Oncology II: Common Cancer Types and Treatment Flashcards
Lung Cancer Skin Cancer Breast Cancer Prostate Cancer Cell cycle treatments BSA calculations Other Medicatoins McAbs
skin cancer warning signs
ABCDE
Asymmetry
Border irregularities
Color inconsistent
Diameter >6mm
Evolving size, color, shape
breast cancer risk factors
female
alcohol use
smoking
inc BMI
no exercise
poor nutrition
why does an increased BMI present a risk factor for breast cancer development
as BMI increases, androgens stored in adipose are converted to estrogen via aromatase
what syndrome places males at a risk for breast cancer
Klinefelter Syndrome where patients have XXY chromosome
Patient is a pre-menopausal female with ER/PR + breast cancer. What is first line? Why?
SERM!
tamoxifen, bc it covers estrogen released from the ovaries which is the case in premenopausal
PLUS adjuvant for 5-10 years
Patient is post-menopausal female with ER/PR+ breast cancer. What is first line?
Aromatase inhibitor
anastrozole
letrozole
exemestane
PLUS adjuvant for 5-10 years
what medication is used as breast cancer prophylaxis in post-menopausal females who are ER/PR+
raloxifene
tamoxifen BBW
endometrial cancer
uterine cancer
tamoxifen
CI
ADE
CI in QT prolongation, warfarin use, DVT/PE hx, pregnancy
ADE: dec MBD –> + Ca and Vitamin D
hot flashes/night sweats
treatment of choice for tamoxifen-induced hot flashes/night sweats
venlafaxine
raloxifene BBW
increased risk of thromboembolism
anastrazole ADE
inc risk of OP –> + Ca and Vit D
inc risk CVD
which has a higher risk of CVD
SERM or aromatase inhibitors
aromatase inhibitor
treatment of choice for HER2+ breast cancer
trastuzumab
pertuzumab
what is the common toxicity with trastuzumab and pertuzumab for HER2+ breast cancer
cardiotoxicity
tamoxifen counseling points
take Ca and Vitamin D to promote bone health
endometrial cancer risk
hot flashes/night sweats - venlafaxine an option
vaginal bleeding possible
decreased libido
raloxifene counseling points
blood clot risk
aromatase inhibitor counseling points
(anastrazole, letrozole, exemestane)
hot flashes/night sweats
inc risk CVD
muscle damage/pain
prostate cancer treatment options
GnRH agonist PLUS antiandrogen
or
GnRH antagonist
GnRH agonists
medications
use
ADE
leuprolide (Lupron depot)
Goserelin (Zoladex)
for prostate cancer with an antiandrogen
ADE: dec MBD (Ca, Vit D, DEXA scans), hot flashes/night sweats, weakness, impotence, bone pain, difficulty urinating
antiandrogens
medications
first gen: bicalutamide
second gen: apalutamide
doralutamide
enzalutamide
GnRH antagonists
medications
ADE
Degarelix (Firmagen SQ)
Relugolix (Orgovyx)
ADE: OP risk (Ca, Vit D, DEXA scans!)
Which medications work in the M phase of the cell cycle
VT
Vinka alkaloids
- vincristine
- vinblastine
Taxanes
- paclitaxel
- docetaxel
Which medications work on the G1 phase of the cell cycle?
asparginase
interferons
steroids
Which medications work on the S phase of the cell cycle (DNA replication)?
antimetabolites
- MTX
- 5-FU
- capecitabine
Topo I inhibitors
- irinotecan
- topotecan
Medications that work on G2 phase of cell cycle?
Topo II inhibitors
- etoposide
- bleomycin
max life dose of bleomycin
400 units per life
max dose of vincristine
2mg/dose
cell cycle independent agenst
alkylating agents
- carmustine
- cyclophosphamide
- ifosfamide
anthracyclines
- doxorubicin
- mitoxantrone
platinum compounds
- cisplatin
- carboplatin
cyclophosphamide and ifosfamide
toxicity concern and prophylaxis?
hemorrhagic cystitis
mesna!
BSA equation
square root of (cm x kg) / 3600
alkylating agents
CC dependent or independent
meds
BBW
ADE
cc independent
busulfan, cyclophosphamide, ifosfamide
BBW: hemorrhagic cystitis (cyclo and ifos)
myelosuppression
ADE: SJS/TEN, infection reactivation (HBV, CML, TB, HCV), hepatotoxicity, emesis, mucositis, alopecia, neurotoxcity, secondary malignancy
mesna
use
MOA
cyclophosphamide and ifosfamide induced hemorrhagic cystitis
cyclophsophamide is metabolized to acrolein which concentrates in bladder; mesna prevents concentration in bladder
platinum-based chemo agents
cc dep or independent?
medications
ADE
cc independent
cisplatin, carboplatin
SE
cisplatin: nephro and oto toxicity, highly emetogenic, max is 100mg/m2/cycle to protect kidneys
__________ is used for cisplatin-induced nephrotoxicity prophylaxis
amiphostine
anthracyclines
cc dep or indep
medications
pearls
BBW
cc independent
doxorubicin: lifetime dose 450-550 mg/m2, consider dexrazoxazone at doses >300mg/m2, RED discoloration of bodily fluids
BBW: cardiotoxicity, vesicant, myelosupp, secondary
malignancy
mitoxantrone: BLUE discoloration of bodily fluids
BBW: cardiotoxicity, myelosupp, secondary
malignancy
Irinotecan
MOA
SE
BBW
Topo-I - inhibitor
cell cycle S
SE: N/V/D, alopecia, diarrhea, abd pain, acute cholinergic sx
BBW: myelosupp, diarrhea (early and late)
Patient presents with irinotecan-induced delayed diarrhea. Treatment?
loperamide
Patient presents with irnotecan-induced cholinergic symptoms (flushing, sweating, diarrhea, cramps). Treatment?
atropine
Etoposide
MOA
administration
BBW
ADE
MOA: Topo II inhib in G2 phase of cell cycle
admin: infuse over 30-60 min to prevent hypotension, IV prep must be </= 0.4mg/mL 2/2 poor aqueous solubility
BBW: myelosupp
ADE: HSRxn, anaphylaxis, secondary malignancy
is bleomycin myelosuppressive
no
bleomycin
MOA
administration
BBW
ADE
Topo II inhibitor in G2 phase of cell cycle
NEED TEST DOSE, max is 400 units/life
BBW: pulmonary fibrosis, anaphylaxis
ADE: HSRxn, pneumonitis, mucositis, hyperpigmentation, fever, chills, N/V (mild)
vincristine
MOA
administration
ADE
pearls
vinka alkaloid in M phase of cell cycle
administered IV! Max is 2mg/dose
ADE: vesicant, CNS toxicity, peripheral neuropathy
C for CNS toxicity
vinblastine
MOA
administration
ADE
pearls
vinka alkaloid in M phase of cell cycle
administered IV!
ADE: B for bone marrow suppression
Which chemo agents are NOT myelosuppressive
bleomycin
vincristine
vinka alkaloids BBW
IV administration only
vesicants
peripheral sensory neuropathies (parasthesias)
autonomic neuropathy (gastroparesis, constop), SIADH
If a patient is receiving paclitaxel they should be pre-treated with _______________________
diphenhydramine, steroids and H2RA
If a patient is receiving docetaxel they should be pre-treated with _______________________
steroids x3 days starting one day before docetaxel
5-FU
MOA
given with __________ to inc efficacy
antidote
BBW
SE
pyrimidine analog/antimetabolite in the S phase of cell cycle
given with leucovirin to increase efficacy
antidote = uridine triacetate
BBW inc INR
SE: hand-foot-mouth, mucositis, diarrhea
capecitabine
MOA
CI
SE
BBW
antidote
pyrimidine analog/antimetabolite in the S phase of cell cycle
po prodrug of 5-FU
CI CrCl <30mL/min
SE: hand-foot-mouth, mucositis, diarrhea
BBW: inc INR
antidote: uridine triacetate
paclitaxel and docetaxel
MOA
BBW
SE
DDI
taxanes in M phase of cell cycle
BBW: severe HSRxn, myelosuppression, fluid retention (docetaxel)
SE: peripheral sensory neuropathy, myalgias, arthralgias, alopecia, hepatotoxicity
DDI: platinum-based (cisplatin and carboplatin) dec taxane eliminiation –> need to reduce taxane dose
what is an additional benefit of pretreating docetaxel with steroids other than to curb HSRxn
aids in reducing fluid retention ADE
Patient is on paclitaxel and provider wants to initiate cisplatin. How should dose be adjusted?
A. discontinue taxane
B. patient will require an increased cisplatin dose
C. patient will require and increased paclitaxel dose
D. patient will require a decreased paclitaxel dose
D. patient will require a decreased paclitaxel dose
Paclitaxel elimination is inhibited by cisplatin and other platinum, requiring a decreased paclitaxel dose
Patient initiated on 5-FU and develops toxicity. What could be a possible explanation?
A. G6PD deficiency
B. HLA-B*5701 gene mutation
C. DPD deficiency
D. renal insufficiency
C. DPD deficiency
When do we need to dose adjust taxanes paclitaxel and docetaxel
hepatic impairment
methotrexate
doses >/= ______________ require the addition of ___________
500mg/m2
leucovirin
Why is sodium bicarb added in methotrexate treatment
to alkalinize urine and decrease nephrotoxicity risk
Avoid MTX in patients with _________ due to ________
3rd spacing (edema, ascites, pleural effusions)
decreased CL
Patient initiated on MTX develops AKI. What is the antidote?
A. glucarpidase (Voraxane)
B. leucovirin
C. uridine triacetate
D. NS
E. lactated ringers
A. glucarpidase (Voraxane)
Doses of MTX are higher or lower in chemo than in RA?
higher
Match the McAb to the MOA
Bevacizumab (Avastin) EGFR-i
Trastuzumab (Herceptin) CD20-i
Cetuximab (Erbitux) VEGF-i
Rituximab (Rituxan) anti-HER2
Pembrolizumab (Keytruda) PD-L1 i
Nivolumab (Opdivo)
Trastuzumab (Herceptin) anti-HER2
Bevacizumab (Avastin) VEGF-i
Cetuximab (Erbitux) EGFR-i
Rituximab (Rituxan) CD20-i
Pembrolizumab (Keytruda) PD-L1 i
Nivolumab (Opdivo) PD-L1 i
What drug am I?
I need to be pre treated with benadryl
Please test for EGFR gene expression first
BBW severe/fatal infusion reaction, cardiac arrest
Can cause an acneiform rash that, if occurs in first two weeks, is a sign treatment will be successful!
Avoid sunlight
cetuximab
What drug am I?
I need to be pre-treated with benadryl, steroids and APAP
BBW: Hep B reactivation, PML, SJS/TEN, infusion reaction
Check for Hep B before starting me!
Rituximab (Rituxan)
What drug am I?
I cannot be given 28 days before or after a surgery because I will impair wound healing and have BBW for severe fatal bleeding, GI perforation and wound opening.
Monitor for proteinuria, HTN, nephrotic syndrome, HF and thrombosis
Bevacizumab (Avastin)
What drug am I?
You must use a 0.22 micron filter with me
I have BBW for HF, embryo-fetal death, birth defects, infusion reactions, pulm toxicty, hepatotox, interstital lung disease and pneumonitis
Trastuzumab (Herceptin)
MTX BBW
myelosupp
aplastic anemia
renal damage
hepatotoxicity
interstitial pneumonitis
SJS/TEN
GI tox
immunosuppression
TLS
teratogenicity/fetal death
MTX DDI
A. NSAIDs, PPIs, cephalosporins, salicylates, probenacid
B. NSAIDs, H2RA, beta lactams, salicylates, probenacid, sulfonamides
C. NSAIDs, PPIs, beta lactams, salicylates, probenacid, sulfonamides
D. NSAIDs, H2RA, cephalosporins, salicylates, probenacid, sulfonamides
C. NSAIDs, PPIs, beta lactams, salicylates, probenacid, sulfonamides
In order to use tyrosine kinase inhibitors, patients must be positive for ________________.
philadelphia chromosome (BCR-ABL)
Oral chemo agents imatinib (Gleevec) and Capecitabine (Xeloda) must be given with or without food?
with food
Common TK-inhibitor toxicities
heart - QTp
skin - acneiform rash, SJS/TEN
lg int - diarrhea
hand-foot syndrome
liver - 3A4 substrates (DDI and toxicities)
What cancer are TK-i s commonly used in
CML