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Gastrointestinal > Tumors Of GI Tract > Flashcards

Tumors Of GI Tract Flashcards

1
Q

Colorectal CA

A

Bevacizumab

Cetuximab

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2
Q

Gastric Cancer

A

Glutamic Acid

Trastuzumab

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3
Q

GI Carcinoid

A

Methylsergide

Octreotide

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4
Q

GI stromal tumor

A

Imatinib

Sunitinib

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5
Q

Pancreatic CA

A

Erlotinib

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6
Q

Liver CA

A

sorafenib

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7
Q

oral form of 5FU

A

capecitabine

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8
Q

Conventional agents used in various combinations used to treat GI tumors

A 
Capecetibine
Cisplatin-MESNA
Docetaxel
Doxorubicin
5-FU
Gemcitabine
INFN-alpha
Ironotecan
Leucovorin
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9
Q

incidence of colorectal cancer in US

A

3rd most common

2nd most deadly

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10
Q

conventional regimens for colorectal CA

A

FOLFOX (5FU, leucovorin oxaplatin)

FOLFIRI (irinotecan instead of oxaplatin)

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11
Q

targeted therapies improve outsomes for colorectal cancer except in patients with

A

KRAS+ mutations (GOF)

*obviously BRAF would prove targeted therapy innefective too, but he doesnt list it here

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12
Q

targeted therapies for colorectal CA

A

bevacisumab

cetuximab

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13
Q

esophageal CA tx
dysphagia is presenting symptom
*invasion of MP-mets has occured usually by dx.

A

cisplatin-5FU
cis-5FU-vinblastine
*taxanes as second line therapy

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14
Q

4th most deadly CA

A

gastric

*5 year survival 20%

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15
Q

all patients for gastric cancer should be tested for

A

HER2 status

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16
Q

tx of her2 + gastric cancer

A

trastuzumab, 5FU/cisplatin

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17
Q

her2 negative therapy

A

5FU, cis, with or without anthracyline (doxo/doce)

*ironotecan + docetaxel are allowable too

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18
Q

anciallary agent for gastric cancer

A

glutamic acid-gastric acidifier to counterbalance deficieny of HCL in gastric juice

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19
Q

four reasons/mechanisms why treating gastric cancer is so difficult

A

EBV infection-fundus mainly
Microsatellite instability-body=antrum
Genomic stability-antrum>body
Chromosomal instability-cardia

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20
Q

tx of GI carcinoid tumors

A

octreotide

methylsergide

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21
Q

describe carcinoid tumors

A

arise from cells linking endocrine and central nervous system-responsible for produciton of key neurosecretory hromones

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22
Q

MOA for octreotide

A

somatostatin receptors that inhibit seretion of serotonin and other gI-panc peptides
-results in increased intestinal absorption of H2O and electrolytes, dec gastric acid, increased intestinal transit time

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23
Q

tachyphylaxis is a problem with which agent

A

octreotide-treatment is 12 mos

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24
Q

serotonin antagonist

A

methylsergide-inhibits diarrhea arising from serotonin effects in the GI

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25
Q

inhibits disease progression in 75% of pt.’s with GI carcinoid syndrom

A

IFN alpha

*substantial side effects

26
Q

maybe the best tx for carcinoid tumors

A

ifn alpha

27
Q

GIST demographics

A

<1%
equally in all geographic and ethnic groups=men and women equally affected
50-80 years old

28
Q

GIST types

A

80% KIT +
5% KIT negative
5-8% PDGFRA-mutant
12-15% wild type

29
Q

treatment of GIST with conventional cytosoxic therapy is…

A

useless because of P-GP overexpression

30
Q

1st line treatment for GIST

A

imatinib-now over 5 year survival

31
Q

delayed imatinib resistance seen in most GIST patients due to

A

secondary mutations in separate protions of CIT coding sequence

32
Q

GIST patients with unresectable GIST who progress oin higher dose imatinib

A

sunitinib- second line therapy

33
Q

with pancreative cancer must replace

A

panc enzymes to alleviate malnutrition

34
Q

demographics for panc cancer

A

44K cases pa.
OS < 4%
<20 organ confined on dx.

35
Q

drugs for panc cancer

A
  1. gemcitabine or 5FU/folinic acid

2, gemcitiabine and erlotinib or FOLFIRINOX

36
Q

LEUCOVORIN IS SAME THING AS

A

FOLINIC ACID

37
Q

USE WITH 5FU TO DRIVE 5FU INTO INTERMEDIARY METABOLISM AND INCREASE 5FU EFFECTIVENESS

A

LEUCOVORIN/FOLINIC ACID

38
Q

LIVER CA DEMOGRAPHICs

A

29K cases ps.

<30% organ confined at dx

39
Q

80% of liver ca cases worldwide are associated with

A

HBV or HCV

-affects p53 pathway

40
Q

describe TACE therapy

A

doxorubicin injected with the hepatic arterial branch feeding the tumor is occluded with an embolic agent.
*super-selective catheterization of segmental arteries feeding tumor spares normal tissue and miimizaes dispersion of drug away from tumor site

41
Q

standard of care for advanced HCC

A

sorafenib-increases overall survival rate

42
Q

cetuximab targets

A

EGFR

43
Q

side effects for bevacizumab

A

BLEEDING
GI PERFORATION
WOUND DEHISCENCE

44
Q

SIDE EFFECTS WITH CETUXIMAB

A

cardiac arrest

respiratory arrest and or suddend eath

45
Q

MOA for erlotininib

A

EGFR-TKI

46
Q

issues with erlotinib

A

GI toxicity
prolonged bleeding
elevated LFT’s
occular toxicity

47
Q

take before meals

A

glutamic acid

48
Q

imatinib MOA

A

adjuvant TKI after resection of KIT + GIST

49
Q

REDUCED FOLATE ANTAGONIZES WITH 5FU

A

LEUCOVORIN

50
Q

serotonin antagonist in GI

also used for migranes

A

methysergide-vasoconstrictor of large and small arteries

51
Q

monitor blood glucose with

A

octreotide-somatostain analog-inhibits insulin and glucagon and GH

52
Q

Somatostatin analog; reduces duodenal bicarbonate, amylase, reduces gastric acidity, inhibits gallbladder contractility and bile secretion, inhibits meal-induced increases in superior mesenteric artery and portal venous blood flow

A

octreotide

53
Q

mutli kinase inhibitor
in both tumor and vasculature
(S/TK’s and RTK’s)

A

sorafenib

54
Q

kinases included for inhibition by sorafenib

A 
VEGFR-2
VEGFR-3
PDGFR-beta
KIT-RTK
FMS-like tyrosine kinase3
RET
55
Q

hand food skin reaction

A

sorafenib

56
Q

side effects of sorafenib

A

hand-foot syndrome

57
Q

kinases inhibited byt sunitinib

*mutli-kinase inhibitor

A 
PDGFRbeta
VEGFR1
VEGFR2
FLT3
KIT
CSR-1R
RET
58
Q

side effects of sunitinib

A

thrombocytopenia
bleeding
QT prolong
GI perforation

59
Q

moa for traszutumab

A

her2/neu antibody-causes her2 downregulation-p27 (CDKI) then accumulates-cell cycle arrest
*also inhibits HERS cleavage/shedding mediated by MMP’s

60
Q

side effects of trastuzumab

A

LVEF dysfunction
cardiomyopathy
anaphylaxis, angioedema, pulmonary toxcicity (worse with intrinsic lung disease)

Gastrointestinal (9 decks)

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