Oncology Common Cancer Types and Treatment Flashcards
What is the difference between complete response and partial response?
Complete - treatment destroyed all known tumor cells
Partial - at least 30% of the tumor was eliminated
What is neoadjuvant therapy
Radiation or chemo given before surgery to shrink tumor
What is the most common primary therapy for cancer?
Surgery
What is adjuvant therapy?
radiation and/or chemo given after surgery in attempt to eradicate residual disease
What do BRCA1 and BRCA2 genes do?
Suppress tumor growth
Mutations prevent cell repair and cause drastic increase in breast cancer incidence
What is Klinefelter Syndrome and what cancer does it cause a high incidence of?
When a male has one Y and two or more X chromosomes
Causes men to be infertile and produce more estrogen
Higher risk of breast cancer
What hormonal therapy is used in pre and post menopausal women with breast cancer?
Pre - Tamoxifen (first line)
Post - Aromatase inhibitor (anastrozole nad letrozole); tamoxifen second line
What SERM is used for breast cancer prophylaxis, not treatment?
Raloxifene
What cancer medications are SERMs? What cancers are they used in?
Tamoxifen
Fulvestrant
Breast
SERM BBW, CI, SE
BBW: increased risk of uterine or endometrial cancer and thromboembolic events
CI: pregnancy (tamoxifen)
SE: hot flashes/night sweats, vaginal bleeding/spotting, decreased bone density, supplement with calcium/vitamin D with tamoxifen
What medications are aromatase inhibitors
Anastrozole (Arimidex)
Letrozole
Exemestane
Aromatase SE, CI
CI: pregnancy
SE: hot flashes/night sweats, arthralgia/myalgia, osteoporosis, higher risk of CVD
What medication are cyclin-dependent kinasae (CKD4/6) inhibitors
Palbociclib
Abemaciclib
Ribociclib
Aromatase inhibitor MOA
inhibits conversion of androgens to estrogens
CDK4/6 MOA
inhibits downstream signalling of tumor growth
What PSA level indicates prostate cancer?
> 10
What medications are hormonal therapies used for prostate cancer? What if hormonal therapy does not work?
Androgen deprivation therapy
GnRH agonist +/- antiandrogen
GnRH antagonist
Castration resistant - use chemo
What medications are GnRH agonists?
Leuprolide
Goserelin
aka LHRH agonists
GnRH agonist MOA
stimulate production of GnRH (and consequently testosterone) then stop production through negative feedback
GnRH agonist SE and notes
SE: hot flashes, impotence, gynecomastia, bone pain
Note: tumor flare - can given with antiandrogen for several weeks
What medications are GnRH antagonist
Degarelix
GnRH antagonist SE and notes
SE: osteoporosis risk - consider Ca and Vit D supplementation
Note - no tumor flare
What medications are antiandrogens?
First generation: bicalutamide, flutamide, nilutamide
Second gen: Apalutamide, darolutamide, enzalutamide
What medications are androgen biosynthesis inhibitors?
Abiraterone
Abiraterone (Zytiga) MOA
interferes with specific CYP-17 enzyme to decrease testosterone production
***MUST be taken with prednisone to prevent hyperaldosteronism
BSA calculation
Square root of:
Ht (cm) x Wt (kg)
————————-
3600
What metabolite of cyclophosphamide and ifosfamide causes hemorrhagic cystitis?
acrolein
What chemo medications are alkylating agents?
Cyclophosphamide, ifosfamide, carmustine, busulfan
Alkylating agent BBW, SE
BBW: Hemorrhagic cystitis
SE: pulmonary toxicity
What chemo medications are platinum-based compounds?
Cisplatin
Carboplatin
What body fluid discoloration can doxorubicin cause?
Red urine, tears, sweat, and saliva
What body fluid discoloration can mitoxantrone cause?
Blue urine and sclera
What chemo medications are anthracyclines
Doxorubicin
Mitoxantrone
What medications are topoisomerase I inhibitors
Irinotecan
Topotecan
What medications are topoisomerase II inhibitors
Etoposide
Bleomycin
What medications are vinca alkaloids
Vincristine
Vinblastine
What chemo medication is fatal if administered intrathecally?
Vincristine
Must be administered in IV bag to prevent accidental intrathecal administration
What chemo medications are taxanes?
Paclitaxel
Docetaxel
Cabazitaxel
Paclitaxel
Why does docetaxel need to be premedicated with dexamethasone
To prevent severe fluid retention
What chemo meds are pyrimidine analog antimetabolites?
Fluorouracil “5-FU”
Capecitabine (Xeloda)
Pyrimidine analog antimetabolites CI adn SE
CI: CrCl <30
SE: hand-foot syndrome, diarrhea, mucositis
What chemo meds are folate antimetabolites?
Methotrexate
What is the methotrexate antidote?
Glucarpidase (Voraxaze)
Methotrexate BBW, SE, and drug interactions
BBW: myelosuppression, renal damage, hepatotoxicity, GI toxicicty, teratogenicity
SE: Nephrotoxicity, hepatotoxicity, nausea, mucositis
Drug interactions: NSAIDs, salicylates
Arsenic trioxide SE
QT prolongation
What medications are mTOR inhibitors
Everolimus and temsirolimus
mTOR inhibitor MOA
inhibit downstream regulation of vascular endothelial growth factor (VEGF) reducing cell growth, metabolism, proliferation and angiogenesis
Everolimus SE
Mouth ulcers/stomatitis, rash, interstitial lung disease, peripheral edema, dislipidemia, increased BP
What cancer medications are CAR T-cell gene therapies?
Axicabtagene ciloleucel
What cancer medications are Immunomodulators?
Lenalidomide
Pomalidomide
Thalidomide
Immunomodulator BBW
Fetal risk/pregnancy
What cancer medications are protease inhibitors
Bortezomib and carfilzomib
What medications are VEGF inhibitors?
Bevacizumab (Avastin)
Ramucirumab
VEGF inhibitor BBW and SE
BBW: severe/fatal bleeding, GI perforation
SE: impaired wound healing, do not give 28 days before or after surgery
HER2 inhibitor medications
Trastuzumab (Herceptin)
Pertuzumab
EGFR inhibitor medications
Cetuximab
Panitumumab
Leuocyte CD antigens medications
Rituximab
PD-1 inhibitor medications
Pembrolizumab (Keytruda)
Nivolumab
Atezolizumab
Durvalumab
CTLA-4 inhibitor medications
Ipilimumab
Tyrosine kinase inhibitor (TKI) medications and common toxicities
Lapatinib, neratinib, sorafenib, sunitinib Hypothyroidism QT prolongation Rash HTN Hand-foot syndrome Hepatic toxicity Diarrhea
