Chemotherapy V

Question 1

Tyrosine Kinase Inhibitors

Small molecule (2)
Monoclonal Antibodies (3)

Answer 1

Small molecule: Imatinib, Erlotinib

Monoclonal Ab: Trastuzumab, cetuximab, bevacizumab

Question 2

Imatinib MOA

Answer 2

Binds and blocks BCR-ABL

Question 3

Where is Imatinib metabolized

Answer 3

LIVER- avoid coadministration with inducers/inhibitors of CYP3A4

Question 4

Imatinib SE

Answer 4

SUPERFICIAL EDEMA
nausea
MUSCLE CRAMPS
Abdominal pain
Rash
Diarrhea
Anemia
Neutropenia, thrombocytopenia

Question 5

What should you monitor in patients taking Imatinib?

Answer 5

TSH level

Increases clearance of thyroid hormone

Question 6

Imatinib Indications

Answer 6

CML

GI stromal tumors

Question 7

Other drugs like Imatinib?

Answer 7

Dasatanib

Nilotinib

Question 8

Cetuximab MOA

Answer 8

Monoclonal antibody to EGFR (transmembrane TK)

Sensitizes cell to chemo and radiation

Question 9

Cetuximab Indication

Answer 9

Metastatic lung, colon cancer

Head, neck cancers (+radiation)

Question 10

Cetuximab SE

Answer 10

Rash
Diarrhea
HYPOMAGNESEMIA
Infusion reaction
Skin toxicity
Trichomegaly

Question 11

What must you treat patients taking Cetuximab with?

Answer 11

IV therapy for hypomagnesemia

Question 12

What type of mutational analysis should you perform on a patient with COLORECTAL cancer to determine if they will respond to Cetuximab?

Answer 12

KRAS
NRAS

Wildtype: respond to Cetuximab
Mutated: no response

Question 13

Erlotinib MOA

Answer 13

Small molecule inhibitor of the TK associated with EGFR

Question 14

How is erlotinib metabolized?

Answer 14

CYP3A4

Question 15

Erlotinib SE

Answer 15

Rash, nausea, anorexia, fatigue, paronchia (nailbed pain)

Question 16

Perform mutational analysis on non-small cell lung cancers for ____ activating mutations

Answer 16

EGFR

Question 17

Bevacizumab

Answer 17

Monoclonal Ab, binds to VEGF, prevents signaling for new blood vessel formation

Question 18

Bevacizumab Indication

Answer 18

Metastatic colorectal cancer
Metastatic lung cancer

*significant prolongation or survival!

Question 19

Bevacizumab SE

Answer 19

HTN, proteinuria, arterial clots, colon perf, bleeding, reversible posterior leukoencephalopathy syndrome, infusion reactions

Question 20

Small molecule VEGF receptor TK inhibitors

Answer 20

Sorafenib, Pazopanib, Sunitinib

Question 21

Small molecule VEGF receptor TK inhibitors metabolism

Answer 21

CYP3A4

Question 22

Small molecule VEGF receptor TK inhibitors SE

Answer 22

Similar to bevacizumab +
Hand foot syndrome
Congestive heart failure

Question 23

Small molecule VEGF receptor TK inhibitors Indication

Answer 23

All 3 - renal cell cancer (clear cell)

Sunitnib- pancreatic neuroendocrine cancer, GI stromal tumor

Sorafenib- unresectable hepatocellular cancer

Question 24

Trastuzumab MOA

Answer 24

Monoclonal Ab to extracellular domain of EGFR receptor, HER-2 Neu

Question 25

Trastuzumab SE

Answer 25

CARDIAC TOXICITY fever, n/v/d, cough, HA, SOB, back pain, rash, myalgia

Question 26

The greatest risk of cardiac toxicity is in patients taking Trastuzumab and this other drug

Answer 26

Anthrcycline

Question 27

What should you monitor in a patient taking Trastuzumab?

Answer 27

Cardiac ejection fraction

Question 28

Trastuzumab Indication

Answer 28

``` Breast cancer (Her2/neu+) Stomach and gastroesophageal junction cancer (Her2/neu+) ```

Question 29

When should you use trastuzumab?

Answer 29

when Her2/neu is overexpressed

Question 30

Crizotinib Indication

Answer 30

Pts with ALK-anaplastic lympoma kinase rearrangements in adenocarcinoma of lung

Question 31

Vemurafenib Indication

Answer 31

Melanoma with V600E mutation in BRAF (activating mutation)

Question 32

L-asparaginase MOA

Answer 32

Depletes asparagine pools rapidly Leukemia cells lack asparagine synthetase and cannot synthesize asparagine decrease in protein synthesis

Question 33

L-asparaginase SE

Answer 33

CLOTTING (decreased antithrombin 3)

Question 34

L-asparaginase Indication

Answer 34

Acute lymphoblastic leukemia

Question 35

Hydroxyurea MOA

Answer 35

Inhibits DNA synthesis by inhibiting ribonucleotide reductase

Question 36

Hydroxyurea Indication

Answer 36

Acute myelogenous leukemia

Question 37

All-trans retinoic acid MOA

Answer 37

Induces terminal differentiation of leukemic cells

Question 38

All-trans retinoic acid Indication

Answer 38

Acute promyelocytic leukemia (APL)

Question 39

Arsenic Trioxide Indication

Answer 39

Treatment of relapsed APL

Question 40

Arsenic Trioxide SE

Answer 40

QT prolongation