Chemo

Question 1

2 main risk factors for chemo related cardio tox?

Answer 1

Age

Cumulative anthracycline dose

Question 2

Cockroft gault equation

Answer 2

= (140-age)x weight) / 72x creat

Then multiply by 0.85 if female

Question 3

Afatinib

Answer 3

Anti EGFR TKI NSCLC metastatic (NICE approved)

Question 4

Aflibercept

Answer 4

Fake receptor with a antibody backbone
Binds VEGFA VEGFB and placental GF with a higher affinity than their endogenous receptors
Improves PFS and OS in mCRC when combine with folfiri 2nd line in patients who had folfox +- Bev in first line

Question 5

Alemtuzumab

Answer 5

Aka CAMPATH
Anti CD52 monoclonal antibody
CD52 is on both T cells and B cells
Used for CLL in second line

Question 6

Bevacizumab how does it work?

Answer 6

Binds VEGF, mostly VEGFA stopping it activating the VEGF receptor

Question 7

Bortezemib (Velcade)

Answer 7

Small molecular proteasome inhibitor
Cell can’t clear toxic misfolded proteins
Suppresses NFkappaB (which normally promotes cell proliferation and survival)

Question 8

Bosutinib

Answer 8

BCR-ABL inhibitor
CML in 3rd line
Is available on the CDF!

Question 9

Treatment of CLL lines 1,2 and 3

Answer 9

First Imatinib
2nd nilotinib or dasatinib
3rd Bosutinib

Question 10

Cabozantinib

Answer 10

MET and VEGFR2 inhibitor
MET unregulated in cells resistant to Antiangiogenics
Advanced medullary thyroid cancer and RCC

Question 11

What kind of antibody is cetuximab?

Answer 11

Chimeric monoclonal antibody

Question 12

Crizotinib

Answer 12

ALK and MET inhibitor

4-5% of NSCLC and majority of anaplastic large cell lymphomas

Question 13

Dabrafenib

Answer 13

BRAF inhibitor inhibits V600E BRAF

BRAF Is mutated in 50% of melanomas

Question 14

Erlotinib

Answer 14

Anti EGFR TKI

NSCLC

Question 15

Everolimus

Answer 15

MTOR inhibitor

Question 16

What is MTOR? What does MTOR inhibition do?

Answer 16

Intracellular serine-threonine kinase
Is downstream of the PI3K/AKT pathways which is often overactive in malignancy
Inhibiting MTOR lowers VEGF levels

Question 17

Vismodeginib

Answer 17

Hedgehog pathway inhibitor - hedgehog pathway is overactive in BCC

Question 18

Drug associated with Lhermitte’s syndrome? Tingling when bend neck

Answer 18

Cisplatin

Question 19

Which protein do Taxanes stimulate the expression of in order to trigger apoptosis?

Answer 19

Bim

Bcl related pathway

Question 20

How does Imatinib work?

Answer 20

Blocks the activity of the Bcr/abl fusion gene, restoring Bim and Bad apoptotic function

Question 21

What are type 1 and 2 programmed cell death?

Answer 21

Type 1 apoptosis

Type 2 autophagy - MTOR PI3K/AKT regulated

Question 22

What is the first stage in angiogenesis?

Answer 22

Localised degradation of the basement membrane of the parent venue

Question 23

Does tamoxifen increase risk of endometrial cancer?

Answer 23

Yes

Question 24

Does raloxefine increase risk of endometrial cancer?

Answer 24

No- it’s still an agonist in the uterus but is not as active as tamoxifen in the uterus

Question 25

What vascular complication is raloxefine associated with?

Answer 25

Stroke | It does not increase risk of coronary artery disease

Question 26

In which group does bisphosphonate use reduce the recurrence rate of breast cancer?

Answer 26

Post menopausal women

Question 27

Monoclonal ab which causes both a early and delayed neutropenia

Answer 27

Rituximab

Question 28

Which lymphoma has germinal B and non germinal B subtypes with an impact on prognosis? Which is worse?

Answer 28

DLBCL can be divided into germinal B and non germinal B Either gene profiling or Hans criteria Non germinal centre has a worse prognosis only 30% 5 years survival

Question 29

What are two advantages denosumab has over bisphosphonates?

Answer 29

Less nephrotoxic | Longer time to first skeletal event

Question 30

% risk cardiomyopathy with doxorubicin?

Answer 30

3%

Question 31

Mechanism of action of Erubulin?

Answer 31

Microtubule inhibitor

Question 32

How many more times potent than hydrocortisone is: Pred Dex

Answer 32

4: 1 pred 25: 1 dex

Question 33

Ibrutinib use

Answer 33

Mantle cell lymphoma

Question 34

Afanatinib use

Answer 34

NSCLC

Question 35

Trametinib melanoma mechanism

Answer 35

MEK inhibitor melanoma

Question 36

Target of Imatinib

Answer 36

BCR/ABL

Question 37

When does the interstitial lung disease of TKIs usually present?

Answer 37

Within 1 month of starting

Question 38

Should Erlotinib be taken on full or empty stomach?

Answer 38

Empty stomach- if take with food absorb more and get more toxicity

Question 39

Which drug causes visual disturbances where when patient sees you walk they see a trail behind you?

Answer 39

Crizotinib (inhibits ALK and c met)

Question 40

What does carbamazepine do to pazopanib levels?

Answer 40

Carbamazepine induces CYP450 so will lower levels of pazopanib

Question 41

What does phenytoin do to pazopanib levels?

Answer 41

It induces CYP450 so levels of pazopanib will fall

Question 42

What does ketoconazole do to pazopanib levels?

Answer 42

It inhibits CYP450 so get higher levels of pazopanib don't clear it as much

Question 43

What is the T790M mutation associated with?

Answer 43

Acquired resistance to anti EGFR TKIs

Question 44

What is the T315I mutation associated with

Answer 44

Acquired resistance to BCR-ABL TKIs

Question 45

Which chemo drug is affected by levels of TPMT deficiency?

Answer 45

6 mercaptopurine | Deficiency of TPMT get higher haematological toxicity which can be fatal

Question 46

Which drug metabolism is UGT1A1 associated with?

Answer 46

Irinotecan | Polymorphisms leading to reduced level of this enzyme lead to higher rates of Irinotecan toxicity

Question 47

When do you need to give mesna? (With which drugs?)

Answer 47

Everyone having ifosfamide | Only with high dose cyclophosphamide

Question 48

How does mesna prevent haemorrhagic cystitis?

Answer 48

Provides a S-H group which binds to toxic metabolites of ifosfamide and cyclophosphamide

Question 49

How do you know how much mesna to give?

Answer 49

60% of the dose of the alkylating agent in divided doses | every 4 hours

Question 50

What drug do you have to give b12 and folate to the patient before you start it and why? When do you give it?

Answer 50

Pemetrexed Start it 1 week before chemo and continue for 21 days after finish Minimises toxicities

Question 51

How can acute doxorubicin toxicity be minimised? Is it reversible or irreversible?

Answer 51

It is reversible | Can minimise by slowing down infusion rates

Question 52

What is the P-glycoprotein pump on cells?

Answer 52

It is a multi drug resistance efflux pump

Question 53

Which route of administration of Bortezemib minimises peripheral neuropathy?

Answer 53

SC Administration (it can be given IV or SC)

Question 54

Mechanism of action of Abiraterone?

Answer 54

Irreversible inhibitor of CYP17

Question 55

What is ofatumumab used for?

Answer 55

Refractory CLL | It's anti CD20 like rituximab