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NAPLEX - OUR cards > Oncology II: Common Types & Treatments > Flashcards

Oncology II: Common Types & Treatments Flashcards

1
Q

Breast cancer that is estrogen receptor and progesterone receptor positive - how is this treated with adjuvant hormonal therapies?

A

Premenopausal: tamoxifen x 5 years, reassess menopausal status; if still pre-menopausal, tamoxifen x 5 more years. If postmenopausal, can do tamoxifen x 5 years or an aromatase inhibitor x 5 years

Postmenopausal: AI x 5 years, or if intolerant give tamoxifen x 5 years

AI: anastrazole (Arimidex), letrozole (Femara), exemestane (Aromasin)

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2
Q

What is the preferred treatment of postmenopausal stage IV hormone positive breast cancer?

A

Fulvestrant with palbociclib

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3
Q

How is metastatic breast cancer typically treated?

A

Based on metastases

Visceral (vital organs, ie lungs liver brain) metastases that are immediately life threatening are usually treated with cytotoxic chemotherapy plus HER-2 targeted monoclonal antibodies (trastuzumab +/- pertuzumab) if HER-2 positive

Nonvisceral or non-life threatening visceral: hormonal therapy, acts more slowly but is better tolerated than cytotoxic chemo

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4
Q

HER-2 targeted monocloncal antibodies

A

Trastuzumab

Pertuzumab

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5
Q

SERMS place in therapy?

A

Used in pre- and postmenopausal women with hormone receptor positive breast cancer
Also used in men with breast cancer

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6
Q

AI place in therapy?

A

More effective in postmenopausal women, first-line in that case unless they are intolerant to AI’s
Also used in pre-menopausal women who have been on tamoxifen for 5 years and are still pre-menopausal after those 5 years.
FDA approved for postmenopausal women only

Used in pre-menopausal in combination with GnRH agonist only, otherwise it wont work

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7
Q

Tamoxifen drug interactions

A

Major substrate of CYP3A4, 2C9, and 2D6
Recommend venlafaxine over fluoxetine, paroxetine for hot flashes (strong 2D6 inhibitors)
Underlined

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8
Q

Side effects of SERMs

A

DVT/PE, menopausal symptoms, hot flashes, flushing, edema, weight gain, hypertension, mood changes, amenorrhea, vaginal bleeding/discharge
(Underlined)

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9
Q

Raloxifene place in therapy

A

FDA approved for prophylaxis

Not for treatment of breast cancer

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10
Q

Tamoxifen brand, dose

A

Soltamox

20 mg PO daily

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11
Q

Fulvestrant dose, brand

A

500 mg IM day 1, 15, 29, then monthly

Faslodex

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12
Q

AI warnings

A

Anastrazole, letrozole, exemestane

Higher risk of osteoporosis, hyper risk of CVD compared to SERMs

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13
Q

Anastrozole brand, dose

A

Arimidex

1 mg PO daily

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14
Q

Letrozole brand, dose

A

Femara

2.5 mg PO daily

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15
Q

Exemestane brand, dose

A

Aromasin

25 mg PO daily

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16
Q

Side effects of AI

A

Anastrazole, letrozole, exemestane

Edema, DVT/PE, bone pain, osteoporosis, menopausal symptoms, hot flashes, arthralgia/myalgia, lethargy/fatigue, N/V, rash, hepatotoxicity, hypertension, dyslipidemia

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17
Q

Palbociclib brand, place in therapy

A

Ibrance
Cyclin-Dependent kinase inhibitor, inhibits downstream signaling and tumor growth
Used with letrozole (Femara, AI) or fulvestrant (Faslodex, SERM) and significantly improves outcomes

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18
Q

Raloxifene counseling

A

Discontinue at least 72 hours prior to and during prolonged immobilization period due to inc risk of blood clots

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19
Q

Tamoxifen counseling

A

Can cause some serious but rare side effects such as endometrial cancer, stroke, or blood clot. Can also increase risk of getting cataracts.

20
Q

GnRH agonist - agents, counseling, notes

A

Leuprolide (Lupron Depot)
Goserelin (Zoladex)

Increases risk of osteoporosis

Can cause “tumor flare” when given because initially causes surge in testosterone because it works to reduce testosterone by a negative feedback mechanism. Give with antiandrogens for several weeks to prevent tumor flare symptoms.

Side effects: Hot flashes, impotence, gynecomastia, peripheral edema, bone pain, injection site pain, QT prolongation, dyslipidemia, hyperglycemia

21
Q

Prostate cancer - Antiandrogen options, place in therapy

A

Used in combination with GnRH agonists to prevent tumor flare
1st generation - Bicalutamide (Casodex) - 50 mg PO daily
2nd generation - Enzalutamide (Xtandi) - 160 mg (4 x 40 mg) daily - different from 1st gen in that they dont cause an upregulation of the expression of androgen receptors, so they can be used as monotherapy

22
Q

BSA calculations for chemotherapy (2 main formulas)

What are the formulas and what weight do you use? (actual, IBW, or adjusted?)

A

Dubois and Dubois: BSA = 0.007184 x height^0.725 x weight (kg)^0.425

Mostellar: BSA = sqrt (Ht x Wt / 3600)

Use actual body weight!! (Underlined)

23
Q

Unique concerns for cyclophosphamide and ifosfamide

A

Hemorrhagic cystitis (ensure adequate hydration, give mesna)

SIADH (cyclophosphamide) - retain water

Mesna: chemoprotectant, must be given prophylactically with ifosfamide and high doses of cyclophosphamide

24
Q

Unique concerns for carmustine

A

Use non-PVC bag and tubing

Can cause pulmonary toxicity

25
Q

Unique concerns for dacarbazine

A

Protect from light (decomposed drug turns pink) (don’t leave it in da car. get it?)
Hepatic necrosis

26
Q

Unique concerns for procarbazine

A

MAO-i, avoid interacting drugs/foods

27
Q

Unique concerns for Lomustine (Gleostine)

A

Fatal toxicity occurs with overdosage - only one dose every 6 weeks

28
Q

Unique concerns for cisplatin

A

Nephrotoxicity, ototoxicity (due to accumulation)
Nephrotoxicity - need adquate hydration
Ototoxicity - audiograms at baseline and before each dose
Highly emetogenic - 3 drug antiemetic agent required for prevention of CINV

CONFIRM doses > 100 mg/m2/cycle due to risk of renal toxicity, otoxocity

29
Q

Amifostine (Ethyol) place in therapy

A

Used as a chemoprotectant with cisplatin to prevent nephrotoxicity

30
Q

Unique concerns for carboplatin

A

Myelosuppression; dose related

Doses calculated by target AUC using Calvert formula

Total carboplatin dose (mg) = Target AUC x (GFR + 25)

AUC range 2-8 mg/mL, GFR capped at 125 mL/min

31
Q

Unique concerns for oxaliplatin

A

Acute sensory neuropathy, occurs 1-7 days post administration
Exacerbated by exposure to cold, including cold beverages

32
Q

Boxed warnings carboplatin

A

Anaphylactic like reactions - risk increases with repeated exopsure; caution when > 6 rounds of carboplatin are used

33
Q

Which chemo agents are associated with cardiotoxicity?

A

Anthracyclines
Doxorubicin, other -rubicins, Mitoxantrone
Associated with cardiomyopathy and heart failure
Related to total cumulative anthracycline dose the patient received over their lifetime
Lifetime maximum dose = 450-550 mg/m2

34
Q

Dexrazoxane (Zinecard, Totect) place in therapy

A

Zinecard = Chemoprotectant for doxorubicin to reduce doxorubicin cardiotoxicity

Totect = chemoprotectant to protect against extravasation

35
Q

Unique concerns doxorubicin liposomal

A

Red urine discoloration

Hand-foot syndrome

36
Q

Unique concerns mitoxantrone

A

Blue urine discoloration

37
Q

What part of the cell cycle do vinca alkaloids target?

A

M phase

38
Q

Drug class effects vinca alkaloids

A

Vincristine, Vinblastine, vinorelbine

Constipation (autonomic neuropathies), peripheral neuropathies

VinCristine = CNS toxicity (neuropathy)
VinBlastine and vinorelBine = bone marrow suppression

Potent vesicants = use warm compresses

39
Q

Boxed warnings for vinca alkaloids

A

Intrathecal administration can cause progressive paralysis and death
Labeled to prevent accidental intrathecal administration

40
Q

Vincristine dosing

A

Capped at 2 mg/dose regardless of calculated mg/m2 dose

Give in small IV bag, not syringe to prevent accidental intrathecal administration

41
Q

Where do taxanes work?

A

M phase

Paclitaxel, docetaxel, cabazitaxel

42
Q

Drug class effects of taxanes

A

Paclitaxel, docetaxel, cabazitaxel

Peripheral sensory neuropathies

Infusion-related hypersensitivity reactions and fatal anaphylaxis,
Premedication regimens vary

Give taxanes BEFORE platinum based compounds because elimination of taxanes is reduced by cisplatin/carboplatin

Must use non-PVC bag and tubing

43
Q

Paclitaxel unique concerns

A

Premedicate with diphenhydramine, corticosteroid, H2RA

44
Q

Docetaxel unique concerns

A

Premedicate with corticosteroids for 3 days, starting 1 day prior to docetaxel
Causes severe fluid retention
Some formulations contain alcohol, cause alcohol intoxication symptoms

45
Q

Paclitaxel albumin-bound unique concerns

A

No premedication required ; infusion related reactions are due to the solvent systems, NOT the taxanes.

46
Q

Which taxane brand does not require premedication

A

Abraxane
paclitaxel that is albumin-bound
No solvent like the other taxane formulations

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