Targeted Agents

Question 1

Zejula generic

Answer 1

Niraparib (PARPi)

Question 2

Lynparza generic

Answer 2

Olaparib (PARPi)

Question 3

Rubraca generic

Answer 3

Rucaparib (PARPi)

Question 4

Niraparib indications

Answer 4

Primary maintenance for: HRD, HR-proficient, BRCAmt (PRIMA)

Question 5

Olaparib indications

Answer 5

Primary maintenance for: BRCAmt* (+/- bev), HRD (+bev), BRCAmt/HRD with ascites (+bev)*

Question 6

Rubraca indications

Answer 6

Recurrent ovary treatment, recurrent ovary maintenance

Question 7

Opdivo generic

Answer 7

Nivolumab (anti PDL1)

Question 8

Nivolumab indications

Answer 8

Off label, recurrent or persistent ovary treatment

Question 9

Bevacizumab dosing

Answer 9

(Avastin) VEGF inhibitor, 10mg/kg D1, D15 q28d OR 15mg/kg q21d
Infuse over 90min first time, then over 60min if tolerated.

Question 10

Only PARPi to cross blood-brain barrier

Answer 10

Niraparib (Zejula)

Question 11

Bevacizumab adverse effects

Answer 11

HTN (25%), hoarse voice, sore throat, bloody nose, GI (N/V/D), bowel perf (1-2% for ovarian, 2-3% for cervix d/t radiation), poor wound healing, VTE, PRES (rare), proteinuria (nephrotic syndrome), ovarian failure, change in taste perception, fistula (especially cervix), epistaxis, gingivitis

Question 12

When do you need to hold avastin for proteinuria?

Answer 12

If >2+ protein on urine dip, get a 24hr urine protein. If >2g, hold avastin. Can restart once normalizes.

Question 13

Describe MOA of bevacizumab.

Answer 13

Monoclonal antibody, VEGF inhibitor, inhibits angiogenesis.

VEGF-A interacts with receptor on epithelial cells (VEFG-R2). Bev binds VEGF-A extracellularly, making it unable to activate the receptor.

Question 14

Absolute contraindications to bevacizumab

Answer 14

surgery within 28 days (especially abdominal or bowel), nephrotic syndrome, existing fistula or wound complication

Question 15

Indications to discontinue bevacizumab

Answer 15

fistula, bowel perf, heart failure, hemorrhage, HTN crisis, PRES, VTE

Question 16

Why does a dentist need to know if patient is on avastin?

Answer 16

May need to be held if planning invasive dental work

Question 17

Zometa (zoledronic acid) use and dosage in oncology?

Answer 17

Bisphosphonate
Bone metastases - 4mg q 3-4wks
Hypercalcemia of malignancy - 4mg IV, q7d as needed if corrected Ca>12

Question 18

MOA zometa

Answer 18

Inhibits bone resorption by inhibiting osteoclast activity, inhibits skeletal calcium release induced by tumors, decreases serum Ca and Phos and increases their elimination

Question 19

Nivolumab/opdivo

Answer 19

Anti-PD1 monoclonal antibody, immune checkpoint inhibitor.
Binds PD1 receptor, blocking PDL1/2 from binding. Negative PD1 signaling that regulates T-cell activation and proliferation is disrupted causing release of PD1 mediated inhibition of immune response, including antitumor immune response.
(PDL1 normally binds PD1 to inhibit Tcell from killing tumor cell).

Question 20

Nivolumab dosing

Answer 20

240mg q2 weeks
480mg q4 weeks
May be weight-based dosing if in combination with other agents

Question 21

Nivolumab AEs

Answer 21

Infusion reaction, dermatologic tox, colitis, hyper/hypothyroidism, adrenal insufficiency, pulmonary toxicity, myocarditis, encephalitis, nephritis

Adverse rxn: give corticosteroids, hold or DC