Oncology II: Common Cancer Types & Treatments Flashcards
Arimidex generic/drug class/SE
Anastrozole
Class: Aromatase inhibitors
S/SX: DVT, PE, hot flashes
PO chemotherapy medication that is refrigerated
Etoposide
pg. 829
Red Devil Drugs
Doxorubicin*
“Ruby = Red”
Smurf Drugs
Mitoxantrone
IV Methylene Blue
Amiodarone
Doxycycline
Rituximab carries a high risk for what severe adverse reaction?
Severe/fatal infusion-related reactions
Which Mab requires an over-expression of HER2 gene to be used?
trastuzumab (Herceptin)
Brand name of rituximab
Rituxan
A patient received a cumulative dose > 300 mg/m^2 of doxorubicin. What agent can the patient receive to reduce the risk of cardiomyopathy?
dexrazoxane
Totect: extravasation
Zinecard/Totect: cardioprotection at high doses
Body Surface Area Equation
BSA (m^2) = square root of [Ht (in) x Wt (lb)] / 3131
What is required prior to starting an immunomodulator? Name the immunomodulators.
Pregnancy test [Boxed Warning: fetal risk/pregnancy]
–Immunomodulators–
lenalidomide (Revlimid)
pomalidomide (Pomalyst)
thalidomide (Thalomid)
What drug can be used in premenopausal women and in men with breast cancer?
Tamoxifen
Drug Class: SERM
ADR of raloxifene use
Hot flashes/night sweats & DVT/PE
What drug class blocks the enzyme responsible for the conversion to estrogen?
Aromatase inhibitors
anastrozole, letrozole, exemestane
A patient has chronic myelogenous leukemia (CML). What drug requires that the patient be positive for Philadelphia chromosome (BCR-ABL)? (generic/brand)
imatinib (Gleevec)
Boxed warning for IV MTX
Stomatitis, diarrhea, myelosuppression, & teratogenicity
Audiograms are performed at baseline and before each dose of which chemotherapeutic agent?
Cisplatin
Nephrotoxic & Ototoxic
mesna (Mesnex) is given prophylactically with ________ and with high doses of ___________. This is to prevent what?
ifosfamide (Ifex) and HD of cyclophosphamide (Cytoxan) to prevent hemorrhagic cystitis
Principle toxicities of cisplatin
Nephrotoxicity
Ototoxicity
CINV
Which agent is least likely to cause neutropenia?
Bleomycin because it doesn’t cause myelosuppression
Pyrimidine Analog Antimetabolites
Agents
Fluorouracil “5-FU” - given with leucovorin to increase efficacy
capecitabine (Xeloda) - prodrug of 5-FU; Dihydropyridine dehydrogenase (DPD) deficiency increase risk of severe toxicity
Alkylating Agents
cyclophosphamide
ifosfamide
carmustine
busulfan
What is the metabolite that cyclophosphamide and ifosfamide produce called?
acrolein
*concentrates in the bladder and causes hemorrhagic cystitis**
Warning signs of melanoma skin cancer
A - asymmetry B - border C - color: uneven D - diameter: > 6mm E - evolving size/shape
Aromatase inhibitors side effects
Hot flashes/night sweatings
Arthralgia/myalgias
Osteoporosis
DVT/PE
Generic name of Avastin
bevacizumab
impairs wound healing: do not administer 28 days before or after surgery
What aromatase inhibitor agent is ONLY approved for post-menopausal women? Formulations (generic/brand)
anastrozole (Arimidex) - PO
fulvestrant (Faslodex) - IM
Hormone therapy targets which receptors and how long is treatment?
HER2/NEU receptors
5-10 years to suppress cancer recurrence
What drug is used first-line in premenopausal women with breast cancer? MOA?
Tamoxifen
Drug Class: SERMs
MOA: Tamoxifen binds to estrogen receptors on tumors
What drug class is used first-line in post menopausal women with breast cancer? MOA?
Aromatase inhibitors block the aromatase enzyme that catalyzes the conversation from androgens to estrogens.
What drug is used as prophylaxis in post menopausal women who have osteoporosis and breast cancer? Drug class? Side effects?
Raloxifene
Drug class: SERM
SE: hot flashes & has a risk for blood clots
What other drugs is used as an alternative in unique circumstances when tamoxifen is not a reasonable option? Generic/Brand? Drug class? Side effects?
fulvestrant (Faslodex)
- Drug class: SERD
- SE: Increase LFTs, injection site. pain & hot flashes
toremifene (Fareston)
- Drug class: SERM - SE: hot flashes, vaginal bleeding, decrease libido
What drug needs a pharmacogenomic testing of the HER2 gene expression prior to using? Generic/Brand? MOA? Monitoring?
trastuzumab (Herceptin)
MOA: binds to the HER2 receptor, preventing dimerization (test positive for HER2 overexpression)
Monitoring: LVEF at baseline & during treatment
What type of drugs require premedications of steroids, acetaminophen and diphenhydramine?
Monoclonal antibodies
Monoclonal antibodies were designed to do what?
Attach to specific antigens
That drug class is used first-line in combination with hormone treatment in metastatic breast cancer? Side effects?
Mammalian Target of Rapamycin (mTOR) inhibitors
SE: mouth ulcers, rash, interstitial lung disease, peripheral edema, dyslipidemia, high BP
Name the aromatase inhibitor.
anastrozole (Arimidex)
*increase risk of osteoporosis & CVD
Hormone Treatments used in Prostate Cancer are called?
Androgen deprivation therapy (ADT)
“AKA Chemical castration”
ADRs: impotence, weakness, hot flashes & loss of bone density
Name the Gonadotropin-Releasing Hormone (GnRH) Agonists
Generic/Brand? SE?
leuprolide (Lupron Depot)
goserelin (Zoladex)
SE: hot flashes, bone pain, impotence, gynecomastia, tumor flare (give with concurrent antiandrogen ‘bicalutamide’ for several weeks)
*calcium/vitamin D supplementation
How are combination chemotherapy regimens administered?
In 2 - 6 week cycles, followed by days or weeks without treatment for patient to recover from myelosuppression.
Name the chemotherapy classes that inhibit the S-phase of the cell cycle.
Antimetabolites (MTX, 5-FU, capecitabine)
Topoisomerase I (irinotecan & topotecan)
** AT the S-phase, the DNA replicATes**
Name the chemotherapy classes that are cell cycle independent.
Alkylating agents (cyclophosphamide & ifosfamide)
Anthracyclines (doxorubicin & mitoxantrone)
Platinum Compounds (Cisplatin, Carboplatin & Oxaliplatin)
Name the chemotherapy classes that inhibit the M-phase of the cell cycle.
Taxanes (paclitaxel & docetaxel)
Vinca Alkaloids (Vincristine & Vinblastine)
Name the chemotherapy class that inhibit the G2-phase of the cell cycle.
Topoisomerase II (Etoposide & Bleomycin)
GFR is commonly “capped” at what ____ mL/min/1.73 m^2 for which chemo agent?
125
Carboplatin
Which chemotherapy agent can be exacerbated by exposure to cold and causes acute sensory neuropathy?
Oxaliplatin
Which chemo agent can cause delayed diarrhea? What is the DOC for delayed diarrhea?
Irinotecan - loperamide ~ 24 mg/day
Which vinca alkaloid is associated with more bone marrow suppression?
vinblastine
B - bone marrow suppression (myelosupression)
Which vinca alkaloid is associated more with CNS toxicity (neuropathy)?
vincristine
C - CNS
How is vincristine prepared?
small IV bag “piggyback” rather than syringe
Which chemo agent causes severe fluid retention (pleural effusion, cardiac tamponade and/or edema)?
Docetaxel
Which taxane does NOT require premedication?
Paclitaxel albumin-bound (Abraxane)
*does NOT require non-PVC bag/tubing & NO hypersensitivity reactions**
Which pyrimidine analog antimetabolite comes in an oral formulation?
capecitabine (Xeloda)
oral prodrug of 5-FU
Leucovorin is the active form of what?
folic acid
*hence why it’s given with MTX to bypass the enzyme block of dihydrofolate reductase causes by MTX
What is the antidote given that will rapidly lower methotrexate levels that remain high despite adequate hydration and urinary alkalinization with bicarb?
glucarpidase (Voraxaze)
What chemo drug class, when taken orally may alter if taken with food?
Tyrosine kinase inhibitors (imatinib - Gleevec)
Common toxicities of TKIs
Hypothyroidism QT prolongation Hepatic metabolism - hepatic toxicity Diarrhea HTN Hand and Foot Syndrome SJS/TEN
Which chemo oral agents must be taken with food?
Imatinib (Gleevec)
Capecitabine (Xeloda)
Which chemo oral agents can be taken without regard to food?
Tamoxifen
Anastrozole
Which chemo agents should be prepared in a non-PVC container and infused with non-PVC tubing?
Docetaxel & Paclitaxel
*can cause leaching of DEHP when placed in PVC containers
Arsenic trioxide, often used as 2nd-line therapy for acute promyelocytic leukemia, has what concern?
QT prolongation - Boxed Warning
**Tretinoin (all-trans retinoic acid) is 1st-line
Casodex
generic/drug class/SE
Generic: bicalutamide
Drug class: 1st generation antiandrogen
SE: hot flashes & impotence
A patient undergoes pharmacogenetic testing and is found to be KRAS-negative (wild type). What chemo agent can this patient receive?
Cetuximab
pg. 835
A patient undergoes pharmacogenomic testing and is found to have eGDR-positive expression. What chemo agent can this patient receive?
Cetuximab
What receptor does rituximab target?
CD20 antigen on the B-cells
What medication carries a boxed warning that encompasses epistaxis and hemoptysis?
Bevacizumab
