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NAPLEX review 2024 RXPrep Book > Oncology: Oncology II: Common Cancer Types & Treatment > Flashcards

Oncology: Oncology II: Common Cancer Types & Treatment Flashcards

1
Q

Complete response is when

A

treatment has destroyed all known tumors

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2
Q

Partial response is when

A

at least 30% of tumor has been eliminated

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3
Q

BRCA1 and BRACA2 Gene mutations

A

normally genes suppress tumor growth

mutations prevent cell repair and inc breast cancer mutations

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4
Q

Klinefelter syndrome

A

Men with 1 Y, and multiple X
higher risk of breast cancer

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5
Q

Hormone-sensitive cancer treatment

A

treated with adjuvant (endocrine) therapy for 5-10yrs to suppress cancer recurrence

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6
Q

1st line adjuvant txm for premenopausal females with hormone-sensitive cancer

A

tamoxifen

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7
Q

SERM for breast cancer prevention in post menopausal females at risk for cancer?

A

Raloxifene

also inc bone density, indicated for osteoporosis prevention but not 1st line due to hot flashes/risk of blood clots

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8
Q

Why are Aromatase inhibitors not useful in premenopausal women

A

AIs reduce estrogen production by blocking aromatase enzyme, but dont block ovarian estradiol production

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9
Q

HER2 overexpression

A

oncogene that promotes breast tumor growth
20% of breast tumors over express HER2 on cell surface

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10
Q

SERMs Boxed warnings

A

inc risk of uterine or endometrial cancer
inc risk of thromboembolic events
QT prolongation

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11
Q

SERMs Contraindications

A

Dont use w/ warfarin = tamoxifen
Hx of DVT/PE = tamoxifen/raloxifene
pregnancy/breast feeding = raloxifene
QT prolongation = tamoxifen

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12
Q

SERMs side effects

A

Hot flashes
night sweats
vaginal bleeding/spotting
vaginal discharge/dryness/itchy
dec libido
weight gain

Dec bone density, supplement with calcium/vit D
Tamoxifen = teratogenic

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13
Q

Selective Estrogen Receptor Degrader (SERD)

A

Fulvestrant (Faslodex)

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14
Q

Fulvestrant (Faslodex) SE

A

SE: inc LFTS, hot flashes, injection site pain

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15
Q

Aromatase inhibitors

A

Anastrazole
Letrozole
Exemestane

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16
Q

Aromatase inhibitors info

A

Higher risk of osteoporosis
higher risk of CVS compared to SERMs

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17
Q

Aromatase inhibitors CI and SE

A

CI: pregnancy
SE: hot flashes/night sweats, arthralgia/myalgia

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18
Q

CDK4/6 inhibitors

A

Palbociclib
Abdemaciclib
Ribociclib

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19
Q

CDK4/6 inhibitors warnings & SE

A

Warnings: interstitial lung disease
SE: Neutropenia, anemia, nausea, diarrhea, fatigue, alopecia, blurred vision
Risk of TE events

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20
Q

Prostate Specific Antigen levels

A

> 4 = might be prostate cancer
4 - 10 = overlaps with BPH too
10 = prostate cancer likely

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21
Q

tumor flare in prostate cancer

A

When giving GnRH agonist, causes initial inc of T so its given with anti androgen, after awhile T drops and anti androgen can be stopped

due to negative feedback loop

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22
Q

GnRH agonists

A

Leuprolide (Lupin)
Goserelin (Zoladex)
Histrelin (Supprelin)
Triptorelin (Trelstar)

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23
Q

GnRH agonist Contraindications

A

Pregnancy
breastfeeding

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24
Q

GnRH agonist side effects

A

Hot flashes
impotence
gynecomastia
bone pain
QT prolongation

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25
Q

GnRH antagonist

A

Degarelix (Firmagon)
Relugolix (Orgovyx)

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26
Q

GnRH antagonist unique concerns

A

Osteoporosis. risk, consider vit D/calcium supp
No tumor flare, dont need anti androgen

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27
Q

GnRH antagonist CI and SE

A

CI: pregnancy
SE: similarly to GnRH agonist, Hot flashes, impotence, gyno, bone pain etc

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28
Q

1st gen anti androgen boxed warnings

A

Hepatotoxicity (Flutamide)
interstitial pneumonitis (nilutamide)

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29
Q

1st gen anti androgen meds

A

Bicalutamide
Flutamide
Nilutamide

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30
Q

1st gen anti androgen side effects

A

hot flashes
gyno

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31
Q

2nd gen anti androgen meds

A

Apalutamide (Erleada)
Darolutamide (Nubeqa)
Enzalutamide (Xtandi)

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32
Q

2nd gen Anti androgen warnings

A

seizures
myocardial ischemia
QT prolongation
can cause fetal harm

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33
Q

2nd gen Anti androgen side effects

A

HTN
peripheral edema
hot flashes
fatigue

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34
Q

Androgen Biosynthesis inhibitor

A

Abirateron (Zytiga)

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35
Q

Abirateron (Zytiga) side effects

A

mineralocorticoid excess
hepatotoxicity

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36
Q

Which patients body weight should be used for chemo dosing

A

their actual body weight

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37
Q

Cell cycle independent agents

A

Alkylating agents
platinum based compounds
Anthracyclines

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38
Q

Alkylating agents work by…..

A

cross-linking DNA strands and inhibiting protein synthesis and DNA synthesis

can cause DNA mutations and lead to secondary malignancies

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39
Q

Alkylating agents

A

Cyclophosphamide
Ifosfamide (Ifex)
Carmustine/Lomustine
Busulfan (Myleran)
Mitomycin

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40
Q

Cyclophosphamide and Ifosfamide unique concerns

A

Hemorrhagic cystitis = adequate hydration and use Mesna

Mesna given prophylactically with Ifosfamide and high dose cyclophosphamide

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41
Q

Alkylating agent boxed warnings

A

Myelosuppresion
Hemorrhagic cystitis
pulmonary toxicity = carmustine
neurotox = ifosfamide
hepatic necrosis = dacarbazine

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42
Q

Alkylating agents warnings

A

severe skin reactions, SJS/TEN
reactivation of infections = HBV, CMW, TB, HSV
hepatotoxicity

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43
Q

Alkylating agent side effects

A

Pulmonary toxicity = busulfan, carmustine/lomustine
Mod-high emetic potential

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44
Q

Mitomycin unique concerns

A

vesicant, antidote is DMSO and cool compresses

IV = hazy blue and make piss blue/green

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45
Q

Mitomycin Boxed warnings

A

bone marrow suppression
hemolytic uremia syndrome

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46
Q

Mitomycin CI

A

thrombocytopenia
coagulopathy
bleeding

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47
Q

Mitomycin SE

A

N/V
fatigue
alopecia
mucos membrane toxicity
leukopenia

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48
Q

Platinum based therapies

A

Cisplatin
Carboplatin
Oxaliplatin

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49
Q

Platinum based therapies common side effects

A

peripheral sensory neuropathy
ototoxicity
nephrotoxicity

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50
Q

Which platinum based therapy has highest risk of nephrotoxicity and CINV

A

Cisplatin

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51
Q

Cisplatin unique concerns

A

Nephro/Ototoxicity = cumulative
Amifostine = chemoprotectant used to prevent nephrotoxicity
highly emetic

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52
Q

Cisplatin boxed warnings

A

Anaphylactic like reactions, inc with repeated exposures, caution when > 6 cycles used
Cisplatin doses > 100mg/m2/cycle = check by provider
myelosuppresion

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53
Q

Oxaliplatin unique concerns

A

cold sensitivity = drinking cold beverages, eating ice cream etc

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54
Q

Platinum based therapies side effects

A

peripheral neuropathy
inc LFT
N/V
QT prolongation = oxaliplatin

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55
Q

Anthracyclines

A

Doxorubicin (Adriamycin)
Doxorubicin liposomal
Mitoxantrone

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56
Q

Doxorubicin unique concerns

A

potent vesicant
drug is red = discoloration of sweat, tears, urin
total lifetime dose not to exceed 450-550mg/m2
Dexrazoxane = for extravasation/chemoprotectant

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57
Q

Doxorubicin, other - ubicins boxed warnings

A

myocardial toxicity
vesicant
myelosuppresion
secondary malignancy

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58
Q

Doxorubicin, other -ubicins side effect

A

N/V - use antiemetics

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59
Q

Doxorubicin liposomal boxed warning and side effects

A

Boxed warning: myocardial toxicity
SE: hand-foot syndrome

60
Q

Is liposomal doxorubicin interchangeable with regular?

A

no

61
Q

Mitoxantrone boxed warning

A

myocardial toxicity

62
Q

Cell-cycle specific agents

A

Topoisomerase I & II inhibitor,Vinca alkaloids, Texans, Pyrimidine Analog Antimetabolites, folate antimetabolites

63
Q

Topoisomerase I inhibitors work by…..

A

block the coiling and uncoiling o the double stranded DNA helix during the S phase of the cell cycle

64
Q

Topoisomerase I inhibitors

A

Irinotecan
Topotecan

65
Q

Irinotecan boxed warnings

A

myelosuppresion
use only when ANC > 1500 and platelets > 100K
Diarrhea (Early and Late)

66
Q

Irinotecan side effects

A

N/V/D
alopecia
diarrhea
abdominal pain

67
Q

Topoisomerase II inhibitors

A

Etoposide
Bleuomycin

68
Q

Topoisomerase II inhibitors work…

A

same as Topo I inhibitor, just work on Topo II

69
Q

Etoposide unique concerns

A

Infusion rate related hypotension, give over atleast 30-60min
IV prep < 0.4 mg/ml to avoid precipitation

70
Q

Etoposide boxed warnings

A

myelosuppression

71
Q

Etoposide Side effects

A

Hypersensitivity reactions
anaphylaxis
secondary malignancies

72
Q

Bleomycin unique concerns

A

max lifetime dose of 400 units due to pulmonary toxicity
not myelosuppresive
premedication used

73
Q

Bleomycin boxed warnings

A

Pulmonary fibrosis
anaphylaxis

74
Q

Bleomycin side effects

A

hypersensitivity reaction
pulmonary reactions
N/V
Chills
Fever

75
Q

Vinca alkaloids work by….

A

inhibiting function of microtubules during the M phase of cell cycle

76
Q

VinCrisitine is associated with….

A

more CNS toxicity than other vinca alakaloids

77
Q

vinBlastine and vinorelBine are associated with….

A

more bone marrow suppression than vincristine

78
Q

Vinca Alkaloids

A

Vincristine
Vinblastine

79
Q

Vincristine is often capped at what dose?

A

2mg/dose

80
Q

Vinca Alkaloid boxed warnings

A

Vesicants
IV admin only

81
Q

Vinca Alkaloid side effects

A

peripheral sensory neuropathy
autonomic neuropathy

82
Q

Taxanes work on…..

A

inhibit the function of microtubules during the M phase of the cell cycle

83
Q

Taxanes include….

A

Paclitaxel (Abraxane)
Docetaxel
Cabazitxel (Jevtana)

84
Q

Docetaxel unique concerns

A

premeditate w/ steroids for 3 days starting 1 day prior
severe fluid retention

85
Q

Taxane boxed warnings

A

Severe hypersensitivity reactions = not Paclitaxel
myeliosuppresion

86
Q

Pyrimidine analog antimetabolite mechanism

A

inhibits pyrimidine synthesis during the S phase of the cell cycle

87
Q

Pyrimidine analog antimetabolites meds

A

Fluorouracil 5-FU
Capecitabine (Xeloda)
Gemcitabine

88
Q

Fluorouracil, 5-FU unique concerns

A

Leucovorin given with to inc efficacy

89
Q

Capecitabine Boxed warnings

A

Significant inv in INR and up to 1 month after treatment

90
Q

Capecitabine contraindications

A

severe renal impairment, CrCl < 30

91
Q

Pyrimidine analog antimetbolite side effects

A

Hand-foot syndrome
diarrhea
mucosities
caridotox
photosensitivtiy
dementia

92
Q

Folate antimetabolites work by

A

interfering with enzymes involved in the folic acid cycle, blocking purine and pyrimidine biosynthesis during the S phase

93
Q

Folate antimetabolite medications

A

Methotrexate (Trexail)
Pemetrexed (Alimta)
Pralatrexate (Folotyn)

94
Q

Methotrexate Boxed warnings

A

myelosuppressio
renal dmage
hepatotoxicity
GI toxicity
teratogenic

95
Q

Methotrexate side effects

A

Nephrotoxicity = dose related
hepatotoxicity
nausea
diarrhea
stomatitis
mucositis

96
Q

Levoleucovorin vs Leucovorin dosing

A

Levoleucovorin is given at 1/2 the dose of Leucovorin

97
Q

Methotrexate antidote

A

Glucarpidase

98
Q

Methotrexate drug interactions

A

all dec clearance of methotrexate

NSAIDs
Salicylates
Beta lactase
PPI
sulfonamide ABX
probenacid

99
Q

MAbs that target VEGFs

A

“ci”

Bevacizumab
Ramucirumab

100
Q

MAbs that target EGFR

A

“Tu”

Cetuximab
Panitumumab

101
Q

MAbs that target HER2

A

“Tu”

Trastuzumab
Pertuzumab

102
Q

MAbs that target CD20/CD30

A

“Tu”

Rituximab
Brentuximab

103
Q

MAbs that target immune system (PD-1, PD-L1, CTLA-4)

A

“li”

Ipilimumab
Pembrolizumab

104
Q

Bevacizumab (Avastin) unique concerns (VEGF)

A

impairs wound healing, dont give 28 days prior or after surgery

105
Q

Bevacizumab (Avastin) boxed warnings (VEGF)

A

Severe/fatal bleeding
GI perforation

106
Q

Trastuzumab (Herceptin) unique concerns (HER2)

A

test for HER2 expression
monitor LVEF

107
Q

Trastuzumab (Herceptin) boxed warnings (HER2)

A

HF
embryo-fetal death = avoid preg 7 months after txm
severe infusion related reasons

108
Q

Cetuximab (Erbitux) unique concerns (EGFR)

A

test for EGFR expression and KRAS
KRAS wildtype = poor response colorectal cancer

109
Q

Cetuximab (Erbitux) boxed warnings

A

Severe/fatal infusion related reactions
cardiac arrest

110
Q

Cetuximab (Erbitux) side effects

A

acneiform rash
SJS/TEN
ocular toxicities
N/V/D

111
Q

Cetuximab (Erbitux) notes

A

rash occurs in 1st 2 weeks of treatment, patient expected to have better response
avoid sunlight, use sunscreen

112
Q

Rituximab (Rituxan) unique concerns

A

premeditate with Tylenol, Benadryl, steroid

113
Q

Rituximab (Rituxan) boxed warnings

A

Hep B reactivation
SJS/TEN
severe/fatal infusion reactions

114
Q

PD-1 inhibitors

A

Keytruda = Pembrolizumab
Opdivo = Nivolumab

115
Q

PD-1 inhibitor unique concerns

A

immune mediated toxicities

116
Q

PD-1 side effects

A

immune mediated toxicities

117
Q

CTLA-4 inhibitor

A

Yervoy = ipilimumab

118
Q

Ipilimumab (Yervoy) unique concerns

A

REMS program

119
Q

Ipilimumab (Yervoy) boxed warnings & side effects

A

Boxed warning: fatal immune mediated reactions

SE: pneumonitis, nephrotoxicity, ocular toxicity

120
Q

Tyrosine kinase info info

A

oral admin
have to before pharmacogenomic testing prior to starting
some TKIs have specific targets, others are multi-targeted

121
Q

TKI used in Chronic myelogenous leukemia (CML) drugs

A

BCR-ABL inhibitors

Imatinib (Gleevec)
Dasatinib (Sprycel)
Nilotinib (Tasigna)

122
Q

TKI used in Chronic myelogenous leukemia (CML) unique concerns

A

must be Philadelphia chromosome (BCR-ABL) positive for use

123
Q

Imatinib, Dasatinib, Nilotinib boxed warnings

A

QT prolongation = nilotinib
vascular occlusions, HF

124
Q

Imatinib, Dasatinib, Nilotinib Side effects

A

myelosuppression
N/V/D
QT porlongation
fluid retention
edema
skin rash
inc LFTs
HF

125
Q

TKIs used in Melanoma

A

BRAF inhibitors

Vamurafenib (Zelboraf)
Dabrafenib (Tafinlar)

126
Q

Vamurafenib, Dabrafenib unique concerns

A

Must be BRAF V600E or V600K mutation positive to use

127
Q

Vamurafenib, Dabrafenib warnings

A

new malignancies
QT prolongation

128
Q

MEK1 and 2 inhibitors

A

Cobimetinib (Cotellic)

129
Q

Cobimetinib (Cotellic) unique concerns

A

used in combo with BRAF n patients with V600E/V600K mutations

130
Q

Cobimetinib (Cotellic) side effects

A

HTN
HF
Hepatotoxicity
Hand-foot syndrome
Visual impairment

131
Q

EGFR inhibitors, used in non-small cell lung cancer (NSCLC)

A

Afatinib (Gilotrif)
Erlotinib (Tarceva)

132
Q

EGFR inhibitor unique concerns

A

must be EGFR mutation positive to use

133
Q

EGFR inhibitor side effects

A

acneiform rash
dry skin
pruritus
N/V/D
mucositis
stomatitis

134
Q

Acneiform rash from EGFR inhibitors indicates that patient will have what kind of response?

A

expected to be better

135
Q

Anaplastic Lymphoma Kinase (ALK) inhibitors

A

Alectinib (Alecensa)
Brigatinib (Alunbrig)

136
Q

ALK inhibitor unique concerns

A

must have ALK mutation to use

137
Q

ALK inhibitor warnings and side effects

A

warning: QT prolong, hepatotoxicity, bradycardia, interstitial lung disease

Side effects: Skin rash N/V/D, edema

138
Q

Lapatinib (Tykerb) Info, Warnings, Side effects

A

Info: HER2 inhibitor
Warning: Hepatotoxicity, GI toxicity, cardiotoxicity
Side effect: N/V/D, hand-foot syndrome

139
Q

Neratinib (Nerlynx) Info, Warnings, Side effects

A

Info: HER2 inhibitor
Warning: Hepatotoxicity, GI toxicity = req premeditate w/ antidiarrheal meds
Side effect: N/V/D, hand-foot syndrome

140
Q

Sorafenib (Nexavar) Info, Warning, Side effects

A

Info: TKI, multiple targets
Warnings: Hepatotoxicity, cardiac toxic, hen, SJS/TEN, impaired wound healing
Side effect: QT prolong, skin changes, hand-food syndrome, N/V/D, thyroid dysfunction

141
Q

Sunitinib (Sutent) Info, Warnings, Side effects

A

Info: TKI, multiple targets
Boxed warning: Hepatotoxicity
Side effect: QT prolong, skin changes, hand-food syndrome, N/V/D, thyroid dysfunction

142
Q

Common toxicities for TKIs

A

Hypothyroidism
QT prolongation
Diarrhea
Hepatic toxicity
Rash
Hand-foot syndrome

143
Q

Which oral agents should be taken with food or within 1 hr after meal

A

Imatinib = Gleevec
Capecitabine = Xeloda
Thalidomide = Thalomid
Exemestane = Aromasin

144
Q

Which oral agents should be taken on empty stomach, 1hr before or 2hrs after food

A

Nilotinib = Tasigna
Erlotinib = Tarceva
Sorafenib = Nexavar
Temozolomide = Temodar
Abiraterone = Zytiga
Pomalidomide = Pomyalyst

145
Q
A

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