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Renal > Renal Carcinoma Rx > Flashcards

Renal Carcinoma Rx Flashcards

1
Q

Principal therapy for curing renal cancer?

A

Surgical excision

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2
Q

Indications for chemotherapy in renal cancer?

A

advanced stage/grade, metastasis, adjunctive therapy with surgery/radiation, medical circumstances that exclude surgery

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3
Q

Metastatic sites?

A

Lymph nodes (most common), Liver/Lungs/Bone (worst prognosis), adrenals, brain, contralateral kidney, subQ skin nodules

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4
Q

What is a Wilm’s tumor?

A

Nephroblastoma seen in children, usually ages 3-4

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5
Q

Genetic condition significant in Clear cell renal cell carcinoma?

A

von Hippel-Lindau gene mutation

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6
Q

Pathophysiology of von Hippel-Lindau?

A

No pVHL synthesis–> excessive HIF–> translocates to the nucleus and up-regulates VEGF

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7
Q

Bevacizumab?

A

anti-VEGF monoclonal antibody

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8
Q

Axitinib MoA?

A

blocks VEGFR and PDGFR tyrosine kinase

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9
Q

Pazopanib MoA?

A

blocks VEGFR, PDGFR, FGFR, and c-Kit

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10
Q

Sunitinib MoA?

A

blocks VEGFR tyrosine kinase

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11
Q

Sorafenib MoA?

A

blocks VEGFR, PDGFR, KIT, and Raf tyrosine kinsaes

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12
Q

Everolimus and Temsirolimus MoA?

A

blocks mTOR activity

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13
Q

Effects of Everolimus and Temsirolimus?

A

Immunosuppresant, Inhibition of cell-cycle progression and angiogenesis, and promotion of apoptosis

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14
Q

Resistance to Everolimus and Temsirolimus?

A

Incompletely understood, but might arise through the action of a 2nd mTOR complex that isn’t inhibited by the drugs

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15
Q

General indications of Everolimus and Temsirolimus?

A

refractory patients, or those with a poor prognosis. They prolong survival and delay disease progression

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16
Q

Metabolism of Everolimus and Temsirolimus?

A

CYP3A4 (Rx-Rx interactions)

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17
Q

Most common adverse drug effects seen with Everolimus and Temsirolimus?

A

mild maculopapular rash, mucositis, anemia, and fatigue (all of these are very common)

18
Q

Specific adverse drug effect seen in Everolimus?

A

Pulmonary infiltrates (stop the Rx if patient develops cough, dyspnea, or radiologic evidence of infiltrates)

19
Q

Treatment for Everolimus induced pulmonary infiltrates?

A

Stop the Rx, treat the patient with prednisone (speeds up resolution)

20
Q

The tyrosine kinase inhibitors?

A

Axitinib, Sunitinib, Sorafenib, Pazopanib

21
Q

Primary MoA of the TKIs?

A

inhibit VEGFR tyrosine kinases

22
Q

Metabolism of TKIs?

A

CYP3A4 (Rx-Rx interactions)

23
Q

General adverse effects seen with TKIs?

A

Cardiovascular issues (VEGFR inhibition); HTN (normally requires acute management), QT prolongation, thromboembolism, hemorrhagic events, blood dyscrasias

24
Q

Drugs producing QT prolongation?

A

Pazopanib and Sorafenib

25
Q

Drugs producing hepatic failure?

A

Pazopanib and sunitinib (black box warning, know this)

26
Q

Drugs producing Stevens Johnson Syndrome (hypersensitivity)?

A

Sorafenib and Sunitinib

27
Q

Other general adverse effects of TKIs?

A

Proteinuria, Endocrine dysfunction (Thyroid/Adrenals/Blood glucose), and elevated hepatic enzymes

28
Q

Bevacizumab adverse effects?

A

Thromoboembolic events, hypertension, CHF, proteinuria, and blood dyscrasias

29
Q

Black box warning for Bevacizumab?

A

Hemorrhage, GI perforations, and Wound healing complications

30
Q

IL-2 drug?

A

Aldesleukin

31
Q

Administration of Aldesleukin (IL-2)?

A

IV (in hospital)

32
Q

Syndrome of adverse effects seen with Aldesleukin?

A

Capillary Leak Syndrome (Hypotension, low PVR, tachycardia, hematologic toxicity, pulmonary edema, renal toxicity)

33
Q

Common complication of Aldesleukin therapy?

A

Development of sepsis; can occur in 70% of patients without abx therapy

34
Q

Low dose infusion of IL-2?

A

possibly leads to selective expansion of a subset of NK cells that have a high affinity IL-2 receptor

35
Q

MoA of Interferon-alpha 2b therapy?

A

upregulation of genes for antiviral, anti-proliferative, and anti-tumor activity

36
Q

Administration of Interferon-alpha 2b?

A

SubQ, 3 times weekly

37
Q

Black Box warning for Interferon-alpha 2b?

A

Neuropsychiatric, autoimmune, ischemic, and infectious disorders

38
Q

Most common adverse effects of Interferon-alpha 2b?

A

Fatigue, Fever, Flu-like symptoms, leukopenia, and neutropenia?

39
Q

Administration of TKIs?

A

Oral

40
Q

Administration of Temsirolimus?

A

IV- weekly

41
Q

Administration of Everolimus?

A

Oral- daily

Renal (5 decks)

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