Cancer

Question 1

What are the charcteristics of cancer cells?

Answer 1

1. Uncontrolled cellular growth
2. Ability to invade adjacent structures and/or travel to distant areas
3. Incapable of physiological functions of the mature tissue of origin
4. Altered protein, enzymes systems, membrane characteristics and cytogenetics

Question 2

TMN staging

Answer 2

• TMN staging for solid tumors
  
  • Tumor
  • Nodal status
  • Metastasis

Question 3

What does adjuvant chemotherapy mean? neoadjuvant chemotherapy?

Answer 3

adjuvant chemotherapy- giving chemo after surgery to reduce the risk of local and systemic recurrence

neoadjuvant chemotherapy- giving chemo prior to surgical intervention to reduce tumor size and to remove micrometastases

Question 4

Cytotoxic chemotherapy

Answer 4

Toxic to all cells but specifically to those that are rapidly dividing cells

Question 5

Wht does doubling time mean? Gompertizian growth? Log-kill hypothesis?

Answer 5

• Doubling time- time it takes for tumor cell production to double in size
• Gompertizian growth- early growth is exponential, but as tumor gets bigger, growth slows due to decreased nutrients/ blood supply
• Log-kill hypothesis- a given dose of chemotherapy kills the same fraction of tumor cells regardless of the size of the tumor at the time of treatment

Question 6

Cytotoxic dosing? Dose intensity vs dose density?

Answer 6

Dosing- weight based dose, actual weight

Dose density- want to give same amount of chemo at scheduled time

Dose intensity- compress dosing time as short as possible (more chemo in short period of time)

Question 7

MOA of alklating agents? class side effects?

Answer 7

MOA- prevents cell division by cross-linking DNA strands

Myelosupression is dose limiting toxicity

ADR- nausea/ vomitting, myelosupression, alopecia, sterility/ infertility, secondary malignancies

Question 8

Cyclophosphamide/ Ifosfamide

Answer 8

Alklating agent

Hemorrhagic cystitis (bladder bleeding) due to acrolein metabolite

Give ifosfamide with Mesna (binds acrolein and excreted through the urine)

Question 9

Cisplatin

Answer 9

Alkylating Agents

Causes- nephrotoxicity, nausea/vomitting, ototxicity

Question 10

Oxaliplatin

Answer 10

Alkylating Agent

Neuropathies (exacerbated by cold temp)

Question 11

MOA of antimetabolite? class side effects?

Answer 11

MOA- compete with normal metabolite or falsely insert themselves for a metabolite normally incororated into DNA and RNA. Nucleotide synthesis. Works on S phase

ADR- myelosuppression, mucosities, mild N/V/D

Question 12

Methotrexate (MTX)

Answer 12

Antimetabolite

Renal toxicity (do not give with Cisplatin)

Leucovorin rescue for high doses

Question 13

Cytarabine

Answer 13

Antimetabolite

Cerebellar toxicity

Ocular irratation- use eye drops

Question 14

Cepecitabine

Answer 14

Antimetabolite

Hand foot syndrome

Question 15

MOA of antitumor antiboitics? anthracyclines? Bleomycin? Class ADR?

Answer 15

anthracyclines- block DNA and RNA transcription

Bleomycin- inhibits DNA synthesis (only cell cycle specific agent)

ADR- N/V, alopecia, stomatitis, myelsupression

Question 16

Bleomycin

Answer 16

Antitumor antiboitc- lung toxicity, pulmonary fibrosis, interstitial pneumonities

Question 17

Anthracyclines

Answer 17

Doxarubicin- cardiotoxic-CHF

Life time max dose

Dexrazoxane- used to reduce cardiotoxicity with anthracylibes

Question 18

Taxanes and vinca alkaloids MOA?

Answer 18

Taxanes- prevent microtubule disassembly

vinca alkaloids- prevent microtubule formation

Both workin M phase

Question 19

Docetaxel and Pactitaxel

Answer 19

• Docetaxel- neuropathies, peripheral edema, hypersensitive reactions (due to solubilizing agents)
• Pactitaxel- neuropathies, hypersensitive reactions (due to solubilizing agents)
  
  • premedicate with H1 and H2 blockers plus steroids

Question 20

Vincristin

Answer 20

Vinca alkaloid,

neuropathy, constipation DO NOT GIVE INTRATHECALLY (DEADLY)

Question 21

Irinotecan

Answer 21

Prevent DNA repair in cancer cells

Topoisomerase 1 inhibitor- diarrhea (cholinergic reaction)

Treat with atropine loperamide

Question 22

Etoposide

Answer 22

Prevent DNA repair in cancer cells

Topoisomerase II inhibitor- secondary cancer

Question 23

Asparaginase

Answer 23

Prevent DNA repair in cancer cells

Enzyme- natural product

Hypersensitivity reactions, hyperglycemia, pancreatitis, coagulopathy

Question 24

Marine based products- Eribulin and Trabectedin

Answer 24

• Eribulin-
  
  • sea sponge
  • microtubule like agent
  • toxicities- fatigue peripheral neuropathies, N/V
• Trabectedin
  
  • Sea squirt
  • alkylating agent
  • toxicities- fatigue, hand-foot mouth syndrome, N/V, hepatic damage

Question 25

Tamoxifen

Answer 25

SERM Pre/ Post menopausal women ADR- contracts, endometrial cancer, VTE, \*CYP269 active metabolitle\* **_INTERACTION WITH SSRI_**

Question 26

Letrozole, anatrozole, exemestane

Answer 26

Aromatase inhibitors- inhibits the conversion of androgens to estrogens Postmenopasual women (preferred) ADR- osteoporosis, factures, arthralgias

Question 27

Raloxifene

Answer 27

**_NOT USED FOR THE TREATMENT OF BREAST CANCER_** only for primary prevenetion

Question 28

Leuprolide, goserelin, triptorelin

Answer 28

**LHRH agonist**- inhibit the pituitary (through negative feedback) from relasing LH and FSH which stops stimulation of the testes to produce testoserone (can also be used in breast cancer with same MOA but stops stimuation of ovaries to produce estrogen) Initially there is a **tumor flare** before negative feedback loop works

Question 29

Degarelix

Answer 29

LHRH antagonist- directly inhibits pituatary from realeasing LH and FSH

Question 30

Bicalutamide, flutamide, nilutamide, enzalutamide, apalutamide, abiraterone

Answer 30

Anti- androgen- blocks androgen recepotors only ## Footnote **Only for prostate cancer**

Question 31

MOA of targeted therapy? Monoclonal antibodies and molecularly targeted therapy? Class ADR?

Answer 31

**MOA**- prevent tumor cells from entering cell cycle or target signals that trigger cancer growth, metastasis and immortaility **Monoclonal antibodies**- antibodies that match an antigen on the cencer cell surface **molecularly targeted therapy**- block signaling inside the cell ADR- fatigie, hair thining, N/V, myelosupression, **hair dipigmentation**, dysphonia, hypothyroidism **QT prolongation**- nitotinib, pazopanib, ponatinib

Question 32

VEGF(R) inhibitor- bevacizumab, sunitinab, pazapanib, regorafenib

Answer 32

Inhibit formation of new blood vessles ADR- **hypertension**, proteinuria, **bleeding, impaired wound healing**

Question 33

EGFR inhibitors- erlotinib, gefitinib, alectinib, cetuximab, panitumumab

Answer 33

**Acneiform rash** Rash indicates the treatment is working **Treatment**- tetracyclines, topical antiboitics

Question 34

mTOR inhibitors- everolimus, sirolimus, temsirolimus

Answer 34

ADR- hyperglycemia, dyslipidemia, mucosal sensitivity, **Ulcers** DDI- 3A4 inhibitor **Treat ulcers with- dexamethasone s/s**

Question 35

BCR-ABL mutation

Answer 35

Periorbital edema CYP 3A4 substates

Question 36

CD20- rituximab, ofatumumab, obinutuzumab

Answer 36

Targeted B cell therapy for lymphoma, and leukemia Infusion reactions, myelosupression

Question 37

HER2 inhibition- Trastuzmab, pertuzumab

Answer 37

cardiotoxicity do not give same time as anthyrcyclines

Question 38

HER2 inhbition- lapatinib

Answer 38

ADR- Fatigue, diarrhea, **hand-foot syndrome,** drug interactions with strong 3A4 inducers/ inhibitors