TARGETED Therapies

Question 1

Monoclonal antibodies

Answer 1

• work to inhibit cancer cell growth
• may bind to specific antigens/receptors on surface of cancer cells and cause cell death
• may be conjugated to cytotoxic drugs or radioactive compounds
• may activate the immune system to recognize and destroy tumor cells
• all are IV infusions
• infusion-related reactions

Question 2

“tu”

EGFR

Answer 2

• tumor

TARGET = epidermal growth factor receptor (EGFR)
- inhibits growth factor from binding to surface of tumor cell and promoting cell growth

= COMMON TOXICITIES =
= skin toxicity (acneiform rash)
= development of rash is correlated with response to therapy

Question 3

“tu”

HER2

Answer 3

• tumor

TARGET = human epidermal growth factor 2 (HER2)
- inhibits growth factor from binding to surface of tumor cell and promoting cell growth

= COMMON TOXICITIES =
= cardiotoxicity
= embryo-fetal toxicity

Question 4

“tu”
CD20
CD38

Answer 4

• tumor

TARGET = cluster of differentiation antigens (CD20, CD38) expressed on cell surface of hematopoietic cells
- binds to antigens expressed on specific hematopoietic cells and causes cell death

= COMMON TOXICITIES =
= CD antigens are expressed on normal and malignant hematopoietic cells
= suppression of specific hematopoietic cells
= bone marrow suppression
= increased risk for reactivation of viral infections

Question 5

“li”

Answer 5

• immune system

TARGET = immune system (PD-1, PDL-1, CTLA-4)

• interferes with body’s ability to “down regulate” the immune system
• increased immune recognition of tumor antigens

= COMMON TOX =
= immune system becomes overactive
= potentially life-threatening immune-mediated reactions
= colitis, hepatic toxicity, thyroid dysfunction, myocarditis

Question 6

“ci”

Answer 6

• “circulatory” system

TARGET = vascular endothelial growth factor (VGEF)
- inhibits growth of blood vessels

= COMMON TOXICITIES =
= inhibition of blood vessel growth - HTN - proteinuria
= hemorrhage/thrombosis
= impaired wound healing

Question 7

VEGF inhibitors

Answer 7

bevacizumab = Avastin
ramucirumab = Cyramza

*impairs wound healing

BOXED WARNINGS
= severe/fatal bleeding
= GI perforation
= surgical wound dehiscence

SIDE EFFECTS
= HTN

Question 8

HER2 inhibitors

Answer 8

trastuzumab = Herceptin/Ogivri
pertuzumab = Perjeta
ado-trastuzumab = Kadcyla 

*monitor LVEF - baseline & during treatment

BOXED WARNINGS
= HF
= embryo-fetal death + birth defects

Question 9

trastuzumab

Answer 9

Herceptin
Ogviri
HER2 inhibitor

*monitor LVEF via ECHO or MUGA

BOXED WARNINGS
= HF
= embryo-fetal death + birth defects
= SEVERE INFUSION-RELATED REACTIONS + PULMONARY TOXICITY

Question 10

ado-trastuzumab

Answer 10

Kadcyla
HER2 inhibitor

• trastuzumab conjugated to a microtubule inhibitor

Question 11

EGFR inhibitors

Answer 11

cetuximab - Erbitux
panitumumab - Vectibix

test for EGFR gene expression + KRAS mutation

KRAS wild type
KRAS mutation = poor response in colorectal cancer

for NSCLC
==> EGFR + = better response rates

Question 12

cetuximab

Answer 12

Erbitux
EGFR inhibitors

BOXED WARNINGS
= severe/fatal infusion-related reactions
= cardiac arrest