PHARM LUNG CANCER

Question 1

MOA carboplatin

Answer 1

platinum drugs that form DNA intra-strand cross links

Question 2

MOA cisplatin

Answer 2

platinum drug that forms DNA intra-strand crosslinks

Question 3

MOA of ifosfamide

Answer 3

forms intra and interstrand cross links

Question 4

MOA of cyclophosphamide

Answer 4

pro drug alkylating agent that forms DNA cross-links, resulting in inhibition of DNA synthesis and function

Question 5

MOA of doxorubicin

Answer 5

intercalator, free radicals bind to DNA causing strand breakage; inhibits topoisomerase II

Question 6

Etoposide MOA

Answer 6

inhibits topoisomerase II, resulting in DNA damage

Question 7

irinotecan/topotecan MOA

Answer 7

inhibits topoisomerase I, resulting in DNA damage

Question 8

Gemcitabine MOA

Answer 8

DNA polymerase inhibitor

Question 9

MOA of pemetrexed

Answer 9

Dihydrofolate reductase inhibitor

Question 10

Paclitaxel MOA

Answer 10

prevent microtubule disassembly into tubulin monomers

Question 11

Vincristine/Vinorelbine MOA

Answer 11

prevent assembly of tublin dimers into microtubules

Question 12

Erlotinib MOA

Answer 12

EGFR TK reversible inhibitor

Question 13

Crizotinib MOA

Answer 13

reversible multiple TK inhibitor

Question 14

Bevacizumab MOA

Answer 14

antibody to VEGF resulting in inhibition of tumor vascularization

Question 15

who gets screened w/ CT for lung cancer?

Answer 15

pts 55-80 w/ 30 pack-yr hx of smoking who quit 15 yrs prior

radiation exposure risk is greater than benefit of finding tumors early

Question 16

which mutations in lung cancers do you want to test for?

Answer 16

look for EGFR and EML4-ALK mutations in adenocarcinomas

Question 17

what is the indication for erlotinib?

Answer 17

only used in adenocarcinomas w/ EGFR overexpression

Question 18

what is the indication for crizotinib?

Answer 18

used in adenocarcinomas with EML4-ALK mutations

Question 19

what is the indication for bevacizumab?

Answer 19

used in adenocarcinomas

Question 20

what is a very common adverse effect of erlotinib?

Answer 20

Rash

Question 21

How would you treat a severe rash caused by TKIs?

Answer 21

reduce dose of chemo agent

1. protective sun lotion
2. steroid creams
3. consider tetra cycline as pre-emptive therapy

Question 22

what are 5 general ways that explain the resistance to conventional chemotherapy agents

Answer 22

1. mutations in target
2. decreased metabolic activation
3. decreased metabolic degradation
4. increased repair
5. MDR efflux pump

Question 23

Name some drugs that have the MDR efflux pump

Answer 23

doxorubicin
vinca alkaloids
taxanes
etoposide

Question 24

which tumor genotype are you looking for in adenocarcinoma which may increase sensitivity to the drug?

Answer 24

exon 19 or L858R in ATP binding site of EGFR

Question 25

which tumor genotype are you looking for in an adenocarcinoma which may decrease sensitivity to erlotinib?

Answer 25

T790M in ATP binding site of EGFR

Question 26

what are some strategies that will mitigate overdiagnosis?

Answer 26

1. screen only pts w/ appropriate risk 2. change threshold for positive test 3. change terminology (use of the word cancer) 4. reduce freq. of screening 5. reduce low-yield diagnostics 6. improve safety and efficacy of screening tools

Question 27

which 3 cancer chemotherapy drugs have a dose limiting toxicity other than myelosuppression?

Answer 27

Cisplatin-->renal tubular damage, failure, MLS Vincristine-->neurotoxicity, ANS dysfunction, GI status (impaction) etoposide-->myelosuppression, hematologic toxicity

Question 28

which mutations are more common in smokers?

Answer 28

KRAS mutations

Question 29

which mutations are more common in never smokers?

Answer 29

EGFR mutations

Question 30

what are the potential downsides to blocking formation of new blood vessels in tumors?

Answer 30

1. prevent chemodrugs from getting to their target | 2. induce more aggressive cells that have increased capacity to spread

Question 31

how do we test for EGFR mutations?

Answer 31

DNA sequencing

Question 32

how do we test for ALK gene rearrangement testing?

Answer 32

FISH

Question 33

what is the standard treatment for SCLC?

Answer 33

Etoposide + Cisplatin or Carboplatin

Question 34

what is the standard treatment for NSCLC?

Answer 34

Cisplatin AND one of the following: paclitaxel, gemcitabine, docetaxel, vinorelbine, irinotecan or pemetrexed

Question 35

intrathecal administration of what class of drugs is fatal?

Answer 35

vinca alkaloids

Question 36

which chemo agent has this side-effect profile: interstitial lung disease, stomach or intestinal perforation, corneal perforation/ulceration and rash?

Answer 36

erlotinib

Question 37

how do you want to take erlotinib?

Answer 37

on an empty stomach because it has variable bioavailability with food

Question 38

which chemo drug has this side-effect profile? - Visual disorders - Edema - GI toxicity (N/V/D/C)

Answer 38

crizotinib

Question 39

which chemo drug has this side-effect profile? LIFE-THREATENING BLEEDING (post-surgical) Hemorrhage (gastric perforation) HTN (arterial thromboembolism) Alopecia Asthenia, Dizziness, Headache fistulas

Answer 39

Bevacizumab

Question 40

which chemo drug do you absolutely avoid using on squamous cell carcinoma of the lung?

Answer 40

Bevacizumab