progression and should not be used with curative intent
45
When is platelet infusion indicated?
Plts <10,000 (<30,000 w/ active bleed)
46
What antiemetics are used for acute CINV?
(<24 hrs after chemo)
5HT-3 RAs (1st line, can add on others)
NK1 RAs
Dexamethasone
Olanzapine
47
What antiemetics are used for delayed CINV?
(>24 hrs after chemo)
NK1-RAs + steroids + 5HT RA + olanzapine
48
What antiemetics are used for anticipatory CINV?
BZD (given evening prior to chemo)
49
How many agents should be used for each class of emetic risk?
High risk: 3-4 agents (NK1-RAs + dexamethasone + 5HT RA + olanzapine)
Mod risk: 2-3 agents (NK1-RAs + steroids + 5HT RA)
Low risk: 1 agent (any but NK1-RAs)
50
When are antiemetics given in relation to chemo infusion time?
Given at least 30 minutes before chemo
51
What should acute dystonic rxns be treated with?
Anticholinergics (ex. benztropine, benadryl)
52
Examples of 5HT3-RAs
-setrons
53
Examples of dopamine antagonists
Prochlorperazine
Promethazine
Metoclopramide
Olanzapine
Droperidol
54
Examples of NK1-RAs
Aprepitant
Fosaprepitant
55
What enzyme are aprepitant/fosaprepitant metabolized via?
CYP3A4
May need to reduce dexamethasone dose due to interaction
56
Key points for 5HT3-RAs (-setrons)
CI with apomorphine
Prolongs QT
Risk of serotonin syndrome
SE: HA, constipation
Minimal sedation
57
Key points for dopamine receptor antagonists
Only give promethazine IM
Metoclopramide: Can cause irreversible tardive dyskinesia; needs dose adjustment if CrCl <40
Avoid in parkinsons disease
Droperidol: can prolong QT
SE: Acute EPS, sedation, decreased seizure threshold
58
SE of cannabinoids (dronabinol, nabilone)
Somnolence
Euphoria
Increased appetite
59
What is the max daily dose for loperamide?
16 mg/day
60
What is hand-foot syndrome?
Occurs when small amounts of chemo drug leaks out of capillaries and into palms or hands and soles of feet causing tenderness, pain, inflammation, and skin peeling
61
What chemo agents can cause hand-foot syndrome?
Capecitabine
Fluorouracil
Cytarabine
Liposomal doxorubicin
Sorafenib/sunitinib
62
What electrolyte abnormalities are associated with tumor lysis syndrome?
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia
63
What agent is 1st line for severe cancer-related hypercalcemia?
IV bisphosphonates +/- calcitonin
Can also use denosumab (different dose than prolia)
64
What premedications must be given with a MAB?
APAP 650 mg PO
Diphenhydramine IV or PO
65
What 2 chemo agents are major vesicants?
Anthracyclines
Vinca alkaloids
66
What is the antidote for vinca alkaloids and etoposide in the event of extravasation?
Hyaluronidase + warm compress
*for all other drugs, use cold compress*
67
What chemo agent cannot be given intrathecally?
Vincristine (fatal)
68
Complete response
Treatment has destroyed all known tumors
69
Partial response
Treatment eliminated at least 30% of the tumor
70
Neoadjuvant therapy
Treatment given before surgery to reduce the size of a tumor
71
Adjuvant therapy
Treatment given after surgery to eradicate residual disease
72
3 types of lung cancer
1) Non-small cell (most common)
2) Small cell
3) Carcinoid
73
Most common cause of lung cancer
Smoking
74
Risk factors for skin cancer
UV exposure
Light skin/hair/eyes
Immunosuppressant therapy
Hx of skin cancer
75
3 types of skin cancer
1) Basal cell
2) Squamous cell
3) Melanoma (rare, but deadly)
76
What are the ABCDEs of skin cancer?
A - Asymmetry
B - Borders that are irregular/notched
C - Color is not same all over
D - Diameter >6 mm
E - Evolving
77
Klinefelter syndrome
Males with XXY chromosomes
78
Treatment duration for hormone sensitive (ER+/PR+) breast cancer
5-10 years
79
1st line treatment for premenopausal females w/ hormone sensitive breast cancer
SERM (tamoxifen)
80
Aromatase inhibitor MOA
Blocks the conversion of androgens to estrogen; only effective in post-menopausal pts
81
Which medication is a SERM indicated only for breast cancer prophylaxis?
Raloxifene
Increases bone density and is also used for osteoporosis treatment/prevention
82
Examples of SERMs
Tamoxifen
Raloxifene
Toremifene
83
Which drug is a SERD (selective estrogen receptor degrader)?
Fulvestrant
84
SERM key points
Warnings: increased risk of uterine/endometrial cancer and thrombotic events
Tamoxifen CI w/ warfarin
SE: hot flashes, night sweats, vaginal bleeding/spotting/discharge/dryness, decreased libido
Venlafaxine preferred drug for SE treatment
Tamoxifen: teratogenic, can decrease bone density - needs vit D/Ca supplementation
85
Tamoxifen is a prodrug metabolized via what enzyme?
CYP2D6
86
SERD SE
Increased LFTs
Injection site rxns
Hot flashes
87
Examples of aromatase inhibitors
Anastrozole (arimidex)
Letrozole (Femara)
Exemestane (Aromasin)
88
Aromatase inhibitor key points
Higher risk of osteoporosis and CVD vs SERMS
CI w/ pregnancy
SE: Hot flashes, night sweats, arthralgias, myalgias
89
Examples of cyclin-dependent kinase (CDK4/6) inhibitors
Palbociclib (Ibrance)
Abemaciclib (Verzenio)
Ribociclib (Kisquali)
90
HER2 inhibitor for breast cancer
Trastuzumab
91
2 options for androgen deprivation therapy
GnRH antagonist
or
GNRH agonist + antiandrogen
92
Examples of GnRH agonists
Leuprolide
Goserelin
Histrelin
Triptorelin
93
GnRH agonist key points
Decrease testosterone via negative feedback mechanism
Can decrease bone density - supplement w/ vit D and Ca
Will cause tumor flare at therapy initiation so must be paired with an antiandrogen
SE: hot flashes, impotence, gynecomastia, bone pain, QTc prolongation, difficulty urinating
CI w/ pregnancy/breastfeeding
94
Examples of GnRH antagonists
Degarelix (Firmagon)
Relugolix (Orgovyx)
95
GnRH antagonist key points
Directly block GnRH receptors
Osteoporosis risk
No tumor flare, can be used as monotherapy
96
Examples of 1st gen antiandrogens
Bicalutamide
Flutamide
Nilutamide
97
Antiandrogen key points
Competitively inhibit testosterone from binding to prostate cancer cells
Disulfiram rxns w/ nilutamide
QTc prolongation w/ apalutamide
SE: hot flashes, gynecomastia
98
Examples of 2nd gen antiandrogens
Apalutamide
Darolutamide
Enzalutamide
99
Androgen biosynthesis inhibitor
Abiraterone
Interferes w/ CYP17 to decrease testosterone production
100
What weight is used in the BSA calculation?
Actual body weight
101
Examples of alkylating agents (chemo)
Cyclophosphamide
Isosfamide
Carmustine
Dacarbazine
Busulfan
Melphan
102
Examples of platinum-based agents (chemo)
Cisplatin
Carboplatin
Oxaplatin
103
Examples of anthracyclines (chemo)
Doxorubicin
Daunorubicin
Epirubicin
Mitoxantrone (anthracenedione)
104
Mitoxantrone will discolor body fluids what color?
Blue
105
Doxorubicin will discolor body fluids what color?
Red
106
Examples of topoisomerase I inhibitors (chemo)
Irinotecan
Topotecan
107
Examples of topoisomerase II inhibitors (chemo)
Etoposide
Bleomycin
108
Storage/admin points for etoposide
IV must be given in non-PVC bag/tubing
Capsules must be stored in fridge
109
Examples of vinca alkaloids
Vincristine - more CNS tox
Vinblastine - more bone tox
Vinblastine - more bone tox
B for Bone, C for CNS
110
Examples of taxanes
Paclitaxel
Docetaxel
Cabazitaxel
111
Key points for taxanes
High risk of severe/fatal hypersensitivity rxns
Must premedicate prior to infusion (usually with steroids + benadryl)
Must be in non-PVC bag
Requires 0.22 micron filter
112
Examples of pyrimidine analogues
Fluorouracil
Capecitabine (FU prodrug)
Cytarabine
Gemcitabine
113
Examples of folate antimetabolites
Methotrexate
Pemetrexed
Pralatrexate
114
What should be given with methotrexate to decrease risk of nephrotoxicity?
Hydration + bicarb (alkalinizes the urine)
115
What meds should not be given with methotrexate?
NSAIDs, salicylates, probenecid
Anything that decreases renal clearance
116
What is a main risk/SE of bortezomib?
Herpes reactivation
Can be prevented w/ acyclovir/valacyclovir
Also peripheral neuropathy
117
Which MABs target vascular endothelial growth factors (VEGF)?
Bevacizumab
Ramucirumab
"ci" = circulatory/vascular
118
Which MABs target epidermal growth factor receptors (EGFR)?
Cetuximab
Panitumumab
119
Which MABs target human epidermal growth factor 2 (HER2)?
Trastuzumab
Pertuzumab
"tuz" = 2
120
Which MABs target CD antigens?
Rituximab
Brentuzimab
121
Which MABs target the immune system (PD-1, PDL-1, CTLA-4)?
Ipilimumab
Pembrolizumab
122
What are VEGF inhibitors used to treat?
Colon cancer, NSCLC
123
What are EGFR inhibitors used to treat?
Colon cancer
124
What are HER2 inhibitors used to treat?
Breast cancer
125
What are CD inhibitors used to treat?
Hematologic cancers (lymphoma, myeloma)
126
What are immune inhibitors used to treat?
NSCLC, melanoma
127
Key points for VEGF inhibitors
Impairs wound healing, cannot be used for 28 days before/after surgery
Warnings for severe bleeding, GI perforation
128
Key points for HER2 inhibitors
Must be HER2+ to use
Monitor LVEF at baseline and during treatment
129
Key points for EGFR inhibitors
Must use 0.22 filter
Must be EGFR+, KRAS- to use
SE: Acneiform rash - occurs during 1st 2 weeks, predictor of better response to drug; can treat with topical steroids/abx
130
Key points for CD inhibitors
Must premedicate with APAP, benadryl, and steroid
Must be CD20+ for rituxumab
Warning for hepB reactivation - must check for hepB prior to initiating
131
Examples of BCR-ABL inhibitors
Imatinib
Dasatinib
Nilotinib
132
Key points for BCR-ABL inhibitors
Must be BCR-ABL+ to use
SE: fluid retention, QT prolongation
Used in chronic myelogenous leukemia (CML)
133
Examples of BRAF inhibitors
Vemurafenib
Dabrafenib
134
Key points for BRAF inhibitors
Must be V600E or V600K + to use
Warnings for new malignancies and QT prolongation
Used in melanoma
135
Which drugs must be taken with food?
Hint - 4
Imatinib
Capecitabine
Thalidomide
Exemestane
136
Which drugs must be taken on empty stomach?
Hint - 5
Nilotinib
Erlotinib
Pomalidomide
Abiraterone
Temozolomide
