PHARM_GICANCER

Question 1

what are the 2 anticancer drugs used to treat carcinoid tumors?

Answer 1

IFN-alpha

octreotide

Question 2

what are the 2 anticancer agents used to treat GIST tumors?

Answer 2

imatinib

sunitinib

Question 3

all pts with gastric cancer should be tested for what mutation?

Answer 3

HER-2 for trastuzumab

Question 4

how does octreotide work in the treatment of GI carcinoid tumors?

Answer 4

acts at somatostatin receptors to inhibit the secretion of serotonin & other GI-pancreatic peptides, which results in increased intestinal absorption of water & electrolytes, decreased gastric acid secretions, and increased intestinal transit time

Question 5

which class of drugs used to treat carcinoid tumors inhibits disease progression and provides symptom relief in 75% of pts?

Answer 5

TNF-alpha inhibitors (may be have greater antitumor activity than somatostatin analogs)

Question 6

why don’t conventional cytotoxic chemotherapeutic agents work in GIST tumors?

Answer 6

due to P-gp overexpression

Question 7

which drug is used as 1st line treatment of unresectable metastatic or recurrent GIST?

Answer 7

imatinib

Question 8

what is the main mutation in GIST tumors?

Answer 8

KIT-mutant

Question 9

how is sunitinib used to treat GIST tumors?

Answer 9

given to pts with unresectable dz who progress on higher dose imatinib

Question 10

80% of liver cancer worldwide are associated with what 2 kinds of infections?

Answer 10

HBV & HCV

Question 11

explain how TACE is used in liver cancer

Answer 11

Trans-catheter arterial chemoembolization

• doxorubicin is injected while hepatic arterial branch feeding tumor is occluded with an emboli agent
• selective catheterization spares normal tissue & minimizes dispersion of drug away from tumor site

Question 12

Bevacizumab MOA

Answer 12

inhibits binding of VEGF to its receptor, resulting in inhibition of tumor vascularization

Question 13

capecitabine MOA

Answer 13

oral pro-drug metabolized to 5-FU

Question 14

cetuximab MOA

Answer 14

rh/mMAb-EGFR

Question 15

Cisplatin MOA

Answer 15

forms DNA intrastrand crosslinks & adducts

Question 16

Docetaxel MOA

Answer 16

microtubule stabilizer inhibiting depolymerization

Question 17

erlotinib MOA

Answer 17

EGFR-TKI

Question 18

Fluorouracil MOA

Answer 18

pyrimidine antimetabolite that inhibits thymidylate synthase & interferes w/ RNA synthesis & function. Also has some effects on DNA

Question 19

Gemcitabine MOA

Answer 19

DNA polymerase inhibitor via incorporation of triphosphate form during DNA synthesis

Question 20

imatinib MOA

Answer 20

oral TKI as adjuvant treatment following complete resection of Kit (CD117) positive GIST

Question 21

IFN-alpha MOA

Answer 21

enzyme activation following cell surface receptor binding and tyrosine kinase activation

Question 22

Mitomycin MOA

Answer 22

mono or bifunctional alkylating agent

Question 23

octreotide MOA

Answer 23

somatostatin analog; reduces duodenal bicarbonate, amylase, reduces gastric acidity, inhibits gallbladder contractility & bile secretions, inhibits meal-induced increases in SMA & portal venous blood flow

Question 24

Sorafenib MOA

Answer 24

oral multi-kinase inhibitor targeting serine/threonine & receptor tyrosine kinases in both tumor & vasculature.

Question 25

Sunitinib MOA

Answer 25

inhibits >80 receptor tyrosine kinases including PDGFR, VEGFR, KIT, FLT3, CSR-1R, RET

Question 26

Trastuzumab MOA

Answer 26

HER-2/neu ab; HER2 is downregulated, cyclin-dependent kinase inhibitor p27 accumulates, & cell cycle arrest occurs. Also inhibits the constitutive HER2 cleavage/shedding mediated by metalloproteases, which may correlate with the clinical activity

Question 27

AEs of bevacizumab

Answer 27

``` Bleeding GI perforation wound dehiscence HTN hypersensitivity ```

Question 28

capecitabine AEs

Answer 28

``` Dihydropyrimidine DH deficiency (familial pyrimidinemia) prevents metabolic activation. Contraindicated in renal dysfunction Adverse CV events Neurologic & hematologic toxicities Interacts with coumarin ```

Question 29

AEs of cetuximab

Answer 29

cardiac arrest, respiratory arrest, and/or sudden death - infusion rxns - acneiform rash common (76-88%)

Question 30

Cisplatin AEs

Answer 30

dose limiting nephrotoxicity bone marrow suppression hearing impairment (ototoxicity) Platinum hypersensitivity

Question 31

Docetaxel AEs

Answer 31

increased treatment realted mortality in NSCLC Edema Contraindicated in hepatic dz neutropenia (dose-limiting tox.)

Question 32

what is the dose-limiting toxicity of docetaxel?

Answer 32

neutropenia

Question 33

AEs of erlotinib

Answer 33

``` GI toxicity (N/V, diarrhea) prolonged bleeding elevated LFTs ocular toxicities rarely ILD ```

Question 34

what are the AEs of fluorouracil?

Answer 34

Severe hematological tox. including BM suppression dihydropyrimidine dehydrogenase deficiency (familial pyrimidinemia) lead to enhanced neurotoxicity; enzyme necessary for degrading fluorouracil to an inactive compound

Question 35

AEs of gemcitabine

Answer 35

``` BM suppression infection peripheral neuropathy arthralgia drowsiness fatigue N/V, diarrhea anorexia common (resolves in 2-3 days) ```

Question 36

AEs of imatinib

Answer 36

GI toxicities common (N/V/C) CHF neurologic tox. fluid retention & edema

Question 37

what are the AEs of IFN-alpha?

Answer 37

Neuropsychiatric events including aggression, depression and suicide Flu-like symptoms: fatigue fever, alaise, myalgia, arthralgia, chills, headache, weight loss

Question 38

what are the AEs of irinotecan?

Answer 38

``` BM suppresssion Diarrhea asthenia fever pain weight loss ```

Question 39

which drug may used in place of 5-FU to treat colorectal cancer?

Answer 39

capecitabine

Question 40

which 2 targeted agents appear to improve outcomes in colorectal cancer, except in pts with KRAS mutations?

Answer 40

bevacizumab | cetuximab

Question 41

what drug class is the 2nd line therapy for esophageal cancer?

Answer 41

taxanes

Question 42

what are the AEs of mitomycin?

Answer 42

BM suppression Thrombocytopenia leukopenia Hemolytic-Uremic Syndrome

Question 43

what are the AEs of octreotide?

Answer 43

dose related diarrhea

Question 44

what do you have to monitor with octreotide therapy?

Answer 44

serum glucose; b/c it inhibits insulin & glucagon

Question 45

which TKI causes QT prolongation, thrombocytopenia and bleeding?

Answer 45

sunitinib

Question 46

what are the AEs of sunitinib?

Answer 46

thrombocytopenia & bleeding QT prolongation sometimes fatal GI complications including GI perfs have occured rarely in pts with intraabdominal malignancies

Question 47

what are the AEs of Trastuzumab?

Answer 47

LVEF dysfunction & cardiomyopathy Severe infusion-related rxns including anaphylaxis, angioedema, & pulmonary toxicity; pulm. tox worse in pts w/ intrinsic lung dz (COPD, asthma, Respiratory insufficiency)