polymorphisms & genetic tests

Question 1

5-FU needs what test

Answer 1

DPD

Question 2

6-MP needs what test, how will dose need adjusted if +?

Answer 2

TPMT loss of function polymorphism. increase dose

Question 3

loss of HGPRT is a unique resistance mechanism for what drug?

Answer 3

6-MP

Question 4

increased glutathione is a unique resistance mechanism for what alkylator

Answer 4

chlorambucil

Question 5

hemorrhagic cystitis is a unique SE of what drug? what is tx?

Answer 5

cyclophosphamide; mecna

acrolein buildup as side product

Question 6

nephrotoxicity and ototoxicity are unique SEs of what alkylator/platinum compound

Answer 6

cisplatin

Question 7

pgp overexpression and glutathione s transferase overexpression are unique resistance mechanisms for what drug

Answer 7

irinotecan (topo I inhibitor)

Question 8

UGT1A1 is a polymorphism that needs to be tested for prior to using what drug? does it increase or decrease toxicity

Answer 8

irinotecan, increased toxicity

Question 9

which of the two topo 2 inhibitors do NOT intercalate

Answer 9

etoposide, doxorubicin does intercalate

Question 10

pulmonary toxicity is unique to what drug

Answer 10

bleomycin, intercalates & single & double strand breaks

Question 11

what is an important dose limiting SE of vincristine (vinca alkaloid, microtubule destabilizer)

Answer 11

neurotoxicity

Question 12

what 2 drugs cause increased cholesterol?

Answer 12

abiraterone & exemestane

Question 13

a patient with this mutation should be given ponatinib instead of imatinib. what other test should be done for imatinib?

Answer 13

T314I; philadelphia chromosome

Question 14

what drug is specific for ITD mutations

Answer 14

quizartinib (FLT3 inhibitor)

Question 15

what drug requires testing for the fusion gene of ALK to ELM4?

Answer 15

alectinib (ALK inhibitor)

Question 16

what drug is used in BRAF-v600 mutations? what drug needs to be administered with this?

Answer 16

dabrafenib; trametinib [will cause RASH]

Question 17

EGFR inhibitors need testing for what mutation

Answer 17

exon 19 or 21 (L858R)

Question 18

gefitinib & afatinib are resistance to patients with ____. what drug can overcome this?

Answer 18

T790M; osimertinib

Question 19

what are the 3 covalent kinase inhibitors

Answer 19

acalabrutinib, afatinib, osimertinib

Question 20

lapatinib & tucatinib need to be prescribed with what drug?

Answer 20

capecitabine (active form of 5-FU)

Question 21

Bevacizumab must be used in combo with what drug?

Answer 21

5-FU

Question 22

what is the dose-limiting SE of ipilimumab? what receptor does it target?

Answer 22

severe immune-mediated AE; CTLA-4

Question 23

pembrolizumab requires a positive test of what for NSCLC?

Answer 23

PD-L1+

Question 24

what BiTE can result in cytokine storm

Answer 24

mosunetuzumab; it targets CD3 & CD20

Question 25

CAR-T therapy targets what CD? what cancer does it tx?

Answer 25

CD19, B-cell leukemia

Question 26

what drug is associated with “synthetic lethality”

Answer 26

olaparib (BRCA1/2 & PARP)

Question 27

Venetoclax targets _______. and for the tx of AML it should be used in combo with ________–

Answer 27

BCL-2 (anti-apoptotic protein that exists in cancers); 5-azacitidine