416 Targeted Cancer Therapies

Question 1

Toxicities of traditional chemotherapy

Answer 1

Bone marrow suppression 
N/V
Peripheral neuropathy 
Diarrhea
Stomatitis 
Alopecia 
Nephrotoxicity 
Fatigue

Question 2

Toxicities of targeted therapy

Answer 2

Hand foot syndrome
Skin rash 
Edema 
Hypothyroidism 
Nausea
Diarrhea
QT prolongation 
Skin discoloration

Question 3

MOA of tyrosine kinase inhibitors

Answer 3

Tyrosine kinase phosphorylates tyrosine
TK receptors bind with other substances to trigger a series of reactions
-block TK receptors to stop cascade

Question 4

Tyrosine kinase inhibitors

Answer 4

EGFR
HER2/Neu
c-KIT
Bcr-abl 
Platelet derived growth factor

Question 5

Bcr-abl TK inhibitors*

Answer 5

Imatinib (Gleevec)*
Dasatinib 
Nilotinib 
Bosutinib 
Ponatinib

Question 6

EGFR TK inhibitors*

Answer 6

Erlotinib (Tarceva)
Geritinib
Afatanib
Osimertinib

Question 7

Common SE of EGFR TKIs

Answer 7

Rash***
Diarrhea
Elevated LFTs

Question 8

ALK inhibitors

Answer 8

Cirzotinib
Ceritinib
Alectinib

Question 9

MOA and indication for ALK’s

Answer 9

MOA: EML4-ALK fusion
Indication: ALK + NSCLC

Question 10

HER2/Neu inhibitor*

Answer 10

Lapatinib (Tykerb)*

Question 11

Lapatinib toxicities

Answer 11

Hand foot syndrome 
GI toxicity 
Interstitial lung disease
LVEF decreases 
QT prolongation 
CYP3A4

Question 12

BRAF inhibitors

Answer 12

Vemurafenib
Trametinib
Dabrafenib
Cobimetinib

Question 13

Indication for BRAF inhibitors

Answer 13

Malignant melanoma (V600E mutation of BRAF gene)

Question 14

Bruton’s TKIs

Answer 14

Ibrutinib

Question 15

Toxicities of Ibrutinib

Answer 15

Bleeding 
Neutropenia 
Increase SCr 
Transient increase in lymphocytes***
Reduce dose if given with CYP3A4 inhibitor

Question 16

Phosphinositide 3-kinase inhibitor

Answer 16

Idealisib

Question 17

Toxicities of Idelalisib

Answer 17

Hepatotoxicity 
Diarrhea 
Colitis 
Intestinal perforation 
Pneumonitis

Question 18

Multi-kinase inhibitors for renal cell carcinomas

Answer 18

Sunitinib malate (VEGF, platelet derived GF) 
Sorafenib (VEGF, platelet derived GF) 
Pazopanib (VEGF, PDGFR, c-KIT)
Axitinib (VEGF, PDGFR, c-KIT)
Regorafenib (VEGF, PDGFR, c-KIT, BRAF)

Question 19

Toxicities of Regorafenib

Answer 19

Hand foot skin reaction
Hypertension
Hepatotoxicity (BBW)
Pain and muscle stiffness

Question 20

Cyclin-dependent kinases (CDK4 and CDK6 inhibitors)

Answer 20

Palbociclib

Ribociclib

Question 21

Nomenclature for monoclonal antibodies:

• o
• xi
• zu
• u

Answer 21

• o = mouse (100% mouse)
• xi = chimeric (34% mouse)
• zu = humanized (10% mouse)
• u = human (100% human)

Question 22

Toxicities of monoclonal antibodies

Answer 22

Acute allergic reaction

-NEED code cart available

Question 23

CD20 targeted antibody agents*

Answer 23

Rituximab (Rituxin)*
Ofatumuab
Obinutuzumab

Question 24

Toxicities of Rituximab

Answer 24

Infusion related reaction
TLS*
Reactivation of Hep B*
CMV

Question 25

Toxicities of Ofatumumab

Answer 25

``` Severe infusion reactions Prolonged thrombocytopenia and neutropenia Reactivation of Hep B Intestinal obstruction Severe infection ```

Question 26

Toxicities of Obinutuzumab

Answer 26

``` PML Reactivation of Hep B Prolonged neutropenia Infusion reaction TLS ```

Question 27

Anti-VEGF monoclonal antibody agents*

Answer 27

Bevacizumab (Avastin)* | Ramucirumab

Question 28

Toxicities of Bevacizumab

Answer 28

``` GI perforation Delayed wound healing*** Thrombotic events HTN Bleeding*** Proteinuria ```

Question 29

Toxicities of Ramucirumab

Answer 29

HTN (monotherapy) Neutropenia (combo) BBW: hemorrhage

Question 30

CD52 targeted antibody agents

Answer 30

Alemtuzumab

Question 31

Toxicities of Alemtuzumab

Answer 31

PROLONGED immunosuppression*** | Infusion related reactions

Question 32

EGFR targeted monoclonal antibody agents

Answer 32

Cetuximab Panitumumab Necitumumab

Question 33

Toxicities of Cetuximab and Panitumumab

Answer 33

Colon cancer (wild type KRAS) Skin rash*** Infusion related reactions

Question 34

Toxicities of Necitumumab

Answer 34

BBW: cardiopulmonary arrest Hypomagnesemia Dermatitis skin rash

Question 35

Anti-HER2/Neu monoclonal antibodies*

Answer 35

Trastuzumab (Herceptin)* Pertuxumab Ado-trastuzumab emtansine

Question 36

Toxicities of Trastuzumab

Answer 36

DLT is cardiovascular*** Infusion reaction Rash Myelosuppression

Question 37

Toxicities of Pertuzumab

Answer 37

``` Left ventricular dysfunction Infusion reaction Rash Myelosuppression Pregnancy ```

Question 38

PD-1 checkpoint inhibitors*

Answer 38

Ipilimumab Nivolumab (Opdivo)* Pembrolizumab (Keytruda)* Atezolizumab

Question 39

Toxicities of PD-1 inhibitors

Answer 39

``` Autoimmune mediated SE: Interstitial lung disease/pneumonitis Colitis Hepatitis Nephritis Endocrinopathies ```

Question 40

BiTE agent

Answer 40

Blinatumomab