Systemic Anticancer Agents Flashcards
What is the PBS criteria for vismodegib?
Metastatic or locally advanced BCC
Inappropriate for sugary
Inappropriate for curative radiotherapy
Must not have failed another hedgehog inhibitor
What are the contraindications to vismodegib?
Hypersensitivity
Pregnancy/lactation
Women of child bearing potential
Children <18 years (premature fusion of epiphyses)
What are the side effects of vismodegib?
Skin: alopecia, SCC
MSK: arthralgia, muscle spasm
GI: dysgeusia, n/v/d/a
Other: fatigue, weight loss
Serious: Hepatotoxicity, pneumonia
What contraception advice is given to patients started on vismodegib?
Females: 2 methods of contraception during and at least 2 years after cessation
Males: contraception during and at least 2 months after cessation
What baseline and ongoing monitoring is required for vismodegib?
Baseline:
Full exam incl. lymph nodes (SCC risk)
FBC, UEC, LFT, CPK, BhCG
Ongoing:
Monthly BhCG
3 monthly FBC, UEC, LFT
What BRAF inhibitors are used in dermatology?
Dabrafenib
Vemurafenib
What are the contraindications to BRAF inhibitors?
Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease
What other drugs do BRAF inhibitors interact with?
CYP3A4 & 2C8 drugs
Warfarin
OCP
Dexamethasone
What are the adverse effects of BRAF inhibitors?
Skin: SCC, BCC, melanoma, warty keratosis, xerosis, vitiligo, photosensitivity, MP eruptions
Extracutaneous: fever, headache, fatigue, arthralgia, GI effects, hepatotoxicity, QT prolongation, hyperglycaemia
What baseline and ongoing monitoring is required for BRAF inhibitors?
Full hx and exam, incl. skin
FBC, UEC, LFT, BhCG, urinalysis, ECG
What PD1 inhibitors are used in dermatology?
Nivolumab
Pembrolizumab
What are the contraindications to PD1 inhibitors?
Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease
What are the adverse effects of PD1 inhibitors?
Skin: morbilliform rash, pruritus, lichenoid eruption, psoriasis, eczema, vitiligo, bullous pemphigoid, panniculitis, SJS/TEN
Infusion reactions
Autoimmune: encephalitis, conjunctivitis/uveitis, hypophysitis, thyroiditis, pneumonitis, myocarditis, hepatitis, colitis, nephritis, diabetes mellitus, neuropathies
What baseline and ongoing monitoring is required for PD1 inhibitors?
Full Hx and exam
FBC, UEC, CMP, LFT, glucose, TFT, BhCG
Sex hormones, prolactin, cortisol/ACTH
Urinalysis
Immunosuppression screen
Cardiac markers, ECG
What are the contraindications to ipilimumab?
Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease
What are the adverse effects to ipilumumab?
Skin: morbilliform rash, pruritus, lichenoid eruption, psoriasis, eczema, vitiligo, bullous pemphigoid, panniculitis, SJS/TEN
Infusion reactions
Autoimmune: encephalitis, conjunctivitis/uveitis, hypophysitis, thyroiditis, pneumonitis, myocarditis, hepatitis, colitis, nephritis, diabetes mellitus, neuropathies
What baseline and ongoing monitoring is required for ipilumumab?
Full Hx and exam
FBC, UEC, CMP, LFT, glucose, TFT, BhCG
Sex hormones, prolactin, cortisol/ACTH
Urinalysis
Immunosuppression screen
Cardiac markers, ECG
What is the MOA and dermatology Indications for imatinib?
Tyrosine kinase inhibitor
Systemic mastocytosis
Unresectable/metastatic DFSP
What are the contraindications to imatinib?
Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease
What drugs interact with imatinib?
CYP3A4 drugs
What are the adverse effects of Imatinib?
Skin: EM/SJS/TEN, alopecia
Haem: cytopaenias, tumour lysis syndrome
CVS: hypereosinophilic cardiac disease, peripheral oedema
GI: n/v/d/a/p, hepatotoxicity, hypoalbuminaemia, deranged LFTs, GI haemorrhage/perforation
Resp: URTI/nasopharyngitis, cough, influenza, dyspnoea, pneumonia
Endo: hypothyrodism, hypokalemia
MSK: arthralgia/myalgia, bone pain
CNS: headache, dizziness, low mood, insomnia
GUS: renotoxicity, high creatinine
Embryofoetal toxicity, growth retardation
What baseline and ongoing monitoring is done for imatinib?
Full Hx & exam (cardiac, renal and GI)
Growth parameters (children)
FBC, UEC, LFT, TFT, CPK, LDH, BhCG, urinalysis
Vismodegib, true / false
A. overall response rate is around 60%
B. SCC is an adverse effect
C. High rates of adverse effects
D. May be loss of efficacy over time / with subsequent treatments
All true
