Pharm clinical cases.

Question 1

What is the prognosis for stage IV squamous cell carcinoma of the lung?

Answer 1

no cure

Question 2

What are the goals of treatment?

Answer 2

palliative treatment

Question 3

What are the factors considered in patients treatment plans?

Answer 3

age, performance status, comorbidities

Question 4

Why are chemo and radiation combined?

Answer 4

synergy - chemo is systemic and radiation is more localized

Question 5

What is the most effective treatment for lung cancer?

Answer 5

surgery, then radiation, then chemo

Question 6

cisplatin toxicity

Answer 6

peripheral neuropathy and ototoxicity

Question 7

gemcitabine toxicity

Answer 7

myelosuppression

Question 8

docetaxel toxicity

Answer 8

peripheral neuropathy

Question 9

nivolumab toxicity

Answer 9

rash, itching, cough, upper resp. infections, SOB, nausea

Question 10

What is the first line therapy for lung cancer chemo? second line?

Answer 10

cisplatin; nivolumab

Question 11

What is the mechanism for nivolumab?

Answer 11

blocks T cell death so that T cells can work on tumor

Question 12

What is the reason for a mixed response in chemotherapy?

Answer 12

drug delivery - blood supply to different organs (ex. BBB can escape drug treatment)

Question 13

What is the treatment for brain metastases?

Answer 13

1 metasteses can cut out; 1-4 that are small, spot radiation; any # can get whole brain radiation which can relieve symptoms that are bad

Question 14

What are the indications for pre-operative (neoadjuvant) therapy in breast cancer?

Answer 14

1. tumor is too large - want to shrink it in order to have more successful therapy 2. for a clinical study - need to study effect of the drug

Question 15

Paclitaxel mechanism

Answer 15

block depolymerization of microtubule into tubulin

Question 16

Traztuzumab

Answer 16

HER2 receptor antibody

Question 17

Lapatinib

Answer 17

HER2 tyrosine kinase inhibitor

Question 18

Pertuzumab

Answer 18

antibody effects different domain of HER2 - synergernistic with traztuzmab

Question 19

Ado-trastuzumab emtansine (kadcyla)

Answer 19

releases chemotherapy into the cell - really toxic - link to traztuzmab so it goes right into cells

Question 20

What are the indication for a bilateral mastectomy?

Answer 20

premenopausal BRCA gene, cosmetic reasons

Question 21

pathologic complete response

Answer 21

the absence of residual invasive disease in the breast and in the axillary lymph nodes at the completion of the neoadjuvant treatment with histologic examination