PHARM: GI Tumors Flashcards
Targeted therapy for Colorectal cancer.
Bevacizumab
Cetuximab
Targeted therapy for Gastric cancer.
Glutamic Acid
Trastuzumab
Targeted therapy for GI carcinoid tumor.
Methysergie
Octreotide
Targeted therapy for GIST.
Imatinib
Sunitinib
Targeted therapy for pancreatic cancer.
Erlotinib
Targeted therapy for Liver Cancer
Sorafenib
MOA: Her-2 neu Antibody; HER2 is downregulated, CDK-p27 accumulates and cell cycle arrest occurs. Inhibits constitutive HER2 cleavage/shedding mediated by metalloproteases (may correlate with clinical activity)
Trastuzumab
MOA: rhu-MAb of VEGF
Bevacizumab
MOA: Inhibitor of many RTKs like PDGFR-alpha and –beta, VEGFR, KIT, FLT3, CSR-1R, RET
Sunitinib
MOA: rh/mMAb of EGFR
Cetuzimab
MOA: Oral multi-kinase inhibitor targeting serine/threonine and receptor TK in both tumor and vasculature. Target examples: Raf, VEGF, PDGFR-beta, Kit, FLT-3, RET
Sorafenib
MOA: EGFR-TKI
Erlotinib
MOA: SS analog; reduces duodenal HCO3-, amylase, gastric acidity and inhibits gallbladder contrations and bile secretion as well as meal-induced increases in SMA and portal venous flow
Octreotide
MOA: Nutritional supplement; used to counterbalance deficiencies of HCl in gastric juice
Glutamic Acid
MOA: Serotonin inhibitor in GI tract
Methysergide
MOA: Oral TKI as adjuvant treatment following complete resection of Kit (CD117) positive GIST
Imatinib
MOA: Reduced folate; synergizes with 5-FU
Levucovorin
TOXICITY: Diarrhea and dehydration
Leucovorin
TOXICITY: Bleeding, GI perforation, wound dehiscence, HTN, Hypersensiivity
Bebacizumab
TOXICITY: GI toxicities (pain, bloating, N/V, constipation, stomatitis, dyspepsia) common. CHF. Neurologic toxicity, fluid retention, edema.
Imatinib
TOXICITY: GI toxicity (N/V, diarrhea) prolonged bleeding, elevated LFTs, ocular toxicities; rarely interstitial lung disease
Erlotinib
TOXICITY: Monitor blood glucose because drug inhibits insulin and glucagon. Dose related diarrhea (so give with methysergide)
octreotide
TOXICITY: LVEF dysfunction and cardiomyopathy. Severe infusion-related reactions including anaphylaxis, angioedema, and pulmonary toxicity (worse in patients w/ COPD, asthma, respiratory insufficiency)
Trastuzumab
TOXICITY: Cardiac arrest, respiratory arrest, and/or sudden death; infusion reactions. Acneiform rash common (76-88%), severe in
up to 17% of patients
Cetuzimab
TOXICITY: Hand-foot skin reaction characterized by redness, pain, swelling or blisters on the palms of the hands or soles of the feet. Generally appears in first 6 weeks of treatment.
Sorafenib
TOXICITY: Thrombocytopenia and bleeding. QT prolongation (sometimes fatal), GI complications including GI perforation.
Sunitinib
What drug is also a Vasoconstrictor of large and small arteries; used for migraine therapy?
methysergide
Which cancer has the following treatment plan: Radiation therapy (70% 5YS even if used alone); Radiation + Cisplatin, 5-FU, Mitomycin leads to improved outcomes?
anal cancer
What are folfox and folfiri used for?
colorectal cancer
What is folfox?
5-FU + Leucovorin + oxaplatin
What is folfiri?
5-FU + Leucovorin + irinotecan
How can you tell that a patient with esophageal cancer has invasion to muscularis propria and metastasis?
dysphagia
How may EBV viral infection lead to gastric cancer?
DNA methylation, miss-match repair
How may microsatellite instability lead to gastric cancer?
DNA miss-match repair
If a gastric cancer is HER2 positive, what drug is added to the 5-FU and cisplatin?
Trastuzumab
Why is glutamic acid given with gastric cancer?
ancillary agent that is employed as a gastric acidifier to counterbalance deficiencies of HCl in gastric juice
What type of tumors are rare malignancies arising from cells linking the endocrine and CNS?
GI carcinoid tumors
TRUE or FALSE: GI carcinoid tumors are highly responsive to treatments.
FALSE: no protocol has shown objective tumor response rate of > 15%
Why can octreotide only be given for 1 year?
tachyphylaxis (not as bad with long-acting formulations) and/or disease progression
Why do you give methysergide in GI carcinoid treatment?
serotonin antagonist used to inhibit diarrhea arising from serotonin effects in the GI tract
What drug used to treat GI carcinoid tumors inhibits disease progression and provides symptom relief in 75% of patients?
INF-alpha
What is the problem with INF-alpha?
Toxicity is severe (alopecia, anorexia, fatigue, weight loss, fever, flu-like syndrome, myelosuppression)
What type of tumors are 80% KIT-mutants?
GI stromal tumors
Why is treatment with cytotoxic chemotherapy futile in GIST?
P-gp overexpression pumps the drug out
What is the first line treatment for unresectable, metastatic, or recurrent GIST?
Imatinib mesylate
What is the problem with imatinib?
majority of patients eventually develop imatinib resistance due to secondary mutations in a separate portion of the KIT-coding sequence
What treatment of pancreatic cancer alleviates the malabsorption caused by exocrine insufficiency (that leads to malnutrition)?
pancreatic enzyme replacement
What is FOLFIRINOX and what cancer is it used in?
Pancreatic cancer
leucovorin + fluorouracil + irinotecan + oxiplatin
What is the synergistic combination used in pancreatic cancer?
5-FU/Folinic Acid (Leucovorin)
For what type of cancer is TACE used?
liver cancer
What does TACE stand for?
trans-catheter arterial chemoembolization)-
What is injected in TACE?
doxorubicin
How does TACE spare normal tissue and minimizes dispersion of drug away from the tumor site?
Super-selective catheterization of segmental arteries feeding tumor
