Cancer drugs

Question 1

List the nitrogen mustards

Answer 1

1. Cyclophosphamide (Prodrug! Must be metabolized in liver)

2. Ifosfamide

Question 2

What is the nitrogen mustard’s MOA?

Answer 2

Alkylate DNA by binding to N7 of guanine

Question 3

Cyclophosphamide ADE?

Answer 3

Pulmonary fibrosis, hemorrhagic cystitis

Question 4

Ifosfamide ADE?

Answer 4

CNS, infection. No pulmonary fibrosis and less renal tox than cyclophosphamide

Question 5

Adjuvant therapy with the nitrogen mustards?

Answer 5

Mesna

Question 6

List the platinum drugs

Answer 6

1. Cisplatin

2. Carboplatin

Question 7

MOA of platinum drugs?

Answer 7

Bind N7 of guanine on DNA and produce intra-strand cross links that inhibit replication

Question 8

Cisplatin/Carboplatin ADE?

Answer 8

Renal and oto toxicity

THE DOSE LIMITING FACTOR FOR THE PLATINUM DRUGS IS NEPHROTOXICITY!

Question 9

Cisplatin’s adjuvant therapy?

Answer 9

Amifostine

Question 10

Folic acid analogs?

Answer 10

1. Methotrexate

2. Pemetrexed

Question 11

MOA of folic acid analogs?

Answer 11

Inhibit dihydrofolate reductase thus inhibiting DNA synthesis

Question 12

Folic acid analogs have a ton of ADE’s. What might they do to the lungs?

Answer 12

Pulmonary fibrosis

Question 13

Adjuvant therapy for methotrexate?

Answer 13

Leucovorin

Question 14

List the pyrimadine analogs

Answer 14

Gemcitabine

Question 15

MOA of Gemcitabine?

Answer 15

Pyrimadine analoge (cystine) –> inhibits DNA synthesis –> apoptosis

Question 16

ADE of Gemcitabine?

Answer 16

Hand-foot syndrome (blisters on palms of hands and soles of feet)

Question 17

Camptothecin analogs?

Answer 17

1. Irinotecan

2. Topotecan

Question 18

MOA of camptothecin analogs?

Answer 18

Stabilize topoisomerase I –> DNA breaks

Question 19

ADE of camptothecin analogs? (Hint: GG)

Answer 19

GI, contraindicated in Gilbert’s syndrome (high bilirubin), AChE inhibition (irinotecan only)

Question 20

Vinca alkaloids?

Answer 20

Vincristine, Vinorelbine

Question 21

MOA of vinca alkaloids?

Answer 21

Bind beta-tubulin of microtubules –> prevent microtubule assembly

Question 22

ADE of vinca alkaloids?

Answer 22

Peripheral neuropathy, FATAL with intrathecal (CSF) administration, extravasation

Question 23

What is the podophyllotoxin?

Answer 23

Etoposide

Question 24

Etoposide’s MOA?

Answer 24

Form complex with topoisomerase II & DNA

Question 25

ADE of etoposide?

Answer 25

Leukopenia- dose limiting. Also infection, bleeding

Question 26

What is the taxane?

Answer 26

Paclitaxel

Question 27

MOA of paclitaxel?

Answer 27

Bind beta tubulin to prevent microtubule disassembly (opposite of vinca alkaloids)

Question 28

ADE of paclitaxel?

Answer 28

Peripheral neuropathy, extravasation

Question 29

What is the anthracycline?

Answer 29

Doxorubicin

Question 30

Doxorubicin's MOA?

Answer 30

Intercalate with DNA, complex with topoisomerase II/DNA, and generate free radicals from semiquinone

Question 31

ADE of doxorubicin?

Answer 31

Heart disease

Question 32

Adjuvant therapy of doxorubicin?

Answer 32

Dexroxazone

Question 33

VEGF blocker?

Answer 33

Bevaciuzmab

Question 34

MOA of bevacizumab?

Answer 34

Antibody that binds VEGF --> prevents angiogenesis for tumor growth

Question 35

ADE of bevacizumab?

Answer 35

Hemorrhage (esp with squamous NSCLC)

Question 36

TKI's?

Answer 36

Erlotinib, Crizotinib

Question 37

MOA erlotinib?

Answer 37

EGFR inhibitor (and HER-1)

Question 38

ADE of erlotinib?

Answer 38

Interstitial lung disease, bleeding, BAD FACIAL RASH!

Question 39

MOA of crizotinib?

Answer 39

EML4-ALK inhibitor

Question 40

ADE of crizotinib?

Answer 40

GI, rash, edema

Question 41

How do you treat NSCLC?

Answer 41

First surgery then chemo- Cisplatin and Paclitaxel.. and maybe Erlotinib and maybe Bevacizumab

Question 42

How do you treat adenocarcinoma?

Answer 42

First surgery then chemo. Genetic testing is very important. Use Bevacizumab, Crizotinib, Erlotinib

Question 43

How to treat SCLC?

Answer 43

No surgery. Just chemo and radiation. Use Etoposide +cysplatin or carboplatin

Question 44

Is KRAS more common in smokers or non-smokers?

Answer 44

Smokers