Whites Lectures Flashcards
what drug is the gold standard for leukemia?
Gleveec/Imatinib
when is chemo most affective?
during the GROWTH phase of a tumor
chemo kills via what kinetics?
1st order
major thing that allows for cancer drug resistance
- drug efflux
- multi drug resistance protein (MDR) -> MDR1, MDRP1, BCRP -> eliminate hydrophobic compounds by pumping out drugs
cyclophosphamide side effects
BLADDER toxicity
Doxorubicin side effects
CARDIOTOXICITY
Bleomycin side effects
PULMONARY fibrosis
know the 3 charts/diagrams
1st powerpoint
ABVD
A - doxorubicin
B - bleomycin
V - vinblastine
D - dacarbazine
for HODGKINS lymphoma
CHOP
C - cyclophosphamide
H - hydroxydaunorubicin
O - vincristine
P - prednisone
for NON-HODGKINS lymphoma
FOLFOX
FO - fluorouracil
L - leucovorin
OX - oxiplatin
for COLORECTAL cancer
TIP
T - paclitaxel
I - ifosfamide
P - platinum agent cisplatin
for TESTICULAR cancer
MOA of the alkylating agents and platinum compounds
- nucleophilic attack of the unstable AZIRIDINE ring by electron donor -> directly damage DNA
- nitrogen mustard moiety covalently binds
cyclophosphamide (alkylating agent)
- requires activation of CYP450 enzyme
- can have HEMORRHAGIC CYSTS & BLADDER TOXICITY/CANCER
platinum compounds indications
-non small cell lung cancer (NSLC) and small cell lung cancer
platinum compound that is 1st line treatment in COLORECTAL CANCER?
Oxaliplatin + 5FU & Leucovorin
-be careful with peripheral neuropathy
what platinum compound is for testicular cancer?
-Cisplatin + TIP
anthracycline antibiotics that cause CARDIOTOXICITY
Daunorubicin and Doxorubicin
-chronic -> dilated cardiomyopathy
antibiotic that can cause PULMONARY TOXICITY
Bleomycin
-treat both Hodgkins and SCC of skin/cervix/uvula
antibiotic used to treat rhabdomyosarcoma & Wilms tumor & Ewing sarcoma in children
Dacitnomycin (Actinomycin D)
folate analogue (“-trexate”) PK
if given NSAIDs in RENAL failure -> delay drug excretion -> SEVERE myelosuppression
-prolonged myelosuppression w/ compromised renal function
methotrexate MOA
inhibit DIHYDROFOLATE REDUCTASE in 2 spots -> prevent conversion of DHF to THF
-LEUCOVORIN RESCUE to prevent side effects
what does methotrexate treat?
ALL
-also 1st line treatment in RA
pyrimidine analogues side effects
HAND-FOOT syndrome from Capecitabine use
chest pain w/ ischemia from CA vasospasm w/ 5-FU use
cytarabine (cytidine/pyrimidine analogue)
treat AML
side effect -> chemical CONJUNCTIVITIS
6MP & 6TG (purine analogues)
- treat human leukemias -> ALL
- 6MP + azathioprine predispose to opportunistic infections
- 6MP -> cause AML w/ long term use for Chrohn’s disease
Vinca alkaloid side effects
-NEUROTOXIC -> peripheral neuropathy
Vinblastine (vinca alkaloid)
treat TESTICULAR cancer
-also Hodgkins lymphoma
Vincristine
treat peds w/ leukemia, lymphoma, WILMS tumor, neuroblastoma, RHABDOMYOSARCOM
-inject into CSF -> FATAL COMA & SEIZURES
major side effects of Taxanes
HYPERSENSITIVITY w/ paclitaxel infusion
FLUID RETENTION w/ docetaxel infusion
Topotecan side effects
NEUTROPENIA w/ or w/o thrombocytopenia
Irinotecan side effects
DELAYED DIARRHEA w/ or w/o neutropenia
-give Loperamide to prevent this
main side effects of corticosteroids
glucose intolerance, immunosuppression, osteoporosis, psychosis
aromatase enzyme
converts androgens into estrogen hormones
estrogen receptors
- SERMs -> Tomoxifen
- SERDs -> FULVESTRANT** -> degrades the estrogen receptor on ER+/PR+ breast cancer
side effects of aromatase inhibitors
estrogen depletion -> hot flashes, vaginal bleeding/discharge, increase risk of fracture
Anti-androgens (“-tamides”)
treat PROSTATE cancer
EGFR drugs that treat NSCLC with EGFR mutations
Erlotinib and Afatinib
-acneiform RASH with Erlotinib**
Cetuximab
- bind to EGFR/ERBB1 receptors
- treat COLON cancer and HNSCC
- acneiform rash like Erlotinib
Trastuzamab
- bind to HER2/ERBB2
- treat HER2+ BREAST/gastric cancer
- worry about HEART FAILURE (cardiotoxicity)
Vismodegib
- blocks Hedgehog signaling path
- treat Basal cell carcinoma (BCC)
Vemurafenib
- BRAF inhibitor (V600E)
- treat metastatic MELANOMA
2 drugs that are BTK inhibitors & treat MCL, WM, CLL, SLL
Ibrutinib and Acalabrutinib
Gleevec (imatinib)
BCR-ABL inhibitor (philadelphia chromosome t9;22)
treat CML** & mucosal melanoma
may have fluid retention
Crizotinib
- ALK inhibitor
- treat NSCLC w/ ALK or ROS1 gene rearrangements
- worry about QT prolongation & BRADYCARDIA**
Rapamycin
- mTORC1 inhibitor
- treat RENAL cancer
Bortezomib
- PROTEASOME inhibitor
- 1st line treatment of Multiple Myeloma (MM)** & relapsed mantle cell lymphoma (MCL)
worry about peripheral neuropathy
most common NSCLC
Adenocarcinoma
most common actionable mutation in lung cancer
EGFR mutations
Pembrolizumab
- inhibits PD-1 receptor on T cells
- treat MELANOMA and NSCLC
Ipilimumab
- inhibits CTLA-4
- treat MELANOMA and RENAL CELL carcinoma (in combo w/ Nivolumab)
