Oncology 2: Evan Flashcards
list SERMs brand/generic
tamoxifen (Soltamox)
fulvestrant (Faslodex)
raloxifene (Evista)
toremifene (Fareston)
list AIs brand/generic
anastrozole (Arimidex)
letrozole (Femara)
exemestane (Aromasin)
list CDK4/6-Is brand/generic
palbociclib (Ibrance)
abemaciclib (Verzenio)
ribociclib (Kisqali)
most significant SEs of SERMs?
VTE menopausal symptoms hot flashes flushing edema weight gain HTN mood changes amenorrhea vaginal bleeding/discharge
most significant SEs of AIs?
edema VTE bone pain osteoporosis (common) menopausal symptoms hot flashes arhralgia (common)/myalgia lethary/fatige N/V rash hepatotoxicity HTN HLD
what should not be taken with AIs?
SERMs or estrogen containing products
what drug should be used for hot flashes in patients taking tamoxifen (Soltamox)? why?
venlafaxine b/c it doesn’t inhibit CYP2D6 like paroxetine and fluoxetine
place in therapy for roloxifene (Evista)?
for prophylaxis of breast cancer, not treatment
what is used to treat men with breast cancer?
tamoxifen (Soltamox)
place in therapy for hormonal therapies with regards to breast cancer?
patients with ER+/PR+ breast cancer
place in therapy for AIs with regards to breast cancer
postmenopausal
CAN be premenopausal, but requires GnRH agonist: leuprolide or goserelin
place in therapy for SERMs with regards to breast cancer?
pre- and postmenopausal
list GnRH agonists brand/generic
leuprolide (Lupron Depot)
Goserelin (Zoladex)
complications of GnRH agonists?
osteoporosis
tumor flare (remember these overload the system)
- consider antiandrogen during beginning phase
most significant SEs of GnRH agonists?
hot flashes impotence gynecomastia peripheral edema bone pain injection site pain QT prolongation dyslipidemia hyperglycemia
list GnRH antagonists brand/generic
degarelix (Firmagon)
complications of GnRH antagonsits?
osteoporosis
No tumor flare here
most significant SEs of GnRH antagonists?
hypersensitivity reactions
plust same as agonists
place in therapy for first generation antiandrogens with regards to prostate cancer?
used (only) in combination with GnRH agonists for the first couple of weeks to prevent tumor flares
list first generation antiandrogens brand/generic
bicalutamide (Casodex)
flutamide
nilutamide (Nilandron)
list place in therapy for second generation antiandrogens. Why does this differ from 1st gen?
can be used as monotherapy b/c they don’t cause an upregulation of androgen receptors
GnRH agonist also known as?
leutinizing hormone releaseing hormone (LHRH) agonists
GnRH MOA?
reduce testosterone production through negative feedback, which can cause a tumor flare
androgen biosynthesis inhibitor MOA?
they interfere with CP-17s involvement in the biosynthesis of testosterone from the testes and DHEA/androstenedione from the andrenal glands
adjunctive therapy required with androgen biosynthesis inhibtors and why?
prednisone to cause negative feedback to the adrenals, which prevents them from overproducing aldosterone
list androgen biosynthesis inhibitors brand/generic
abiraterone (Zytiga)
phases of cell cycle
M - mitosis (cell splits) G0 - rest or G1 - post-mitotic (enzyme/protein synth) S - DNA synthesis/duplication G2 - pre-mitotic (RNA/protein synth
Dubois and Dubois equation
BSA = 0.007184
- (height in cm)^0.725
- (weight in kg)^0.425
Mosteller equation
BSA = square root of
((height in cm *
weight in kg)
/ 3,600)
cell cycle non-specific classes
alkylating agents (technically work on G0 though too)
platinum agents
anthracyclines
cell cycle specific classes
vinca alkaloids taxanes topo I inhibitors topo II inhibitors pyrimidine analog antimetabolites folate antimetabolites miscellaneous
targeted therapy classes
MABs
TKIs
where do alkylating agents work in the cell cycle?
non cell cycle specific
where do platinum based compounds work in the cell cycle?
non cell cycle specific
where do anthracyclines work in the cell cycle?
non cell cycle specific
where do vinca alkaloids work in the cell cycle?
M phase
where do taxanes work in the cell cycle?
M phase
where do topo I inhibitors work in the cell cycle?
S phase
where do topo II inhibitors work in the cell cycle?
G2 phase
where do pyrimidine analog antimetabolites work in the cell cycle?
S phase
where do folate antimetabolites work in the cell cycle?
S phase
list alkylating agents only brand/generic
cyclophosphamide (Cytoxan) ifosfamide (Ifex) carmustine (BiNCU, Gliadel Wafer) bendamustine (Bendeka, Treanda) busulfan (Myleran, Busulfex) melphalan (Alkeran, Evomela)
most important boxed warnings for platinum agents?
anaphylaxis
nephrotoxicity
ototoxicity
most important SE of platinum agents?
neuropathy
N/V w/ cisplatin > carboplatin
What is the Calvert Formula used for? what is it?
dosing of carboplatin
total dose (mg) =
(target AUC)
* (GFR + 25)
AUC 2-8 usually
GFR capped at 125
why should patient avoid cold with oxaliplatin?
acute sensory neuropathy
alkylators MOA?
non cell cycle specific (G0 phase though)
cross-link DNA strands
platinum agent MOA?
non cell cycle specific
cross-link DNA strands
antracycline MOA?
non cell cycle specific
intercalaction into DNA
inhibit topo II
create oxygen free-radicals
boxed warnings for antracyclines?
cardiotoxicity
vesicant properties (not liposomal or mitoxantrone)
myelosuppression
SE unique to liposomal anthracyclines compared to other anthracyclines?
hand-foot syndrome
concerns with anthracyclines aside from boxed warnings?
red urine (mito blue) N/V
list anthracyclines brand/generic
doxorubicin (Adriamycin)
daunorubicin
epirubicin (Ellence)
idarubicin (Idamycin PFS)
valrubicin (Valstar) - only for bladder instillation
daunorubicin and cytarabine liposomal (Vyxeos)
doxorubicin liposomal (Doxil, Lipodoxe50)
mitoxantrone
vinca alkaloids MOA?
M phase
inhibit the function of microtubles
main concerns with vinca alkaloids?
for IV use ONLY (intrathecal fatal)
peripheral neuropathies
autonomic neuropathies (constipation > gastroparesis)
vesicant properties
how to vincristine and vinblastine differ in their SEs?
vincristine
- neuropathy more CNS related
- neuropathic constipation more severe
- not myelosuppressive
vinblastine
- neuropathy more peripheral
- neuropathic constipation less severe
- myelosuppressive
taxane MOA
M phase
inhibit the function of microtubules
main concerns with vinca alkaloids?
infusion-related hypersensitivity reactions which can be fatal
peripheral sensory neuropathies
do not prepare vincristine in a ___?
syringe
list taxane brand/generic
paclitaxel (Taxol)
docetaxel (Taxetere)
cabazitaxel (Jevtana)
paclitaxel albumin-bound (Abraxane)
SE unique to doxetaxel (Taxotere) compared to other taxanes? management?
severe fluid retention which requires premedication with dexamethasone
note regarding preparations of taxanes?
use non-PVC bag and tubing (except Abraxane)
topo I inhibitor MOA?
S phase
block DNA coiling/uncoiling
breaks single and double strand DNA
prevents re-ligation as well
list topo I inhibitors brand/generic
irinotecan (Camptosar)
topotecan (Hycamtin)
boxed warning unique to irinotecan compared to topotecan? management?
early diarrhea: atropine
delayed diarrhea: loperamide
boxed warning unique to topotecan compared to irinotecan? management?
use only when ANC >1500 and platelets >100k
topo II inhibitors MOA?
G2 phase
block DNA coiling/uncoiling
breaks single and double strand DNA
prevents re-ligation as well
list topo II inhibitors brand/generic
etoposide IV (Toposar) etoposide phosphate (Etopophos) etoposide capsules (VePesid) - the important one
concern unique to VePesid capsules compared to other etoposide topo II inhibitor formulations?
refrigerate capsules
main side effect with topo II inhibitors?
hypersensativity reactions
concerns unique to etoposide iv compared to other formulations of etoposide (the only topo II inhibitor)?
infusion rate must be at least 30-60 minutes
precipitation issues ([ ] must be 0.4mg/mL or greater)
use non-PVC IV bag and tubing d/t leaching
pyrimidine analog antimetabolites MOA?
S phase
F-UMP active metabolilte replaces uracil in RNA to inhibit pyrimidine synthesis
5-dUMP active metabolite inhibits thymidylate synthetase
list pyrimidine analog antimetabolites brand/generic
fluorouracil = 5-FU (Adrucil) capecitabine (Xeloda) cytarabine cytarabine liposomal (DepoCyt) gemcitabine (Gemzar)
CI for capecitabine (Xeloda)?
CrCl < 30
boxed warning for capecitabine (Xeloda)?
can increase INR for up to 1 months post-treatment
folate antimetabolite MOA?
S phase
interfere with folic acid cycle by blocking purine and pyrimidine synthesis
most important boxed warning for methotrexate?
there are many, but myelossuppression
most important SEs for folate antimetabolites?
nephrotoxicity
hepatotoxicity
most important SEs for MTX?
HD related nephrotoxicity
chronic-use related hepatotoxicity
what dose of MTX requires leucovorin rescue?
500mg/m2 or greater
what adjunctive measures are taken with MTX in addition to leucovorin/levoleucovorin? why?
hydration and IV sodium bicarb, which are used to alkalinize the urine to decrease the risk of nephrotoxicity
most important drug interactions with MTX? why?
NSAIDs and aspirin, their renal affects will decrease the clearance of MTX
list folate antimetabolites brand/generic
MTX (Trexall, Otrexup, Rasuvo, Xatmep)
pemetrexed (Alimta)
pralatrexate (Folotyn)
intrathecal MTX must be free of ___?
preservatives
folate antimetabolites are given with ___?
folic acid or derivative
vitamin B12
what is given with pemetrexed (Alimta) in addition to folic acid and vitamin b12? why?
dexamethasone for dermatologic toxicity
tretinoin AKA all-trans AKA retinoic acid
1st line for APL
Pregnancy issue
RA-APL differentiation syndrome
arsenic trioxide
2nd line for APL
QT prolongation
RA-APL differentation syndrome
asparaginase and pegaspargase
for leukemia
hepersensitivity (less with peg)
prolonged PT/INR
bleomycin
not myelosuppressive
max life dose of 400 d/t pulmonary fibrosis
hypersensitivity reactions
brand name, MOA as anti-cancer, and SEs of everolimus
Afinitor, Afinitor Disperz (Zortress is for transplant)
mTOR inhibitor that also inhibits downstream regulation of VEGF
dyslipidemia, rash, stomatitis, interstitial lung disease
brand name, MOA as anti-cancer, and SEs of temsirolimus
Torisel (no PVC)
mTOR inhibitor that also inhibits downstream regulation of VEGF
dyslipidemia, hyperglycemia, myelosuppression, interstitial lung disease
list immunomodulators brand/generic
lenalidomide (Revlimid)
pamolidomide (Pomalyst)
thalidomide (Thalomid)
main issue with immunomodulators?
Fetal risk of severe birth-defects
list proteasome inhibitors brand/generic
bortezomib (Velcade)
cafilzomib (Kyprolis)
what is used to prevent herpes reactivation as zoster or simplex d/t bortezomib (Velcade)?
acyclovir or valacyclovir
what is the main side effect if the proteasome inhibitors?
peripheral neuropathy
class wide issue with MABs?
infusion-related reactions
