phase B drugs Flashcards
Bevacizumab dose
5-10mg Qw2, 10-15 mg Qw3
Bevacizumab indication
mets CRC, NSCLC, GBM, Ovarian, Cervical, Renal , HCC
A black box warning for bevacizumab
Arterial thromboembolism, fatal hemorrhage, wound dehiscence, GIT perforation
Atezolizumab indication
advanced or metastatic urothelial carcinoma: following platinum, not eligible for platinum,
NSCLC: progression following platinum
NSCLS with PDL1>50%
Breast cancer TNBC, with nab paclitaxel
Extensive SCLC
metastatic melanoma
Atezolizumab dose
840 mg iv 2 wkly, 1200mg 3 wkly, 1680 mg 4 wkly
common side effect of atezolizumab
immune mediated adverse reaction: common being
- pneumonitis
- hepatitis
-colitis
-hypophysitis
- pancreatitis
- neurological disorder
-adrenal and thyroid disorder
Relugolix mechanism of action
GnRh antagonist
relugolix dose
360mg on first day of treatment followed by 120mg taken once daily
common side effect of relugolix
hot flush
glucosed increased
TG increased
AST, ALT increased
constipation
diarrhea
Tamoxifen side effect?
Menopausal symptoms fluid retention, peripheral edema, tumor flare I headache, lethargy, skin rash, pruritus, thromboembolic complication, endometrial hyperplasia
Drug causing neutropenia
Alkylating agents
• Chlorambucil
• Cyclophosphamide • Ifosfamide
• Melphalan
• Mechlorethamine • Carmustine
• Lomustine
• Streptozocin
Anthracyclines
• Doxorubicin
• Daunorubicin • Epirubicin
Cytarabine
Platinum analogs • Cisplatin
• Carboplatin • Oxaliplatin
Methotrexate, 5-FU
Osimertinib side effect
Skin toxicity
Diarrhea is most common GI toxicity
Pulmonary toxicity in the form of ILD
QTC prolongation
Cardiomyopathy and CHF
Fatigue, anorexia, and reduced appetite.
Capecitabine dosage
Dosage:
During radiation therapy: 825 mg/m2 bid through out the entire course of radiation therapy D1-5
Xelox: capecitabine 1000mg/m2 po bid on days 1-14
Mono therapy: 1000-1250 mg/m2
On TNBC: breast: 1250mg/m2 on days 1-14, repeat cycle every 21 days.
Capecitabine side effect
Diarrhea is dose limiting observed up to 55% of patients
Hand foot syndrome
Nausea and omitting
Elevation in serum bilirubin
Myelosuppression
Neurological toxicity
Cardiac symptoms: ECG changes, serum enzyme elevation
Tear duct stenosis, acute and chronic conjunctivitis.
Nivolumab dose
For unresectable melanoma: 240mg iv every 2 weeks or 480 mg iv every 4 weeks
NSCLC: 240mg iv every 2 weeks or 480 mg iv every 4 weeks
Pembrolizumab dose
Melanoma/SCLC/NSCLC: 200 mg iv every 3 weeks or 400 mg iv every 6 weeks
Rituximab dose
375 mg/m2
What are the points to monitor during rituximab administration
Monitor for infusion related events. Including fever, chills, urticaria, flushing, fatigue, headache, bronchospasm, rhinitis, dyspnea, angioedema, nausea, and or hypotension.
Monitor for tumor lysis syndrome. Especially in patients with high number of circulating cells (>25000/mm3) or high tumor burdens. Characterized by hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, and renal insufficiency etc. usually occurs within the first 12-24 hours of treatment
Indication of pembrolizumab
Metastatic melanoma
Metastatic NSCLC
Non squamous NSCLC
Recurrent or metastatic head and neck cancer
Pediatric patient with refractory classical Hodgkin lymphoma
Refractory primary mediastinal large B cell lymphoma
Locally advanced or metastatic urothelial cancer
Unresectable or metastatic MSI-H or dMMR CRC
Gastric or gastroesophageal junction adenocarcinoma
Locally advanced or metastatic squamous cell cancer of the esophagus
Recurrent or metastatic cervical cancer
Hepatocellular carcinoma who have previously been treated with sorafenib
MCC
Imatinib dose
Start with 400 mg once daily, than if progression give 800 mg. In case of exon 9kit mutation start with 800 mg
Things to monitor during imatinib
Weight, cbc, lft, rft
Echo 3 mnthly
Avoid komla, malta, kamranga, batabilebu
Asses for depression, suicide
Screen for hepatitis
List of light sensitive drugs
Cisplatin,dacarbazine, doxorubicin, vinblastine,vincristine
side effect of nivolumab
- significant immune mediated adverse reactions
permanently discontinued in case of - any life threatening or grade 4 toxicity
grade 3 or 4 pneumonitis
grade 4 colitis
SGOT/SGPT >5 of upper level of normal
serum creatinine >6 X ULN
any severe or grade 3 toxicity that recurs
indication of nivolumab
- adjuvant treatment of melanoma with lymph node involvement following complete surgical resection
metastatic NSCLC
recurrent NSCLC with no EGFR/ALK mutation
resistant SCLC
advanced renal cell cancer
advanced or metastatic urothelial carcinoma
single agent or in combination with ipilimumab for hepatocellular carcinoma
Trastazumab dose
loading dose of 4mg/kg iv over 90 minutes followed by maintenance dose of 2mg/kg iv on a weekly basis.
another alternative schedule is:
8mg/kg iv administered over 30-90 minutes followed by maintenance dose of 6mg/kg iv every 3 weeks
indication of trastazumab
metastatic breast cancer: first line therapy in combination iwth paclitaxel with HER3 positive
metastatic breast cancer second and third line therapy
early stage breast cancer FDA approved for adjuvant therapy of node positive , Her 2 positive
metastatic gastric and gastro esophageal junction adenocarcinoma
