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BCOP- Joey > Drugs > Flashcards

Drugs Flashcards

1
Q

Albumin-bound sirolimus (Fyarro)

A

Sarcoma

Perivascular epithelioid cell tumors

Dose reduce for hepatic impairment

DLT: mucositis/stomatitis

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2
Q

Atezolizumab (tecentriq)

A

Sarcoma, bladder (first-cisplatin ineligible PD-L1 cps >5% or second line), melanoma, NSCLC PD-L1 >/=1%, SCLC, HCC (with bev)

Alveolar soft part sarcoma

Anti-PDL-1 antibody

ADR: severe life threatening immune mediated rxn, infusion rxn-premeditate

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3
Q

Avapritinib (Ayvakit)

A

Sarcoma-NEOADJUVANT if resectable! Also for for metastatic unresectable GISTwith PDGFRA exon 18 mutation including D842V

Tyrosine kinase inhibitor that blocks PDGFRA and KIT D842V

-Cyp3A4 interactions
-electrolytes abnormalities with diarrhea
-take on empty stomach
-cognitive impairment: memory impairment and confusion
-brain bleeds, seizures
-300 mg daily on empty stomach

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4
Q

Dacarbazine (DTIC)

A

Sarcoma, HL

Alkylating agent - triazine

-renal and hepatic dose adjustment
-flu-like syndrome
-DTI: myelosuppression

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5
Q

Dactinomycin (actinomycin D, cosmegen)

A

Sarcoma

Antineoplastic ABX

-Max: 2500 mcg
-hepatic dose adjustment
-extravasation
DLT: myelosuppression

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6
Q

Denosumab (Xgeva)

A

Sarcoma

Giant cell tumor of bone: 120 mg q4weeks- first week give additional 120 mg on d8 and d15

-hypocalcemia, hypophosphatemia

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7
Q

Doxorubicin (adriamycin)

A

Sarcoma, bladder, uterine sarcoma, endometrial, breast, AML, ALL, DLBCL, BL, HL, MM, thyroid, SCLC

Anthracycline, topo-2 inhibitor (cell cycle specific)

-Lifetime dose: 450 mg/m2
-emetogenicity
-high: >60mg/m2
-moderate: <60mg/m2
-LVEF before/during/after tx
-radiation recall skin rxn
-extravasation-WORST VESICANT!
-dose reduce for hepatic impairment-for bili 1.2 or more
-can stain urine and contact lenses for 24 hours after last dose
-DLT: myelosuppression, cardiomyopathy

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8
Q

Pegylated Doxorubicin liposomal (doxil)

A

Kaposi sarcoma, recurrent gyn CA, breast

-20 mg/m2 q21d
-LVEF prior to use
-monitor hepatic function
-DLT: hand foot syndrome- more than conventional!
-do not sub for conventional on mg per mg basis
-less cardio toxicity than conventional

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9
Q

Eribulin (halaven)

A

Sarcoma, breast cancer

Microtubule inhibitor

Breast: metastatic after 2+ lines of therapy including anthr and taxane
-soft tissue sarcoma- refractory to 2+ regimens

-renal and hepatic adjustment
-QTc
-peripheral neuropathy
-electrolyte abnormalities
-DLT: myelosuppression

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10
Q

Entrectinib (Rozlytrek)

A

TRK inhibitor, also inhibits ROS1 and ALK

NTRk gene fusion positive: sarcoma(GIST), met breast, NSCLC (NTRK or ROS1), recurrent ovarian, thyroid, pancreatic, gastric/esophageal (rare), colorectal (NRTK +)

-QTc, cardiac ADRs
-better CNS penetration than larotrectenib so better for CNS tumors
-increased CNS toxicity
-Edema
-pain withdraw
-hematologic toxicity
-capsules only

Adults and peds 12+ y/o (larotrectinib doesn’t have age minimum)

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11
Q

Gemcitabine (gemzar)

A

Sarcoma, non-muscle invasive bladder ca, ovarian, cervical , breast, R/R NHL, HL, head/neck, NSCLC, SCLC, biliary tract, pancreatic

Antimetabolite (pyramidine analog),

-Fixed dose infused over 10 mg/m2/minute- (sarcoma) increase in retention but more toxicity so we don’t use it!- although it is used, at least with sarcomas

-DLT: myelosuppression, thrombocytopenia!
-rarely- TTP, hepatic uremic syndrome
-flu-like symptoms

Cell cycle specific (mostly s)

“The cytarabine of solid tumors”

Usually over 30 mins- fast phosphylation and cellular uptake

Hepatotoxicity- hematologically safe in hepatic impairment but may cause added hepatotoxicity

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12
Q

Ifosfamide (ifex)

A

Sarcoma, testicular, uterine sarcoma, R/R NHL, HL

Alkylating agent- nitrogen mustard

-DLT: hemorrhagic cystitis
-hydrate 2-3L/Day, IVF NS not D5W!!
-ALWAYS WITH mesna: 60-100% dose of ifos, cont 12-24 hr after ifos
-neurotoxicity- d/t chloracetaldehyde 2-48 hr after infusion- pretreat with albumin. STOP infusion if it happens and give methylene blue
-note: monitor electrolytes especially sodium to decrease risk of neurotoxicity (ifos can cause siadh)
-Avoid with aprepitant and fosaprepitant
-cardiotox at very high doses
-renal tubular acidosis- tx with sodium bicarb or sodium acetate based fluid

Cell cycle non-specific

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13
Q

Imatinib (gleevec)

A

Sarcoma, ALL, CML (1st line chronic phase), melanoma

BCR-ABL TKI- gen 1

-400 mg daily->inc to BID
-800 mg: KIT exon 9 mutation

With food and large glass of water

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14
Q

Larotrectinib (vitrakvi)

A

TRK inhibitor

Sarcoma-gist, breast cancer, recurrent ovarian, thyroid
TRK inhibitor, TKI, NSCLC, pancreatic, gastric/esophageal (rare), colorectal (NTRK+)

-CNS penetration
-hematologic toxicity
-pain withdraw
-capsules and oral solution

Adults AND pediatrics (note that for entrectinib must be 12+ y/o)

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15
Q

Methotrexate (MTX)

A

Sarcoma, CNS tumors, bladder, breast, AML, ALL, BL, DLBCL, CNS ppx (HD and IT), MCL (hyperCVAD)

Antimetabolite- pyramidine analog- cell cycle specific

-large VD- delayed clearance
-avoid in ascites, edema, pleural effusions
-nephrotoxicity- via crystallization-renal tubule necrosis (do urinary alkalinization and hydration)
-hepatotoxicity (bump in LFTs is normal and ok)
-mucositis-prevent w/ leucovorin
-myelosuppression- prevent w/ leucovorin
-neurotoxicity 10-14 d after, seizures/stroke like symptoms
-DI: bactrim (HOLD FOR PJP PPX UNTIL MTX CLEARED, cipro, thiazides, salicylates, NSAIDs, PCNs (including cephalosporins), PPIs- can delay clearance, vit C, phenytoin, tetracycline
-high dose: leucovorin rescue, hydration (minimum rate 100 mL/hr) goal UOP 100 mL/hr, urinary alkalinization- ph > 7 (bicarb in IVF or acetazolamide if fluid overloaded)- prevents precipitation

-lvls drawn 24, 48, 72 hr post dose and should be <5 or 10?, <1, and <0.1 respectively

Note: once weekly dose is for RA not cancer

MTX is hydrophilic (need high doses to cross BBB)

Bac to siping thias, saliciting PPIs, I NSAID what I said and it ain’t PCN, like vitamin C, phenytoin, tetracycline

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16
Q

Pazopanib (Votrient)

A

Sarcoma, kidney, recurrent uterine leiomyosarcoma

TKI, VegF inhibitor, PDGFR a and b, c-KIT

-empty stomach (1hr before, 2hr after)
-DI:
-acid reducing agents
-Cyp3A4
-QTc

ADRs: nausea, diarrhea, HTN, HA, low blood cell counts, hair color change, *hepatotoxicity!!!, bleeding, clotting, wound healing, arrhythmia

DLT: HTN, diarrhea, hepatotoxicity

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17
Q

Pembrolizumab (keytruda)

A

Sarcoma, bladder (first-cisplatin ineligible PD-L1 cps >10% or second line (cat 1 for OS benefit)), kidney, prostate if MSI high or dMMR dx and progressed through docetaxel and novel HT, testicular 3rd line MSI-H/dMMR or TMB-H, cervical, endometrial , breast (high risk early stage TNBC, R/R HL, melanoma, head/neck, NSCLC, SCLC, HCC, biliary tract, pancreatic, gastric/esophageal, SCC, colorectal

Anti-pd1 antibody

-severe life threatening immune related ADRs

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18
Q

Pexidartinib (turalio)

A

Sarcoma-250 BiD w/ low-fat meal

TKI against CSF1 receptors.

-adult symptomatic tenosynovial giant cell tumor (TGCT)- severe and not. Amenable to improvement w/ surgery
-BBW: hepatotoxicity (DLT)- REMS!
-ADR: ocular issues, fatigue, high cholesterol, hair discoloration, dyguesia
-DI: Cyp3A4

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19
Q

Regorafenib (stivarga)

A

Sarcoma, CNS tumors, HCC, colorectal

TKI, VEGF

-dermatological toxicity
-hand foot syndrome
-hepatotoxicity
-wound healing
-photosensitivity
-HTN
-fatigue
-diarrhea
-mucositis

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20
Q

Ripretinib (Qinlock)

A

Sarcoma

KIT inhibitor, PDGFR-alpha blocker, TKI

-monitor BP
-echo or MUGA prior and during tx
-cyp3A4 interactions

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21
Q

Tazematostat (tazverik)

A

Sarcoma, R/R FL after 2 prior therapies (irrespective of EZH2 mutation)

Need EZH2 mutation

EZH2 inhibitor, HMT inhibitor

-epithelioid sarcoma not eligible for complete resection- 800 mg BID
-cyp3A4 interactions
-need INI-1 loss

Pain, fatigue, nausea, decreased appetite, vomiting, diarrhea, constipation

Weak cyp3A4 inducer

Cyp3A4 and pgp substrate

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22
Q

Temozolomide (temodar)

A

Sarcoma, CNS tumors, melanoma (last line of CNS Mets), SCLC, pancreatic in PNET

Alkylating agent- triazine

-100% bioavailability
-crosses BBB
-myelosuppression
-lymphopenia!!
-skin rash
-peripheral edema
-fatigue!!
-constipation
-mod-highly emetogenic

-give at bedtime with 5HT3 blocker
-pjp ppx needed if given w/ RT

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23
Q

Trabectedin (yondelis)

A

Sarcoma- myxoid liposarcoma and leimyosarcoma- after 2 lines of therapy, recurrent uterine LMS, platinum resistant ovarian CA

Alkylating agent

-premeditate dex 20 mg iv to prevent hepatotoxicity
-premeditate zofran 16 mg iv (CINV)
-monitor cpk and alkphos prior to each dose
-rhabdo- check cpk. >2.5 ULN hold x3 wks, >5 ULN hold x3 wks then dose reduce
-LVEF (echo): BL and q2-3 mo
-LFTs and bili prior to each cycle
-vesicant!
-24h cont infusion for sarcoma

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24
Q

Vinorelbine (navelbine)

A

Sarcoma, breast, NSCLC, SCLC

Vinca alkaloid, antimicrotubule

-cell cycle specific
-vesicant - central line
-give in mini bag
-neurotoxicity
-peripheral neuropathy
-hepatic adjustment
-myelosuppressive
-constipation- BR

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25
Q

Soft tissue sarcoma chemo regimen

A

First line: doxorubicin + ifosfamide

Second line: Gemcitabine + docetaxel

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26
Q

Angiosarcoma chemo regimen

A

Docetaxel/Paclitaxel + vinorelbine

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27
Q

Sunitinib (Sutent)

A

Sarcoma- GIST second line, kidney, pancreatic in PNET

TKI- VEGF 1, 2, and 3 inhibitor, PDGFR a and b, c-KIT, FLT-3, CSF-1R, RET

ADRs: Nausea, diarrhea, skin/hair color changes, mouth sores, weakness, low wbc/rbc,, HTN, CHF, bleeding, hand/foot syndrome, low thyroid hormone, taste changes

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28
Q

Bevacizumvab (avastin)

A

VEGF inhibitor

CNS tumors, clear cell RCC (rarely), frontline/recurrent ovarian and cervical, recurrent endometrial, non-squamous cell NSCLC, HCC, colorectal

-impaired wound healing-hold for 6 weeks before and 6-8 weeks after surgery (not including port-A-Cath)
-bleeding !
-clotting
-nephrotic syndrome
-GI perforation
-HTN! HTN does NOT preclude people from getting bevacizumab especially if it’s controlled
-proteinuria- okay if scr is fine

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29
Q

Carboplatin (paraplatin)

A

CNS tumors, bladder, testicular AUC 7 x1- only time AUC 7 is used, ovarian, endometrial, cervical, Breast, RR NHL, HL, head/neck, NSCLC, SCLC, gastric/esophageal

Alkylating agent

-nausea
-pancytopenia
-fatigue
-renal toxicity
-DLT: thombocytopenia

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30
Q

Carmustine (BiCNU)

A

CNS tumors

Alkylating agent- nitrosourea

-nausea
-fatigue
-thrombocytopenia
-lymphopenia
-pulmonary toxicity

-equivalent to lomustine but IV so less preferred
-wafer rarely ever used
-great BBB permeability

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31
Q

Cisplatin (platinol)

A

CNS tumors, bladder, cervical, breast, HL, NHL, MM, head/neck, NSCLC, SCLC, biliary tract, pancreatic, gastric/esophageal

-N/V
-nephrotoxicity-hydrate with NS only
-ototoxicity
-neuropathy!
-infertility! (Testicular cancer >400 mg/m2)
-highly emetogenic
-Thrombocytopenia
-relative lack of myelosuppression
-less tolerated than Carboplatin

-Hydrate with NS and can use forced hydration with loop diuretic or mannitol
-supplemental k and mg- electrolyte wasting d/t renal tubule damage

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32
Q

Cyclophosphamide

A

CNS tumors, breast, AML, ALL, CLL with Fludarabine and rituximab
-lymphomas: DLBCL, Burkitts, PMBL, HL, indolent lymphomas, MM, SCLC

Alkylating agent- nitrogen mustard

-N/V
-myelosuppression
-mucositis
-hemorrhagic cystitis- hydrate, give with Mesna if:
-BMT
-hyperCVAD- 1.8 g/m2
-renal dysfunction
-immunosuppressant
-SIADH
-nasal congestion if given too fast

Prodrug activated by liver
-caution w/ dose adjustments, not clear

Cell cycle non-specific

Nadir d7-12 (a bit earlier)

DI: inducers may increase bio activation and increase toxicity

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33
Q

Etoposide (Vepsid, VP-16)

A

CNS tumors, recurrent ovarian, AML, DLBCL, PMBL, BL, HL, MM, NSCLC, SCLC

Topoisomerase II inhibitor, epipidophylotoxin

-hypotension- slow infusion
-DLT-myelosuppression
-N/V- low-mod
-secondary malignancy AML

There is a PO option

Cell cycle specific

non-PCV bag and low sorting infusion set

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34
Q

Irinotecan (camptosar)

A

CNS tumors, SCLC, pancreatic, gastric/esophageal, colorectal

Topoisomerase I inhibitor -camptothecan

Prodrug- SN38 is active metabolite

ADRs:
-diarrhea (acute within 24hrs d/t cholinergic storm- tx w/ atropine, late >24h tx w/ loperamide)
-pancytopenia/neutropenia!!
-nausea/vomiting is big
-fatigue
-does NOT cause hypotension
-myelosuppression is big

-Cell cycle specific
-Smoking decreases activity (at least toxicity and likely efficacy)
-Use 70% of standard dose if know HOMOZYGOUS UGT1A128*

-3A4 substrate- CI with inhibitors (don’t ignore this!!)

Don’t use with Gilbert’s dx

There is a liposomal form

Fun fact: bacterial in gut can convert irinotecan back to active for- so if refractory diarrhea could try cephalosporin/FQ could help

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35
Q

Leucovorin

A

MTX rescue therapy- rescues healthy cells- GIVE WITHIN 42 HOURS! But usually started 20-24 hours after start of MTX

Should prevent mucositis and neutropenia

Rescue: 15 mg/m2 iv starting 24h after starting MTX- may end up needing much higher doses

Required for MTX>500 mg/m2 (HD-MTX) but consider for 100-500 mg/m2

IV to PO is 1:1 unless at higher doses like >35 mg

Used until MTX <0.1

Don’t give within 2hr of glucarpidase. Also, first 48h after glucarpidase use pre glucarpidase luecovorin dose- then dose leucovorin base on MTX lvls

Also used to enhance activity of 5FU- allows it to bind to target enzyme better- IV over 2 hours (not PO)

-also levoleucovorin which is usually used if leucovorin is not available

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36
Q

Lomustine

A

CNS tumors

Alkylating agent- nitrosourea

-oral so preferred over carmustine
-nausea
-fatigue
-thrombocytopenia
-lymphopenia
-pulmonary toxicity
-dispense 1 RX at a time to avoid patient overdose possibility
-prolonged nadir 4-6 wks

-give at night with 5HT3 blocker
-great BBB permeability

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37
Q

Procarbazine

A

CNS tumors, HL

Alkylating agent- methylhyderazine

-PO
-MAO-I activity- seratonin syndrome- beware DIs, low tyramine diet and x1 week after taking drug
-nausea-give at night with 5HT3 blocker
-rash

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38
Q

Rituximab

A

B cell Lymphomas- DLBCL, PMBL, BL, CNS lymphoma, chronic leukemias, indolent lymphomas (FL, MCL, MZL, WM)

-infusion rxn- (fever, chills, rigors, changes in BP)- most commons with first dose- don’t stop infusion, slow it down
-hypersensitivity rxn (chimeric mAb) but this is quite rare
-hep b reactivation
-PML- due to long immunosuppression
-can decrease efficacy of vaccines
-risk IgM tumor flare in WM- caution if high IgM (>4000)
-rapid infusion- if tolerated start with cycle 2- over 90 minutes (20% in 30 mins and 80% over next 60). Don’t do
If CV dx or lymphocyte count >5000.

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39
Q

Teniposide (vumon, VP-26)

A

CNS tumors

Topoisomerase II inhibitor - epipodophyllotoxin

-Myelosuppression
-mucositis
-N/V
-diarrhea
-hypotension!

Not used for glioma

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40
Q

Vincristine (oncovin)

A

CNS tumors, mostly just hematologic CAs, also ITP, ALL, DLBCL, PMBL, BL, HL, indolent lymphomas, SCLC

Antimicrotubule

-cell cycle specific
-neuropathy- can be reversible!
-constipation-DLT (autonomic neuropathy)!
-NOT myelosuppressive!
-hepatic-dose reduce for elevated bili
-3a4 interactions- fluconazole ok but other azoles interact
-SIADH-hyponatremia

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41
Q

Glucarpidase

A

Tx of toxic MTX levels with evidence of new renal impairment - 48-60 hrs from start of MTX infusion

Continuous infusions
-36h level>30
-42h level>10
-48h level>5

Infusions over <6h
-24h level >50
-36h level>30
-42h level >10
-48h level >5

you still need leucovorin for intracellular MTX- glucarpidase only eliminates extra cellular MTX

*and scr must be elevated (50%+ increase from BL)

hour markers a measured from the *start of the MTX infusion

-don’t give leucovorin within 2 hours
-don’t repeat glucarpidase within 48 hours of first dose

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42
Q

Avelumab (bavencio)

A

Bladder, kidney, metastatic merkel cell carcinoma
PD-L1 inhibitor

Bladder- second line for maintenance following platinum based chemo could become SO

Downside: dosed twice weekly, requires premeds when initiating therapy

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43
Q

BCG (Tice BCG)

A

Biological response modulator (similar to IL-2)- need intact immune system-no immunosuppressants

Non-muscle invasive bladder cancer

Given intravesically

Used as induction and maintenance x1-3 yrs for high risk

Give at least 7-14 d after TURBT- to avoid systemic absorption and BCG sepsis (tx with anti-tuberculosis therapy)

Flu-like symptoms (after 3rd dose), dysuria, bladder spasms, hematuria, allergic rxn, exposure precautions x48hrs

Don’t use in people w/ infections on ABX

Compound separately

NOT used preoperatively

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44
Q

Docetaxel (Taxotere)

A

Antimicrotubule

Cell cycle specific

Bladder, prostate (with pred), gyn, breast, head/neck, NSCLC, SCLC, gastric/esophageal

DLT: neutropenia, neuropathy, (less than paclitaxel)

ADRs: tearing, edema (give steroids!!)myalgias, more neutropenia than paclitaxel, skin rxns, irritant

-Dose reduce for hepatotoxicity!
-3A4 substrate
-Dex 8 mg BID x3 d starting the day before
-controversy over dose in Asians

Other:
-inflammatory moa
-free radicals (stop vit C)

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45
Q

Enfortumab vedotin (Padcev)

A

Antibody drug conjugate - antimicrotubule

Nectin-4 targeting antibody-drug conjugate with MMAE payload

Metastatic Bladder- 1st line with pembro

ADRs: skin reactions/ rash, pruritis, neuropathy, hyperglycemia, ocular toxicity, diarrhea

Loperamide prn, fragrance free lotion, ppx artificial tears, blood glucose monitoring

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46
Q

Erdafitnib (Balversa)

A

FGFR inhibitor

Metastatic Bladder-FGFR/FGFR2 mutations and progressed on at least 1 line of platinum therapy (second line )

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47
Q

Mitomycin (mutamycin, jelmyto)

A

Anti tumor antibiotic

Bladder-NMIBC, MIBC if w/ 5-fu + RT

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48
Q

Nadofaragene firadenovec-vngc
(Adstiladrin)

A

Gene therapy- intravesical

High risk BCG unresponsive NMIBC w/ Cis w/ or w/o papillary tumors

Delivers gene copy to bladder lining that encodes interferon-Alfa 2b that stimulates immune system to attack

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49
Q

Nivolumab (Opdivo)

A

Bladder, kidney, R/R HL, HL, melanoma, head/neck, NSCLC, SCLC, HCC, gastric/esophageal, colorectal (dMMR/MSI-H or POLE/POLD1)

Immune checkpoint inhibitor -PD-1 inhibitor

Bladder-2nd line, no PDL1 required

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50
Q

Penbrolizumab (Keytruda)

A

PD-1 inhibitor

Bladder- 1st line for platinum ineligible, or 2nd line, other indications

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51
Q

Sacituzumab govitecan (Trodelvy)

A

Antibody drug conjugate- SN38 (active metabolite of irinotecan) payload is topo-I inhibitor

Bladder/ mUC after platinum and IO

-1) Refractory metastatic TNBC after 2 lines or 2) metastatic HR+ HER2- endocrine refractory dx or visceral crisis ( not HER2 low-l). Used instead of fam-trastuzumab if not HER2 low

-Treat diarrhea with loperamide

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52
Q

Vinblastine

A

Antimicrotubule

HL, bladder

-cell cycle specific

Myelosuppression

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53
Q

Durvalumab

A

PD-L1 inhibitor

Bladder- second line, NSCLC, SCLC, cholangiocarcinoma, HCC

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54
Q

Trilaciclib

A

CDK 4/6 inhibitor

Myelosuppression prevention-given before platinum/etoposide containing regimens or a topotecan regimen for ES-SCLC

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55
Q

Defibrotide

A

Treats Veno-occlusive dx which is emergency type of hepatotoxicity often caused by drugs that have ozagamicin

Gemtuzumab ozagamicin
Inotuzumab ozagamicin

VOD usually happens in first 3 weeks after transplant

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56
Q

Brigatinib (Alunbrig)

A

ALK inhibitor

Sarcoma, NSCLC-ALK

ADRs: fatigue, constipation, edema, myalgia, visual disturbance, pneumonitis, GI toxicity, hepatotoxicity, bradycardia, QTc

-early pulmonary toxicity- dose titration: 90 mg QD x7 d—> 180 mg QD
-CNS penetration

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57
Q

Crizotinib (Xalkori)

A

ALK inhibitor, ROS1

Sarcoma, NSCLC- ALK/ROS1, MET exon 14 skipping mutation

ADRs: fatigue, constipation, edema, myalgia, visual disturbance, pneumonitis, GI toxicity, hepatotoxicity, bradycardia, QTc

-moderately emetogenic
-renal dose

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58
Q

Lorlatinib (Lorbrena)

A

ALK inhibitor

NSCLC- ALK, ROS1

ADRs: fatigue, constipation, edema, myalgia, visual disturbance, pneumonitis, GI toxicity, hepatotoxicity, bradycardia, QTc

-MOST CNS penetration
-CNS ADRs (nightmares, hallucinations, depression)
-neuropathy
-hypercholesterolemia- tx with statins don’t dose reduce

-option for resistant mutations: ALk G1202R, L1196M, (except compound L1196M/G1202R)

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59
Q

Axitinib (Inlyta)

A

Kidney

TKI- VEGF inhibitor

ADRs: HTN, fatigue, N/V/D, poor appetite/wt loss, voice changes, hand/foot syndrome, constipation. HTN, bleeding, clotting, wound healing, lfts, hypothyroidism

Short t1/2: quick onset of large dx burden and quick offset if ADRs

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60
Q

Belzutifan (welireg)

A

Von-hippel-lindau (VHL) associated RCC after PD-L1 and VegF

Also VHL associated: CNS hemangioblastoma, pancreatic neuroendocrine tumors

Hypoxia inducible factor inhibitor

ADRs: anemia (hold for Hgb<8), fetal embryo toxicity, fatigue, dyspnea, nausea, HA, hyperglycemia, hypoxia

Enzyme Inducer- birth control failure!

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61
Q

Cabozantinib (cabometyx- tablets) ( cometriq- capsules)

A

Kidney, thyroid, HCC (2nd line)

TKI- VEGF inhibitor, MET, AXL

ADRs: N/V/D, diarrhea, fatigue, poor appetite/ wt loss, HTN, hand/foot syndrome, constipation. Bleeding, clots, intestinal perforation, fistulas
-hold 3 weeks before and 2 weeks after surgery (wound healing)
-mod-high emetogenic
-empty stomach
-higher risk of hand/foot syndrome than other VEGF inhibitors

Thyroid:
Tablets (cabometyx-140 mg QD) and capsules (cometriq- 60 mg QD) are not interchangeable

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62
Q

Everolimus

A

Kidney, recurrent endometrial (w/ letrozole), breast cancer, WM, pancreatic

mTOr kinase inhibitor

ADRs: immunosuppressive, mouth sores (use dex mouthwash), nausea, loss of appetite, rash, diarrhea, fatigue, edema, hyperglycemia, hypercholesterol. Rare lung damage
DLT: mucositis- use dexamethasone mouth rinse (solution NOT elixir- (etoh free)) QID no food within an hour

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63
Q

IL-2

A

Kidney Ca

Rarely used d/t AE and better therapies available

*need excellent PFS and good renal function

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64
Q

Ipilimumab (Yervoy)

A

Kidney, Melanoma, NSCLC, HCC, -colorectal (if dMMR/MSI-H, or POLE/POLD1. Only in combo with nivo)

Immune checkpoint inhibitor- anti CTLA4 mAb

First FDA approved ICI

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65
Q

Lenvatinib (Lenvima)

A

Kidney, recurrent endometrial, melanoma, thyroid, HCC, biliary tract

TKI- VEGF 1, 2, and 3 inhibitor; FGFR 1, 2, 3, and 4 inh, PDGFRa; c-KIT, and RET

ADRs: , diarrhea, N/V/D, proteinuria, fatigue, decreased appetite. joint/muscle pain, swelling of arms/legs. Bleeding, clots, severe HTN, intestinal perforation, kidney/liver/heart failure, hypothyroid, mucositis, hypocalcemia
-voice hoarseness (reversible and not dose related)
-mod-high emetogenic- GIVE with ANTIEMETIC
-hold 1 wk before and 2 wks after surgery (wound healing)

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66
Q

Sorafenib (Nexavar)

A

-Kidney- historically used but not anymore except certain circumstances
-Thyroid
-HCC cat 1

TKI- VEGF inhibitor, FLT-3-ITD, RET

ADRs: fatigue, rash, diarrhea, HTN, hand/foot syndrome, cardiotoxicity, LFTs, QTc, wound healing impairment, bleeding
-empty stomach

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67
Q

Temsirolimus (Torisel)

A

Kidney- historically used but now only under certain circumstances, endometrial

mTOR kinase inhibitor

ADRs: mouth sores, rash, nausea, loss of appetite, edema in face/legs, hyperglycemia, hypercholesterol,

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68
Q

Tivozanib (Fotivda)

A

Kidney

TKI-VEGF inhibitor- blocks all three VEGF receptors, c-KIT, PDGFR-beta

ADRs: nausea, diarrhea, HTN, poor appetite, cough, mouth sores, fatigue, voice changes, bleeding, clotting, wound healing, thyroid, kidney, heart problems

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69
Q

abiraterone (Zytiga, Yonsa)

A

Prostate- only for de novo metastatic dx

Anti-androgen

mCSPC and mCRPC

Give with prednisone:
-mCSPC: 5 mg PO daily
-mCRPC: 5 mg PO Twice daily

500 mg fine particle formulation=1000 mg of original- give w/ Methylprednisolone 4 mg BID

Food affects absorption: 1000 mg give on empty stomach, 250 mg give with breakfast

Adrs: hepatotoxicity, HTN, hyper/hypoglycemia

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70
Q

Apalutamide (Erleada)

A

Prostate

Antiandrogen

m0CRPC (delays mets), m1CSPC

240 mg PO daily

ADR:
-crosses BBB- falls, seizures. This is CLASS EFFECT
-diarrhea, rash, hypothyroidism, HTN

Drug interaction! Inducer!!!

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71
Q

Bicalutamide (Casodex)

A

Prostate

Antiandrogen

No monotherapy- use with LHRH agonist or antagonist to prevent tumor flare

ADR:
-class effect- crosses BBB: falls, seizures, diarrhea

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72
Q

Cabazitaxel (Jevtana)

A

Prostate (give with pred or dex)

Taxane- antimicrotubule

m1CRPC, must try docetaxel first

20 mg/m2 standard- if 25 mg/m2 give with G-CSF

Less fatigue and asthenia than docetaxel

Diarrhea and FN (intermediate)

Contains polysorbate 80 and ethanol

Non-PCV and low sorting infusion set

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73
Q

Darolutamide (Nubeqa)

A

Prostate- m0CRPC, m1CSPC with docetaxel

Antiandrogen

m0CRPC, evidence for triple therapy for newly diagnosed, de novo metastatic, high risk/volume CSPC

Different from enazalutamde and apalutamide- different structure

Reduced CNS toxicity- doesn’t cross BBB penetration- less fatigue and falls

May be more effective in long run-works against mutated receptors

Give with food!

Less drug interactions: weak inducer

Renal and hepatic dose adjustment

600 my BID with food

HTN

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74
Q

Degarelix (Firmagon)

A

Prostate

GnRH antagonist

Cornerstone of therapy- continue throughout dx regardless of progression

Monthly injections

Adrs:
-inj site rxns- can be pretty nasty
-anaphylaxis
-hot flashes
-metabolic syndrome

Preferred over LHRH agonist when tumor flare is big concern (spinal cord compression/injury)

Achieved castration in <7d, unlike 28 days for agonist

Monthly only- LHRH agonists can be given much less often depending on dose

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75
Q

Enzalutamide (Xtandi)

A

Prostate

Anti-Androgen

m0CRPC, m1CRPC, m1CSPC

CNS ADRs: falls, seizures, HTN

Drug interactions! Inducer!

160 mg daily

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76
Q

Goserelin (Zoladex)

A

Prostate, breast

GnRH agonist

Prostate: Cornerstone of therapy and should be continued throughout dx course regardless of progression

Breast: premenopausal with AI of tamoxifen for ovarian suppression

Adrs:
-tumor flare
-hot flashes
-metabolic syndrome

-SubQ

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77
Q

Histrelin (Vantas)

A

discontinued by manufacturer

Prostate

GnRH agonist

Cornerstone of therapy and should be continued throughout dx course regardless of progression

Adrs:
-tumor flare
-hot flashes
-metabolic syndrome

Not listed in guidelines but approved for palliative tx

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78
Q

Leuprolide (lupron, eligard, viadur)

A

Prostate, breast

GnRH agonist

Prostate: Cornerstone of therapy and should be continued throughout dx course regardless of progression

Breast: premenopausal, in combo with AI or tamoxifen for ovarian suppression

Adrs:
-tumor flare
-hot flashes
-metabolic syndrome

Not all leuprolide products are the same regarding formulation, dosing, and route

-SubQ, IM

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79
Q

Lutetium Lu 177 vipivotide tetraxetan (Pulvicto)

A

Prostate

Radiopharmaceutical

PSMA-positive mCRPC previously treated with ADT and taxanes!!

ADrs: fatigue, dry mouth, nausea, anemia, kidney injury, myelosuppression, GI-constipation, infertility, embryo fetal toxicity, wt loss, radiation exposure

Avoid close contact x3-7d, premed w/ antiemetic

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80
Q

Mitoxantrone

A

Prostate- m1CRPC- for palliation with no other tx options. QOL benefit but no OS benefit, AML

Topo-II inhibitor, anthracycline

Very cardiotoxic

Different structure from other anthracyclines so less cross resistance (why it’s used in refractory setting in AML)

Blue

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81
Q

Olaparib (Lynparza)

A

PARP inhibitor

Prostate- m1CRPC with any HRRm mutation except PPP2R2A- after androgen receptor therapy, ovarian

Breast: if germline BRCA 1/2 mutation, early stage, and HER2-negative
-adjuvant x1year- started after surgery, RT and chemo (start at least 2 wks after RT)

Pancreatic- if germline BRCA mutation

Myelosuppression!!! fatigue, nausea, bowel changes (constipation)

Pneumonitis, increased scr

Drug interactions, no grapefruit

Tablets and capsules are NOT interchangeable- capsules mostly phased out of US market

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82
Q

Radium-223 (Xofigo)

A

Prostate m1CRPC- symptomatic bone dx

Radiopharmaceutical

Not used often

Targets bone mets, not for visceral Mets!

IV monthly x6 months

Not just a palliative drug like some other radiopharmaceuticals

Myelosuppression!

First dose requires:
-anc >1500, plt >100, Hgb >10,
Subsequent:
-anc>1000, plt >50,

Don’t use with chemo or other drugs other than ADT and BMA- d/t additive myelosuppression

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83
Q

Relugolix (Orgovyx)

A

Prostate

GnRH antagonist

Requires loading dose, reload if stopped for >7days

Fast onset and offset- compliance is critical

Potential for less CV ADRs than leuprolide

Qtc, diarrhea

Only oral option for ADT

Used as a single agent!

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84
Q

Rucaparib (Rubraca)

A

Prostate-m1CRPC w/ BRCA mutation- after androgen receptor and taxane therapy , ovarian (BRCAm)

Pancreatic- germline or somatic BRCA of PALB mutation

PARP inhibitor

Myelosuppression, fatigue, nausea, bowel changes (constipation)

-Hypercholesterolemia, elevated AST/ALT, increased scr, photosensitivity, MONTHLY CBC

Drug interactions - less than Olaparib, grapefruit ok

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85
Q

Sipuleucel-T (Provenge)

A

Prostate

CA vaccine

Metastatic CRPC, No visceral mets, need good PFS and >6 mo life expectancy and minimal symptoms

Not used often

3 doses are given

Well tolerated

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86
Q

Talazoparib (Talzenna)

A

Prostate- m1CRPC- given in combination with enzalutamide for HRR+ dx

Breast: metastatic germline BRCA1/2 mutation

PARP inhibitor

ADRs:
-myelosuppression-more than Olaparib!!!!esp anemia!
-fatigue
-nausea

Oral

Dose reduce with p-gp inhibitors

Renal dose adjustment

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87
Q

Triptorelin (Trelstar)

A

Prostate

GnRG agonist

Cornerstone of therapy and should be continued throughout dx course regardless of progression

Adrs:
-tumor flare
-hot flashes
-metabolic syndrome

Not frequently used

Intramuscular

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88
Q

Dinutuximab

A

Pediatric Neuroblastoma

Anti-GD2 mAb

10-20 hr infusion x4 days (do not exceed 20 hr infusion)

-pain- need continuous opioid infusion!, infusion rxn, hypotension, capillary leak (give with albumin), cough, ocular/visual issues, electrolyte disturbances, myelosuppression

bleeding, electrolyte abnormalities, increased risk infection, vision changes,
No pregnancy or breastfeeding, pre-meds with NS, APAP Benadryl (not dex), and antiemetics, infusion rxn, n/v

pre meds, pre-hydration, opioid infusion, albumin

Slow infusion to increase tolerance

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89
Q

Bleomycin (Blenoxane)

A

Testicular CA, Hodgkin’s lymphoma

-not myelosuppressive
-max lifetime dose of 400 units
-anaphylactiod rxn- do test dose for lymphoma (debatable)
-hyperpigmentation of skin
-NS only
-reynauds
-CI w/ brentuximab vedotin and w/in 24h G-CSF (debatable)
-measure DLCO- consider stopping if >25% decrease from BL (workbook says decrease of 40-60%)
-avoid if BL DLCO <75% predicted (in general DLCO >60% is acceptable)
-G-CSF- ok with testicular cancer, not ok if HL (unless BEACOPP)

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90
Q

Etoposide phosphate (etopophos)

A

May be substituted for etoposide in patients with etoposide allergy

Equivalent doses

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91
Q

Oxaliplatin

A

Platinum- alkylating agent

-Testicular CA-3rd line with gemzar
-R/R NHL, HL, pancreatic, gastric/esophageal, colorectal

-Qtc!!

-cold sensitivity- resolves in 3-5days but this can lengthen with each infusion
-peripheral neuropathy- can be permanent
-neurotoxicity/neuropathy- can prolong infusion to 6hr and can give ca/mg (not recommended d/t lack of evidence
-coasting- neuropathy may worse over first 3 months of discomtinuation

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92
Q

Paclitaxel (Taxol)

A

Antimicrotubule

Testicular ca-second line, ovarian, endometrial, Breast cancer, head/neck, NSCLC, SCLC, gastric/esophageal

Myelosuppression- worse with 24h infusion- so we don’t do this, Less if given weekly vs q21d

DLT: Peripheral neuropathy - worse with weekly compared to q21d

Hypersensitivity rxn d/t cremephor -premed: diphen, famot, dex
-non-PVC Line w/ 0.22 micro filter bc cremephor can leach DEHP

Mild vesicant-warm v cold debatable

DI:
-increases dox when given after, so give dox—->paclitaxel
-cisplatin increases paclitaxel, so give paclitaxel —->cisplatin

Taxol syndrome- arthralgias/myalgias, likely a type of neuropathy

Cell cycle specific

Caution in liver impairment

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93
Q

Vinblastine (velban, Alkaban-AQ)

A

Vinca alkaloid- antimicrotubule

Testicular CA

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94
Q

Mesna

A

Hemorrhagic cystitis protectant agent

-always with ifos- 20% ifos dose at hr 0, 4, and 8 (for bolus doses<2.5mg/m2/d
-unless for ICE regimen you do 1:1
-for cont inf: 20% as bolus then 40% as cont inf for 12-24h after ifos completion
-sometimes with cyclophosphamide
-available PO but double the dose and it takes bad d/t sulfur moiety
-do 20% as iv at hr 0, then 40% at hr 2 and 40% at hr 6. Repeat if vomit within 2 h (total 100%)

IV Mesna dose is equal to 60-100% of ifos dose

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95
Q

Dexrazoxane

A

Cardioprotectant
-generally for dox >300 mg/m2
-dose 10:1
-give 15-30 mins prior

*metastatic BC but not adjuvant d/t possible decreases efficacy

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96
Q

Amifostine

A

Chemo protectant
-prevention cisplatin nephrotoxicity
-consider for decreased neutropenia- usually use g-CSF
-910 mg/m2 iv over 15 mins, 30 mins before chemo- monitor BP
-200 mg/m2 IVP over 3 mins before each fx of RT
-Can also prevent xerostomia and mucositis in RT pts for head/neck cancer- actually don’t use for mucositis…?
-avoid if good chance of cure
-can cause hypotension (hold BP meds x24 hrs before)
-premeds with NS, 5HT3, and dex
-must give chemo within 30 mins (short half life)

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97
Q

Palifermin

A

Decreases severe mucositis in pts undergoing autologous SCT for a hematologic CA with total body irradiation AND HD chemo conditioning

-60 mcg/kg IV x3 d before start of conditioning regimen and x3 d starting day if stem cell infusion
-don’t give within 24 hours of initiation of conditioning regimen

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98
Q

Ivosidenib (Tibsovo)

A

IDH 1 inhibitor

-IDH1 mutated conventional and dedifferentiated chondrosarcoma
-IDH1 mutated de novo or relapsed refractory AML. Given in combo with HMA or alone for unfit pts older than 75y
-IDH1 mutated cholangiocarcinoma

Serious ADR: differentiation syndrome, QTC prolongation, high WBC, GBS, pulmonary and/or renal dysfunction

3A4 inducer

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99
Q

Valrubicin

A

Bladder Tis in pts who received x2 prior courses of BCG

-800 mg intravesical weekly x6

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100
Q

Anastrazole (arimidex)

A

Aromatase inhibitor- non-steroidal

Ovarian CA maintenance, metastatic or recurrent endometrial Ca -Should be ER/PR positive

Breast- post-menopausal, only pre-menopause if used with ovarian suppression or ablation

DLT: arthralgias/myalgias

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101
Q

Dostarlimab-gxly (Jemperli)

A

Anti-PD-L1 mab

-Advance Endometrial w/ dMMR after platinum failure
-pancreatic MSI-H or dMMR
-primary advanced or recurrent dMMR or MSI-H endometrial CA combo w/ carbo and pacli —-> single agent dostarlimab
-breast- MSI-H/dMMR
-colorectal (dMMR, MSI-H, or POLE/POLD)

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102
Q

Letrozole (Femara)

A

Aromatase inhibitor - non-steroidal

-Recurrent endometrial CA
-maintenance in ER/PR recurrent ovarian
-breast: post menopausal (only premenopausal if ovarian suppression or ablation)

DLT: arthralgias/myalgias

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103
Q

Megestrol (Megace)

A

Anti-neoplastic progestin w/ anti estrogenic properties

Low grade endometrial cancer

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104
Q

Mirvetuximab soravtansine-gynx (Elahere)

A

Anti-folate receptor alpha (75%), antibody drug conjugate- anti-microtubule

FR-a positive (75%+ of cells with PS2+ staining)- platinum RESISTANT ovarian, fallopian, or primary peritoneal CA- who have received 1-3 prior systemic tx

Dose in adjusted body wt due to ocular toxicity - for all BMIs!!- Don’t dose round!!

Ocular toxicity - steroid eye drops day -1 x5d (6x/day)—>x4d (4x/d), lubricating drops; warm compress before sleep, sunglasses, no contact lenses

D5W only
Need 0.22 micro filter

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105
Q

Nab-paclitaxel (Abraxane)

A

Antimicrotubule

Albumin bound paclitaxel

Not used often- exhaust paclitaxel and docetaxel first

Recurrent ovarian CA, endometrial, breast, NSCLC- better response in squamous

pancreatic, NSCLC, metastatic breast

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106
Q

Niraparib (Zejula)

A

PARP inhibitor

Ovarian:
Dose on wt and plt: 200 mg instead of 300 mg for wt<77kg or plt<150k (this is for first line maintenance only)

DLT: thrombocytopenia

Myelosuppression, fatigue, nausea, bowel changes (constipation), WEEKLY CBC

HTN, palpitations

No cyp interactions

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107
Q

Pemetrexed (Alimta)

A

Antimetabolite (pyramidine analog)

-non-squamous NSCLC
-Gyn- recurrent dx

-Give folic acid and B12- prevent severe hematologic toxicity(Start 1 wk before and continue x3 weeks after completion) (neutropenia)
-Give dex 4 bid day before, of and after-prevent skin rash
-crcl cut off is 45 ml/min

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108
Q

Tamoxifen (Nolvadex, Soltamox)

A

SERM

Ovarian maintenance in ER/PR positive

Breast: pre/post menopausal

Estrogenic in bones, lipids, endometrium

Anti-estrogenic in breast and vaginal mucosa

Increase BMD in post-menopausal but decreased in pre-menopausal

Increased endometrial cancer in post-menopausal

VTE, hot flashes, cataracts, hyperlipidemia

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109
Q

Tisotumab vedotin (Tivdak)

A

Antimicrotubule- antibody conjugated to MMAE

Cervical cancer- recurrent or metastatic with dx progression on chemo

ADR: ocular, peripheral neuropathy, fatigue, nausea, epistaxis, alopecia, hemorrhage, rash

-eye exam before each infusion
-steroid, vasoconstrictor, and lubricating eye drops
-ice packs during infusion

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110
Q

Topotecan (Hycamptin)

A

Topo-I inhibitor

Gyn- recurrent dx, SCLC

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111
Q

Trastuzumab (Herceptin)

A

Anti-HER-2 mab

-Endometrial with carbo/taxane for HER2+

-Breast:
-neoadjuvant and adjuvant
-for T>1 cm (consider if < 1cm)
-prefer to give with chemo except anthracyclines
-x1 year
-HER-2+ obviously

-Biliary tract- with Pertuzumab
-gastric/esophageal- adenocarcinoma only

-colorectal (give with lapatinib, tucatinib, or pertuzumab)

Cardiotoxic , pulmonary toxicity, infusion rxn, fetal toxicity , diarrhea

IV

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112
Q

Sodium thiosulfate

A

-prevents cisplatin ototoxicity in kids with non-metastatic hepatoblastoma and other non-metastatic cancers
-meclorethamine extravasation

don’t use is metastatic dx

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113
Q

Hyaluronidase

A

Vinca alkaloid extravasation

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114
Q

Irinotecan

A

Topoisomerase I inhibitor

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115
Q

Purine analogs

A

Azathioprine, mercaptopurine, thioguanine, cladrabine, clofarabine, Fludarabine, nelarabine, pentostatin

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116
Q

Tisagenlecleucel (Kymriah)

A

CAR-T (anti-CD-19)

->/= 2nd relapsed or refractory B-ALL on pts up to 25 y/o
-R/R DLBCL
-R/R FL (after 2+ lines of therapy)

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117
Q

Blinatumomab (Blincyto)

A

Bispecific T-cell engager (anti-CD19/CD3)

-Relapsed ALL, MRD+ ALL (after 3 months/cycles) frontline for ph+ given with tki

-Risk for cytokine release syndrome and neurotoxicity (ICANS)

-Works best with low dx burden

-28 day continuous infusion followed by 2 week break: Can do 7 day bag for home infusion (has preservative so can’t use this bag if <22kg)

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118
Q

I-MIBG (metaiodobenzylguanidine)

A

Radioconjugate for patients with relapsed or refractory Neuroblastoma

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119
Q

Nab-paclitaxel

A

-NSCLC- better response in squamous
-pancreatic
-Bound to albumin to help dissolve in solution better (normal paclitaxel needs cremephor)-
-NO Premeds or inline filter/special tubing
-can give faster w/o hypersensitivity rxn
-kinetics are different- more free paclitaxel
-better uptake into tumor cells bc CA needs amino acids
-approvals: met breast ca, NSCLC, pancreatic ca
-very expensive- data doesn’t necessarily show that it’s better except for…
most benefit in pancreatic cancer d/t better penetration

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120
Q

5-fluorouracil (Adracil)

A

Antimetabolite (pyramidine analog)
-inhibits thymidylate synthetase (continuous infusion) AND
-RNA false base pair (bolus)

Breast cancer, bladder, head/neck, pancreatic, gastric/esophageal, colorectal

Continuous infusion for head/neck ca

May need dose reduction for DPD deficiency (DPYD intermediate or poor metabolizer)

ADRs:
-infusion: hand-foot syndrome, diarrhea
-bolus: myelosuppression so if neutropenia and pt is getting infusion, wouldn’t make sense to decrease dose
-mucositis (cryotherapy w/ ice chips-30 mins before bolus)
-coronary vasospasm- may rechallenge (but premeds with nitrate and calcium channel blocker- continue x48h after)

Often given with leucovorin to increase efficacy

-Topical form for basal cell carcinoma
-radiosensitizer
-photosensitizer (avoid sun)
-major interaction with warfarin- inhibits cyp2c9

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121
Q

Abemaciclib (Verzenio)

A

CDK4/6 inhibitor

Breast cancer:
-use in combination with endocrine therapy !!
-adjuvant therapy x2 y for high risk HR+ HER2 negative that spread to LN and high risk of recurrence:
-4+ LN OR
-1-3 LN + (grade 3 or T=5+cm (T3), or ki67>/=20)
-OR MBC: 1st line (with AI), 2nd line (with fulvestrant +/- LHRH agonist if premenopausal)

diarrhea-more than others!
-less neutropenia than others in class
-hepatotoxicity, VTE

Anemia, thrombocytopenia, fatigue, infections, n/v, alopecia, weakness, interstitial lung dx

For MBC with fulvestrant, preferred over Palbociclib

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122
Q

Ado-trastuzumab emtansine (T-DM1 Kadcyla)

A

HER-2 mAb

Breast cancer: 1) early stage in pts who got trastuzumab and docetaxel/paclitaxel neoadjuvant, then surgery and had cancer remaining at surgery-ADJUVANT ONLY
2) met HER2+ MBC 3rd line +

Trastuzumab link to small amount of chemo to deliver chemo directly to tumor

IV

Emtansine is a microtubule inhibitor

-Extravasation!
-can give with RT (unlike capecitabine)
-tx cardiotoxicity the same as trastuzumab/Pertuzumab combo

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123
Q

Alpelisib (Pirqray)

A

PIK3CA inhibitor , (PI3K)

Breast- HR+, HER2 neg-, metastatic dx-second line post CDK4/6+AI after progression
-for post-menopause (or pre menopause with OAS (like all ET in metastatic breast ca))

In combination *with fulvestrant (REPLACES THE CDK4/6 INHIBITOR, and AI get switched to fulvestrant)

Only for patient with PIK3CA mutation

Second line and beyond (DONT GET TRIPPED UP!)

ADR: *hyperglycemia!! (Will usually need Metformin), diarrhea, rash, hepatotoxicity

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124
Q

Capecitabine (Xeloda)

A

Antimetabolite (pyramidine analog)

Breast cancer, head/neck (1250 mg/m2 BID), pancreatic, gastric/esophageal, colorectal

ADR: think golf man- hand foot syndrome, diarrhea, photosensitivity
-rare cardio toxicity (unlike 5FU)
-ADRs worse if DPD deficiency
-hyperbilirubin, angina, mild myelosuppression
-don’t use if crcl<30 (use 5FU instead)
-coronary vasospasm

DI: warfarin (2c9 inhibitor), phenytoin, allopurinol (decreased conversion to 5FU), PPIs

-More toxicity in US (like folate deficiency) so we give 1000 mg/m2
-available as 150 mg and 500 mg tabs
-consider barriers in pt with upper GI cancer (crush-ability, absorption)
-I think more diarrhea and hand foot syndrome than 5FU

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125
Q

Capivasertib (Truqap)

A

AKT inhibitor

Breast HR+, HER-2 (-), with one or more PIK3CA or AKT1/PTEN alteration

Second line

Give with fulvestrant

VERY similar to alpelisib but addition of AKT1/PTEN

126
Q

Elacestrant (Orserdu)

A

Endocrine therapy- SERD

HR+, HER2 neg, must have ESR1 mutation-metastatic breast ca- post menopausal after at least 1 prior line of therapy (in the metastatic setting)- not first line (DONT GET TRIPPED UP)

Given alone, unlike alpelesib which is with fulvestrant

First oral SERD

Oral- Take with food

Adr: dyslipidemia

127
Q

Epirubicin (Ellence)

A

Anthracycline

Breast cancer

128
Q

Exemestane (Aromasin)

A

Aromatase inhibitor -steroidal

Breast- post menopausal (only premenopausal if ovarian suppression or ablation)

129
Q

Fam-trastuzumab deruxtecan-nxki (Enhertu)

A

HER-2 mAb

Breast cancer: (5.4 mg/kg)
-metastatic ONLY: HR+/HER2- (really HER-2 low) AND endocrine refractory- this is second line if HER2 low (IHC 1+ or 2+ and fish negative)

-NSCLC-HER2 (lower dose- 5.4 mg/kg)
-gastric/GEJ: prior trastuzumab (5.4 mg/kg)
-gastric: 6.4 mg/kg
-colorectal (HER2+, 5.4 mg/kg)
-now any solid tumor with no other options

Monitor for interstitial lung dx! (more than emtansine)

IV

Deruxtecan is topo-1 inhibitor

cardiotoxicity- hold for LVEF drop below 40% or >20% from BL or
If LVEF 40-45 and drop is 10-20% recheck it in 3 wks and permanently stop if not recovered

130
Q

Fulvestrant (Faslodex)

A

Endocrine therapy-SERD (kinda like elacastrant)

Breast- post menopausal (premenopausal if ovarian suppression or ablation) not previously tx with ET and in women w/ progression on ET

Intramuscular- thick/viscous and painful, 2 injections

131
Q

Ixabepilone (Ixempra)

A

Antimicrotubule, epothilone B analog

Metastatic breast cancer after failure of anthracycline, taxane, and capecitabine …
or in combination with capecitabine after anthra and taxane failure

ADR: neutropenia, neuropathy, hypersensitivity (give premeds)

Non-PVC and low sorting infusion set

132
Q

Lapatinib (Tykerb)

A

HER-2 oral TKI

-Breast cancer metastatic only: (with trastuzumab or capecitabine)
-colorectal (HER-2 + and RAS/BRAF wildtype. Must give w/ trastuzumab)

ADR: diarrhea

Oral

133
Q

Iarotrectimib (

A
134
Q

Margetuximab-cmkb (Margenza)

A

HER2 targeted

-Metastatic only Breast cancer- after at least 2+ HER2 therapies (one in metastatic setting )
-given with chemo, replaces trastuzumab

IV

Cardiotoxic- monitor LVEF within 4 wks before and q3 months during and after tx. Hold for dec 16% or 10% to below 50%/hospital limits (like trastuzumab). D/c if >8 wks or 3+ holds

CD16A-158F may predict benefit over trastuzumab

135
Q

Neratinib (Nerlynx)

A

HER2 oral TKI

Breast- ADJUVANT ONLY

X1 yr following 1 yr of trastuzumab: LN+, HR+, HER-2+

Diarrhea- prophylactic loperamide for *first 2 cycles (8 weeks)
or 2 week dose escalation

Oral

136
Q

Palbociclib (Ibrance)

A

CDK4/6 inhibitor

Breast: MBC: in combo with endocrine therapy (AI (1st line) or fulvestrant (2nd line) +/- LHRH agonist if premenopausal)

-Primary toxicity is neutropenia

-QTc prolongation , anemia, thrombocytopenia, fatigue, n/v, infxns, alopecia, weakness, interstitial lung dx

137
Q

Pertuzumab (Perjeta)

A

Her2

-Breast cancer- must give with trastuzumab
-biliary tract cancers- must give with trastuzumab
-colorectal (RAS/BRAF wildtype. Also must give with trastuzumab)

Neoadjuvant and adjuvant

Early stage: Add to trastuzumab if T > 2cm or LN positive

Give x1 year

Preferentially give with chemo (except anthracyclines)

diarrhea more than trastuzumab

IV

138
Q

Pertuzumab, trastuzumab, hyaluronidase-zzxf (Phesgo)

A

HER2

Breast-neoadjuvant and adjuvant

SubQ

139
Q

Raloxifene ((Evista)

A

SERM

Breast cancer in post menopausal

Use over AI if poor BMD, use over tamoxifen if intact uterus

140
Q

Ribociclib (Kisqali)

A

CDK4/6 inhibitor -PREFERRED OUT OF THE 3

Metastatic Breast- MBC in combination with endocrine therapy (AI (1st line) or fulvestrant (2nd line) +/- LHRH agonist if premenopausal)

Qtc prolongation, neutropenia/leukopenia, hepatobilliary toxicity,

N/V, infxns, alopecia, anemia, thrombocytopenia, fatigue, weakness, interstitial lung dx

141
Q

Selpercatinib (Retevmo)

A

RET kinase inhibitor, also VEGF

Metastatic breast cancer RET+, thyroid, NSCLC- RET, HCC-RET+, pancreatic-RET+, colorectal (off label, RET+

ADR: hypersensitivity, HTN, interstitial lung dx, hemorrhagic events, liver toxicity, impaired wound healing, edema, QTc (unlike pralsetinib!! Caution with afib)

-avoid acid reducing agents
-take with food if taking with PPI
-3A4 interactions (like pralsetinib)
-wt based dosing
-good response with brain Mets

142
Q

Toremifene (Fareston)

A

SERM

Metastatic breast cancer- infrequently used

143
Q

Triptorelin (Trelstar)

A

LHRH agonist

Breast: premenopausal in combination with AI or tamoxifen for ovarian suppression

144
Q

Tucatinib (Tukysa)

A

HER2 oral TKI- more selective than others (like Neratinib, so less ADRs)

-Breast: refractory metastatic only: HER2+ in combo with trastuzumab + capecitabine
-colorectal (RAS wildtype, HER2+, unresectable/metastatic that progressed on fluoropyrimidine, Oxaliplatin and irinotecan based chemo

Good activity with brain mets

Oral

*strong 3a4 inhibitor, increases scr!!, diarrhea, lfts

145
Q

Bendamustine (Treanda)

A

Alkylating agent (nitrogen mustard)- has purine analog in structure

-Chronic leukemia in combo with rituximab or obinutuzumab
-DLBCL and HL
-indolent lymphomas, WM
-SCLC

Nadir- 3 wks- so we usually give q28d

-Infections, severe rash (3%), infusion rxn, extravasation, secondary malignancy, TLS (incr risk rash w/ allopurinol), hepatotoxicity
-DLT: myelosuppressive
(lymphompenia, neutropenia, thrombocytopenia)
-consider pjp and HSV ppx

-bendeka (over 10 mins) has largely replaced treanda (over 60 minutes)

-cyp1A2
-omit when bridging to CAR-T
-not recommended if crcl <40

146
Q

Melphalan

A

Alkylating agent- nitrogen mustard

Uveal Melanoma (hepatic delivery kit for liver directed therapy)-REMS d/t peri procedural complications

ADRs: Extreme hematologic toxicity, GI toxicity, black box (hemorrhage, hepatocellular injury, thromboembolic events), hypersensitivity, VOD

MM (oral) in non-transplant eligible pts

147
Q

Chlorambucil (Leukeran)

A

Alkylating agent- nitrogen mustard

-Non-preferred option in chronic leukemias
-FL- historical tx

148
Q

Meclorethamine

A

Alkylating agent- nitrogen mustard

-FDA discontinued manufacture of IV form d/t low demand
-there is a topical form for cutaneous T cell lymphoma

149
Q

Busulfan

A

Alkylating agent- alkyl sulfonate

150
Q

Mitomycin

A

Anti tumor antibiotic, alkylating agent-ethylene imine

151
Q

Thiotepa

A

Alkylating agent-ethylene imine

152
Q

Dexamthasone

A

-great for delayed n/v ppx and TREATMENT
-transient increase in wbc d/t demarginalization (also causes immune suppression)
-antipyretic-masks fever
-lymphocytic
-decreases gut and brain edema
-get bx before giving dex for suspected PCNSL (lymphocytic and can cause false negative)
-spinal cord compression: 4 mg IV q6
-use 12 mg instead of 20 mg if with aprepitant/fosaprepitant
-iv push: perineal burning
-eye drops for HD-Cytarabine
-for Pemetrexed rash
-myopathy/muscle weakness
-thrush
-energy/euphoria
-agitation/psychosis
-gi ulcers
-hyperglycemia
-HTN
-caution in n/v for brain tumors bc it decreases BBB inflammation and increases BBB integrity which decreases chemo exposure

-Used in lymphomas (WM- DHAP, MCL- hyperCVAD)
-MM

153
Q

Paclitaxel v docetaxel

A

More with paclitaxel
-peripheral neuropathy
-more lipophilic (hard to get onto solution)

More with docetaxel
-neutropenia
-mucositis
-docetaxel is stronger

Both:
-nail changes
-full body alopecia
-neuropathy is reversible

154
Q

Asparginase

A

ALL

Not myelosuppressive

ADRs: hypersensitivity (can be allergic or non-allergic (d/t ammonia from asparagine breakdown)
-allergic: usually not first dose. Don’t just increase premeds- drug isn’t working if real allergic rxn. Check activity level and Switch to different bacteria (erwinia instead of ecoli) for grade 3+ rxn
-non-allergic: often first dose. Increase premeds

hyperglycemia, Hypertriglyceridemia, hyperammonium, coagulopathy (clotting more and bleeding), hepatotoxicity often transient, pancreatitis

Want enzyme activity level to be at least 0.1 units/mL on day 7

MOA: depletes asparaginase in blood (normal cells can make their own but CA cells need to import it from outside the cell)

Note: Do NOT switch to erwinia for ADRs! Only switch for inactivation or grade 3+ rxn (ADRs also often worse with erwinia)

155
Q

Antithymocyte globulin equine (Atgam)

A

Immunosuppressant

MDS- Aplastic anemia

-infusion rxns
-serum sickness

156
Q

Azacitadine (Vidaza, Onureg)

A

MDS, AML

Hypomethylating agent

Oral form should not be substituted where IV/SQ is used

-IV/SQ for MDS and low intensity AML tx
-PO for AML maintenance ONLY! (int/poor risk who can’t get allo HCT)

Take oral with antiemetic for at least first 2 cycles

157
Q

Cedazuridine/decitabine (Inqovi)

A

MDS NOT AML!!!

Cytosine deaminase inhibitor/hypomethylating agent

Oral

158
Q

Cyclosporine (Gengraf, Neoral)

A

MDS- aplastic anemia

Calcineurin inhibitor

159
Q

Decitabine (Dacogen)

A

MDS, AML

Hypomethylating agent

-IV (but the PO combination product can be used in MDS as well)
-NO SubQ for like azacitadine

160
Q

Deferasirox (Exjade, Jadenu)

A

MDS- for iron overload

Chelating agent

Oral

*CI in high risk MDS d/t ADRs: liver/kidney damage and GI bleeding

161
Q

Deferiprone (Ferriprox)

A

MDS- Second line for iron overload

Chelating agent

Oral

Can cause agranulocytosis- so use is controversial unlike others

162
Q

Deferoxamine (Desferal)

A

MDS- for iron overload

Chelating agent

IM/SQ

Avoid in crcl<40

163
Q

Eltrombopag (Promactra)

A

MDS- for thrombocytopenia if blasts are low, also for aplastic anemia

Thrombopoetin agonist

Oral

Role unclear in MDS- c/f dx transformation and narrow fibrosis. Consider if severe or refractory thrombocytopenia

164
Q

Epoetin alpha (Epogen, Procrit)

A

MDS

ESA

165
Q

Darbepoetin (Aranesp)

A

MDS

ESA

166
Q

Lenalidomide (Revlimid)

A

-MDS- del5q (consider first BEFORE epo level)
-R/R DLBCL
-indolent lymphomas (FL, MCL)
-MM

Immune modulating agent

REMs: pt (even men), MD, pharmacy

ADR: fetal embryo toxicity (even men), thrombotic events may need ppx of Asa or AC-use saved score), hepatotoxicity, cutaneous rxns, TLS, tumor flare, decreased ability to mobilize for HCT w/ >4 cycles for MM, thyroid issues, diarrhea (use bile acid sequestrant), skin hyperpigmentation (black pts), dermatological rxns (rash), peripheral neuropathy,
-secondary malignancies!!
-with or without food

MM
-tx 25 mg QD
-maintenance: 10 mg daily
-dose reduce for renal impairment
-crcl 30-60: 10 mg/d
-crcl <30: 15 mg QOD
-HD: 5 mg QD
should be able to use if crcl >30

167
Q

Luspatercept (Reblozyl)

A

MDS- ring sideroblasts (15%+ or 5%+ if SF3B1 mutation)

Activin receptor ligand trap

Helps w/ anemia but doesn’t modify the disease course

SubQ injection

168
Q

Filgrastim (Neupogen) and pegfilgrastim (Neulasta)

A

Can be used in MDS

Note: always start filgrastim within 72hs

169
Q

Romiplostim (Nplate)

A

Thrombopoetin agonist

MDS- thrombocytopenia if blasts are low, more commonly used in ITP

SQ

Role unclear in MDS- c/f dx transformation and narrow fibrosis. Consider if severe or refractory thrombocytopenia

Seem to be choice over eltrombopag for thrombocytopenia

Goals plt 100-150k

2 mcg/kg

170
Q

Midostaurin (Rydapt)

A

AML

FLT3 inhibitor

FLT3-ITD/TKD mutation in de novo AML

ADRs: pulmonary toxicity, cardiac issues, anemia, nausea

Daily premedications for nausea and air out capsules (bad taste/smell)

Severe 3A4 interaction- avoid w/ Azoles

171
Q

Quizartinib (Vanflyta)

A

AML

FLT3 inhibitor

FLT3-ITD only mutation in de novo AML

Serious ADRs: cardiac toxicity/arrhythmia (EKG), CNS (seizures, confusion), prolonged myelosuppression, higher incidence of early death (first 30 days)

3A4 substrate

172
Q

Gilteritinib (Xospata)

A

AML

FLT3 inhibitor

FLT3-ITD or TKD mutation in relapse or refractory AML

Serious ADRs: differentiation syndrome, arrhythmia (EKG), liver, fever, PRES, myalgia/arthralgias , orthostatic hypotension, inc cpk , pancreatitis, cytopenias

Long half life

173
Q

Olutasidenib (Rezlidhia)

A

IDH1 inhibitor

Relapsed/refractory AML with IDH1 mutation

Serious ADR: differentiation syndrome, hepatotoxicity

-empty stomach
-3A4 inducer

174
Q

Enasidentib (Idhifa)

A

IDH2 inhibitor

De novo or relapsed refractory AML with IDH2 mutation

Serious ADR: differentiation syndrome, can produce Gilbert’s like indirect hyperbilirubinemia, cytopenias, high WBC, pulmonary and/or renal dysfunction

175
Q

Venetoclax (Venclexta)

A

BCL-2 inhibitor

-AML- 28 day courses
-but get marrow at d21-28 and give 7-14 day break if no dx
-CLL- 1st line
-R/R indolent lymphomas (MCL, WM)
-R/R MM- with dex if t(11;14)- dose is higher (800 mg and no ramp up)

ADRs: GI toxicity, PNA, TLS (do ramp up), serious infxns, cytopenias

-DI with azoles! Must dose reduce venetoclax to 70 mg- in AML stop azole when remission attained
-other DIs: carvedilol (50% dec), digoxin (give dig 6 hrs prior)
-PO only
-take **WITH Food!* affects
Absorption

Note: re-ramp up may be needed if interrupted for >1 week

CLL weekly ramp up: 20, 50, 100, 200, 400 mg

AML can consider 3 day ramp up

176
Q

Glasdegib (Daurismo)

A

Hedgehog pathway inhibitor

AML- unfit for intensive therapy- give with LDAC

-need to take birth control!
-cardio toxicity/QTc
-nausea, dysgeusia

177
Q

All-trans-retinoic acid (ATRA)

A

APL

adr: differentiation syndrome, dry skin, LFTs, HLD, pseudotumor cerebri (increases ICP, give acetazolamide), myositis- give steroid

Induces differentiation of APL cells

PO only

178
Q

Arsenic trioxide

A

APL

Serious adr: differentiation syndrome, LFTs, QTc (monitor twice weekly)

Supplement with k+ and mg+ during tx

MOA: DNA fragmentation —>apoptosis
-also degrades fusion protein PML (promyelocytic leukemia)-retinoids receptor alpha)

*use freimingham or fredericka

179
Q

Asparginase erwinia recombinant (Rylaze)

A

ALL

Use only in severe hypersensitivity (grade 3) or antibody inactivation to Peg-asparginase

180
Q

Brexucabtagene autoleucel (Tecartus)

A

CAR-T therapy: Anti-CD19

Relapsed/ refractory B-cell precursor ALL or R/R mantle cell lymphoma (third line after BTK-I)

Risk for CRS and ICANS

Pts shouldn’t drive x8 weeks after infusion

181
Q

Calasparginase (Asparlas)

A

ALL

Longer half life than peg Asparginase but minimal data in adults and AYA so use with caution

Hydrolysis asparagine (normal cells can make but leukemia cells cannot)

182
Q

Cladrabine (Mavenclad, Leustatin)

A

Antimetabolite (purine analog)

AML, hairy cell leukemia, WM

183
Q

Clofarabine (Clolar)

A

Antimetabolite (purine analog)

AML, ALL

184
Q

Cytarabine

A

Antimetabolite (pyramidine analog)

Cell cycle specific

AML, ALL, NHL

ADRs:
-cerebellar toxicity (increased risk with renal impairment, females, and elderly)- THIS IS FOR HIGH DOSE ONLY (1000 mg/m2+)
-conjuctivitis (water soluble)- pre-tx w/ steroid eye drops (dex + nsaid gtts)- ok to rechallenge .
-Ara-C syndrome: give steroids
-avoid if renal failure!

Pearls:
-metabolized by cytidine deaminase- which is everywhere- happens FAST- why we give it continuously otherwise metabolized to ara-U
-rate limiting step in conversion is deoxy-cytidine-kinase- this can be saturated at higher doses (debate about high doses)- after saturation the rest is metabolized to ara-U
-ara-U is responsible to cerebellar toxicity (why it’s seen with high dose but not standard dose)

-liposomal form for IT
-HIDAC 3000 mg/m2 over 3 hr q12 hr x6 doses (on day 1, 3, and 5)
-DLT- myelosuppression

185
Q

Dasatinib (Sprycel)

A

BCR-ABL TKI- gen 2

ALL, CML chronic phase first line

ADR: pleural effusion (could use diuretics), PAH, myelosuppression, QTc!!, PLT inhibition

Better BBB penetration -preferred in lymphoid variant blast phase

contraindicated in V299L mutation

186
Q

Daunorubicin

A

Anthracycline

AML, ALL

Red urine

187
Q

Daunorubicin and Cytarabine (Vyxeos)

A

AML

this is a LIPOSOMAL product so for secondary AML

-higher rates of prolonged thrombocytopenia and neutropenia (but lower rates of serious infxn- maybe protective of microbiota)
-hemorrhage
-copper overload

188
Q

Dexamethasone/prednisone in leukemia

A

Steroids are part of backbone of tx in ALL- has anti leukemic activity

189
Q

Fludarabine (Fludara)

A

Antimetabolite (purine analog)

-AML, CLL 1st line with cyclophos and/or rituximab
-indolent lymphomas (WM, FL)

Dose reduce for crcl<80

190
Q

Gemtuzumab ozogamicin (Mylotarg)

A

Antibody drug conjugate - anti-CD33

AML- if core binding fx: inv (16), t(16;16), t(8;21) (don’t need CD33+ listed)

Risk of venoocclusive dx-permanently d/c, infusion rxn (give premeds)

191
Q

Hydroxyurea (Hydrea)

A

AML, ALL

Used to reduced WBC (>50-100k) when acute leukemia is suspected (cytoreduction)-generally prior to confirmation of subtype

Also for chronic leukemias

Goal is to decrease complications associated with leukostasis (pulmonary and neurological, stroke)

192
Q

Idarubicin (Idamycin)

A

Anthracycline

AML

Many “theoretical” advantages over daunorubicin (uptake, potency, etc.) but not proven to be better

Red urine

193
Q

Imatinib (Gleevec)

A

BCR-ABL TKI- gen 1

ALL, CML (1st line chronic phase), melanoma

Minor: Diarrhea-self limiting, rash, arthralgia, periorbital edema, fatigue

Severe: myelosuppression- transient, hepatotoxicity, worsening hypothyroidism, mild anemia, fetal embryo toxicity (men can still conceive), bone formation. Expensive

With food and large glass of water

194
Q

Inotuzumab ozogamicin (Besponsa)

A

Antibody drug conjugate (anti-CD22)

R/R- ALL

Black box warnings
-Veno-occlusive dx
-higher post HSCT non-relapse mortality
-better than blinatumomab with higher dx burden

195
Q

Mercaptopurine (Purixan)

A

Antimetabolite (purine analog)

ALL maintenance daily (goal ANC 500-1500)- dose adjust in alternative fashion with MTX by 25% for out of range ANC

Aka 6-MP

Must dose reduce 50-90% if given with allopurinol

Same time every day with or without food

196
Q

Nelarabine (Arranon)

A

Antimetabolite (purine analog)

ALL- good for R/R T-cell ALL

Neurotoxicity

197
Q

Peg-Asparginase (Oncaspar)

A

ALL

Hydrolyses asparagine (leukemic cells cannot make)

198
Q

Tagraxofusp-ezrs (Elzonris)

A

Biological response modulator (anti-CD123)

Indication: blastic plasmacytoid dendritic cell neoplasm (BPDCN)

Warning: capillary leak syndrome

199
Q

Thioguanine (Tabloid)

A

Antimetabolite (purine analog)

ALL

-sinosoidal obstructive syndrome
-may need allopurinol (plus dose modification) if skewed metabolism- but dose reduce 50-75% since they interact

200
Q

Axicabtagene ciloleucel (Yescarta)

A

Car-T cell therapy

CD-19

Adults with relapsed/refractory B-cell NHL or R/R follicular lymphoma, R/R MZL

REMS

Pts should not drive x8 weeks after infusion

201
Q

Lisocabtagene maraleucel (Breyanzi)

A

CAR-T cell therapy

CD19

Relapsed refractory B-cell NHL

202
Q

Ciltacabtagene autoleucel (Carvykti)

A

CAR-T cell therapy targeting BCMA

Relapsed/ refractory multiple myeloma

ADR: Parkinsonism

Lymphodeplete with cyclophos and Fludarabine for 3 days, then start 2-4 days later

Premed with APAP and diphen but NOT dex (decreased efficacy)

203
Q

Acalabrutinib (Calquence)

A

BTK inhibitor

CLL- 1st line, R/R
MCL- R/R

ADR: headache (occurs early and resolves in 4-8wks)
Low incidence of bleeding, HTN, and afib (so less ADRs than ibrutinib)

-tablet form released which does NOT interact with PPI/H2- capsule DOES interact- separate 2h before and after

-3A4 substrate

204
Q

Alemtuzumab(Campath)

A

Anti-CD52 mAb

Chronic leukemia via compassionate use program

205
Q

Asciminib (Scemblix)

A

BCR-ABL and STAMP TKI

Chronic phase CML with:
-T315I mutation OR
-resistance or intolerance to 2 prior TKIs

Dose:
-40 mg BID or 80 mg QD
-T315I mutation- 200 mg BID

206
Q

Bosutinib (Bosulif)

A

BCR-ABL TKI- gen 2

CML- chronic phase 1st line

Bone marrow suppression, diarrhea/GI issues

contraindicated in V299L mutation

With food and large glass of water

207
Q

Duvelisib (Copiktra)

A

P13K inhibitor

CLL- R/R after 2 prior lines of therapy

208
Q

Ibrutinib (Imbruvica)

A

BTK inhibitor

-CLL- 1st line
-R/R DLBCL (non-germinal center)
-indolent lymphomas (WM, MZL, R/R MCL)

ADR: bleeding, afib (don’t hold unless grade 3+), HTN
-arthralgia, diarrhea

-NO warfarin- use alternative AC (Apixaban preffered)

-3A4 substrate

209
Q

Idelalisib (Zydelig)

A

P13K Inhibitor

CLL- relapsed, in combo with rituximab

210
Q

Nilotinib (Tasigna)

A

BCR-ABL TKI- gen 2

CML- 1st line chronic phase)

ADR: QTc!!!, GI and liver toxicity

Empty stomach

Only one that is twice daily

Ok in V299L mutation

211
Q

Obinutuzumab (Gazyva)

A

Anti-CD20 mAb

-Chronic leukemias
-FL

212
Q

Ofatumumab (Arzerra)

A

Anti-CD20 mAb

Chronic leukemias CLL?

Exclusively available via patient access Novartis oncology program (PANO)

213
Q

Omacetaxine mepesuccinate (Synribo)

A

Cephalotaxine; protein synthesis inhibitor

CML:
-chronic phase OR
-pts who PROGRESS to accelerated phase (not for de novo- don’t get tripped up)
for resistant or intolerant to 2 TKIs

SubQ BID-ouch!

Hyperglycemia

214
Q

Pentostatin (Nipent)

A

Adenosine deaminase (ADA) inhibitor

Hairy cell leukemia- one of the preferred initial options

215
Q

Pirtobrutinib (Jaypirca)

A

BTK inhibitor

-CLL -R/R
-MCL- R/R after 2+ lines of therapy including BTK-I

Novel mechanism (non-covalent binding)- allows it to work in patients that progressed in prior BTK-I

-ADR: bleeding, afib, cytopenias

-3A4 substrate, increases digoxin (pgp)

216
Q

Ponatinib (Iclusig)

A

BCR-ABL TKI

ALL
CML- chronic phase with:
-T315I mutation drug of choice- 45 mg but decrease to 15 mg when bcr-abl <1%
-resistance or intolerance to 2 TKIs

Risk for arterial thromboembolic events (it has pan-VegF inhibition), pancreatitis, HF, hepatotoxicity

Obtain via Takeda oncology Here2Assist program

217
Q

Zanubrutinib (Brukinase)

A

BTK inhibitor

-CLL- category 1 preferred for second line and subsequent therapy with or without del(17p)/TP53 mutation
-R/R MCL
-First line WN
-second line MZL

ADR: myelosuppression, PNA, upper respiratory tract infxns, cytopenias
-low incidence of bleeding, HTN, and afib (like Acalabrutinib)

-3A4 substrate

218
Q

BiTE

A

Bi-specific t-cell engager

Brings two antibodies together- one side targets t-cell and the other targets the antigen - then T cell kills antigen

Bypasses need to co-stimulation

Usually tried after CAR-T therapy

Off the shelf- no crazy manufacturing like CAR-T

219
Q

Moxetumomab Pasudotox-tdfk

A

R/R hairy cell leukemia after 2+ systemic therapies including purine analogs

Anti-CD22 mAb conjugated to PSA endotoxin

ADR: infusion rxns, capillary leak syndrome, hemolytic uremic syndrome

Give ASA in d1-8 of each cycle

Product provided as two separate vials- so be careful when making!

Drug no longer available for new starts after 7/2023

220
Q

Brentuximab vedotin (Adcetris)

A

Antibody drug conjugate -CD30

Hodgkin’s lymphoma

221
Q

Epcoritamab (Epkinly)

A

Bi-specific antibody- CD20/CD3

R/R DLBCL- third line

-Step up dosing
-SubQ
-hospitalize x24h following first dose of 48 mg (full dose)
-premed: steroid, diphen, APAP for cycle 1
-premed with steroid for all cycles
-continue steroid x3 days following each dose
-CRS, ICANS
-nausea , diarrhea, pyrexia, MSK pain, abdominal pain, serious infxns

222
Q

Glofitamab (Columvi)

A

Bi-specific antibody- CD20/CD3

R/R DLBCL- third line

-Step up dosing
-MUST get pretreatment dose of obinituzumab 7 days prior to first dose
-max 12 cycles (this is finite unlike epcoritimab)
-premeds: steroid, diphen, APAP for first 3 cycles
-APAP and antihistamine in all subsequent cycles
-CRS, ICANS
-serious infection, tumor flare, MSK pain, rash, fatigue

223
Q

Loncastuximab tesirine (Zynlonta)

A

Antibody drug conjugate -CD19 directed antibody with alkylating agent conjugate

R/R DLBCL (2+ prior tx)-third line

-Premeditate with dex 4 mg bid x3 days beginning day before
-dex is used to mitigate edema because LOOP DIURETICS WONT HELP WITH EDEMA (try spironolactone)

224
Q

Polatuzumab Vedotin (Polivy)

A

Antibody drug conjugate -CD79B

R/R DLBCL: PBR regimen

ADR: thombocytopenia, peripheral neuropathy, infusion rxns (90 minute observation and premed), FN (consider G-CSF), opportunistic infections (HSV/PJP ppx), PML, TLS, hepatotoxicity, PNA

3A4 interactions d/t vedotin!!

225
Q

Prednisone

A

Used in DLBCL, PMBL, BL, HL, indolent lymphomas, MM

226
Q

Tafasitamab (Monjuvi)

A

Anti-CE 19 mAb

R/R DLBCL ineligible for auto HCT; tafasitamab w/ Lenalidomide

227
Q

Selinexor

A

Selective inhibitor of Nuclear export (SINE)

MM, 3rd line DLBCL

ADRs: hyponatremia, neurotoxicity, GI toxicity (diarrhea ~14 days in) hemorrhagic events, N/V

-use dual antiemetic ppx (5HT3 + NK-1/OLZ)
-tablets- with or without food

228
Q

Rituximab Hycela

A

SubQ

CLL, DLBCL, FL: all have different administration times and vial sizes

Must have tolerated at least one full dose of IV

229
Q

Mogamulizumab-kpkc (Poteligeo)

A

R/R cutaneous T-cell lymphoma after at least one prior therapy

Selectively binds to CCR4

-worsens autoimmune mediated things like any autoimmune disorder or GVHD- so caution in these patients!

230
Q

90Yttrium ibritumomab tiuxetan (Zevalin)

A

Radiotherapy

Follicular lymphoma

231
Q

Bortezomib (Velcade)

A

Proteosome inhibitor

-MM
-WM

-Can be inactivated by high intake of vitamin C
-peripheral neuropathy (IV>SQ) (usually within 1st 5 cycles it starts)
-reactivation of HSV/VZV- need ppx
-minimum 72h b/w doses
-blepharitis- tx w/ ketotifen or doxycycline
-thrombocytopenia, hypotension, TMA
-weekly preferred for MM tx

232
Q

Carfilzomib (Kyprolis)

A

Proteosome inhibitor

WM, MM

ADR: cardiac and pulmonary toxicity and renal

-Screen for hep b
-HSV/HSV ppx
-Infusion rxn- premeditate w dex (can be immediate or delayed)
-hydration- decrease TLS and AKI
-slower rate decreases cardiopulmonary tox
-need VTE ppx if given w/ dex!
-max BSA 2.2 to calculate dose
-once weekly may be ok
-watch: EF, BP, electrolytes, liver and renal function, thrombocytopenia, TMA, TTP, HUS, PRES, inc tox w/ Melphalan
-much less neuropathy
-IV not SQ
-hydration before 1st cycle (TLS)

233
Q

Copanlisib (Aloqopa)

A

P13K inhibitor

withdrawn from US market

234
Q

Mosunetuzumab-axgb (Lunsumio)

A

Bispecific antibody - CD20/CD3

FL- R/R after 2+ lines of therapy

-step up dosing
-q21 days x8 cycles (up to 17 cycles of only PR)
-premeds: steroid, APAP, h1 blocker (for cycle 1 and 2, optional beyond that
-hospitalization for monitoring is NOT required
-CRS
-neurologic toxicity
-fatigue, rash, pyrexia, HA, Dec lymphocytes and myelosuppression

235
Q

Degarelix vs relugolix

A

Relugolix is oral

236
Q

Flutamide and nilutamide

A

Antiandrogens, less commonly used that bicalutamide d/t tolerability

Flutamide: diarrhea, hematuria, give with LHRH agonist

Nilutamide: diarrhea, disulfiram like rxn, visual issues, interstitial PNA, give with orchiectomy

237
Q

Darolutamide v daratumumab v durvalumab

A

Darolutamide: prostate

Daratumumab: MM

Durvalumab: bladder second line

238
Q

Belantamab-mafodotin-blmf (Blenrep)

A

Antibody drug conjugate

Targets BCMA

Removed from market- available for
Compassion use only for relapsed refractory multiple myeloma

Infusion rxns, ocular toxicity (lubricating eye drops), thrombocytopenia

REMs

Need eye exam before each infusion, need lubricant eye drops, avoid contact lenses

239
Q

Daratumumab (darzalex , Darzalex faspro)

A

Human IgG1k mAb target ring CD38

-HSV/VSV ppx during tx and for 3 months after
-Upper respiratory tract infections
-screen for hep B
-infusion rnxs (more with IV than SQ)
-premeds with APAP, dex, diphen (may omit for SQ staring with 4th dose)
-could use montelukast to decrease infusion rxn
-different volumes for doses 1 v 2 v 3
-SQ is flat dose
-don’t need IV test dose like rituxan
-abdomen over 3-5 mins
-can interfere with blood type and screening

240
Q

Elotuzumab (Emplicit)

A

Humanized IgG1 mAb that targets SLAMF7 protein

Multiple myeloma -NOT given alone (usually with IMID)
-after 1-3 failed therapies (sooner than car-t and BiTEs)

-GI toxicity
-infusion rxns- premed with dex, diphen, APAP

241
Q

Elranatamab-bcmm (Elrexfio)

A

Bi-specific antibody, BCMA, CD3

R/R MM- at least 4 prior lines of therapy including PI, immunomodulatory agent, and Anti CD38

Step up dosing (like teclistimab), hospitalize and monitor x48 and 24h for doses 1 and 4 respectively

Premeditate with dex, APAP, and diphen before step up doses (prevents CRS)

REMs for CRS and ICANS

Given alone (like teclistimab and talquetamab, unlike elotuzumab)

242
Q

Idecabtagene vicleucel (Abecma)

A

CAR-T targeting BCMA

MM

Lymphodeplete with cyclophos and Fludarabine for 3 days, then start 2 days later

Premed with APAP and diphen but NOT dex (decreased efficacy)

243
Q

Isatuximab-irfc (Sarclisa)

A

Chimeric IgG1 mAb that binds CD38

R/R MM

-HSV/VZV ppx during tx and for 3 months after
-premeds for infusion rxn
-hep B screening
-can interfere w/ blood typing
-infusion rxns
-upper respiratory tract infections
-diarrhea

244
Q

Ixazomib (Ninlaro)

A

Proteosome inhibitor

MM

-HSV/VZV ppx
-ADRs: GI toxicity (N/V/D), fluid retention, dermatological toxicity, peripheral neuropathy (less than velcade)
-oral- capsules
-take on Empty stomach

245
Q

Pomalidomide (Pomalyst)

A

Immunomodulating agent

MM

ADR: dermatological toxicity, myelosuppression, VTE (ppx)
(Less diarrhea and rash than revlimid)

REMS- teratogen

246
Q

Talquetemab-tgvs (Talvey)

A

Bispecific GPRC5D directed CD3 t-cell engager

R/R MM- at least 4 prior therapies including PI, immunomodulatory agent, anti-CD38

Step up dosing for CRS- hospitalized x48h after each step up

Premeds with dex, APAP, diphen (CRS PPX)

REMs for CRS and ICANS

skin and nail toxicity

Given alone (like teclistimab and elrantamab , unlike elotuzumab)

247
Q

Teclistamab (Tecvayli)

A

Bispecific antibody- BCMA and CD3

R/R MM- 4+ prior therapies including PI, immunomodulatory agent, anti- CD38 mAb

CRS ppx: dex + APAP + diphenhydramine (PREVENTS CRS)

ADR: infections (acyclovir, often pjp ppx too), CRS, neurotoxicity

Step up dosing and hospitalization x48h after each dose increase

REMs- CRS/neurotoxicity (ICANS)

Given alone (like elrantamab and talquetamab, unlike elotuzumab)

Approved for new technology add on payment for limited time

248
Q

Thalidomide (thalomid)

A

Immunomodulatory agent

MM

ADR: constipation, peripheral neuropathy, neurotoxicity (sedation), VTE (give ppx)

REMs- teratogen

-Capsules- empty stomach at bedtime
-does not require week off like Lenalidomide and pomalidomide
-no renal or hepatic adjustments

249
Q

Calcitonin

A

Hypercalcemia of malignancy

4-8 units/kg q6-12hr IM or SQ

Onset: 2-4 hrs

Tachyplylaxis- limit to 48h max

nasal form is NOT effective

Not used alone!!

250
Q

Dexrazoxane (for extravasation)

A

-Start within 6 hours
-remove cold packs for at least 15 minutes before, and during tx

251
Q

Aldesleukin (Proleukin)

A

IL-2

Melanoma

Not used much d/t toxicity and low response

Capillary leak syndrome

252
Q

Binimetinib (Mektovi)

A

MEK inhibitor

Melanoma, NSCLC

Ocular toxicity, decrease LVEF

253
Q

Cobimetinib (Cotellic)

A

MEK inhibitor

Melanoma (with vemurafenib)

Highest rates of ADRs of all BRAF/MEK inhibitors: rash, transaminitis, may decreased LVEF

254
Q

Dabrafenib (Tafinlar)

A

BRAF inhibitor

Melanoma, ovarian, thyroid, NSCLC, HCC

ADRs: fever, chills, flu-like symptoms, QTc, hand/foot syndrome, ocular toxicity

-empty stomach
-DDIs: clarithromycin, estrogens/progestins
-hyperglycemia
-alopecia
-arthralgias
-fever- antipyretics, steroids, maybe dose reduction

255
Q

Nivolumab + relatlimab (Opdualag)

A

PD-1 inhibitor + lymphocyte activation gene-3 (LAG3) blocking antibody

Melanoma

Relatlimab only available in this combination

256
Q

Talimogene laherparepvec (Imlygic)

A

Oncolytic virus

Melanoma- unresectable stage III, satellite or in transit lesion

Local injection site rxns

-caution: viral transmission:
-blood may be infectious
-urine is infections day of inj
-avoid contact w/ tx site
-wear gloves, keep covered x 1 wk
-dispose of stuff in sealed plastic bag
-keep covered x1 week
-wash hands
-avoid acyclovir and antiherpetics
-intralesional injection
-fever, chills, fatigue, cellulitis

257
Q

Tebentafusp (Kimmtrak)

A

gp100 targeted Bispecific T cell engager

Melanoma- HLA-A*02:01 pts only - I believe this is uveal melanoma

ADRs: itching/rash (give topical steroid, antihistamine, and maybe oral steroid), CRS

First BiTE for solid tumor

First 3 doses require observation for 16 hours

258
Q

Vemurafenib (Zelboraf)

A

BRAF inhibitor

Highest rate of AES of all BRAF/MEK combos: rash, transaminitis, QTc

Melanoma (with Cobimetinib)

259
Q

Trametinib (Mekinst)

A

MEK inhibitor

Ovarian, Melanoma, thyroid, NSCLC-MEK, HCC

ADR: may decrease LVEF, dermatological toxicity (rash), fevers, ocular toxicity, anemia
-empty stomach
-Refrigerate

260
Q

Rolapitant

A

Nk1 blocker

Not an inhibitor!

Oral

261
Q

Sargramostim

A

GM-CSF

Stimulates granulocytes and macrophages

-Primarily for HCT
-also indicated in AML

262
Q

Eflapegrastim

A

Long acting G-CSF

263
Q

Cetuximab (Erbitux)

A

EGFR inhibitor

-Head/neck
-colorectal (KRAS wildtype)

-Rash, acneform rash, skin/hair/nail toxicity, diarrhea, low mg
-Hypersensitivity (inc risk in southeast US, more than with panitumumab d/t chimeric structure opposed to humanized)- Need Benadryl premed
-check alpha gal IgE (don’t tx if positive)-from lone star tick bite, or develops antibodies!
-hypomagnesemia!!!

264
Q

Toripalimab-tpzi (Loqtorzi)

A

PD-1 inhibitor

Metastatic/recurrent nasopharyngeal carcinoma (with cisplatin/Gemcitabine)- or single agent if progression on platinum

265
Q

Pralsetinib (Gavreto)

A

RET kinase inhibitor, also VEGF

Thyroid, NSCLC- RET

ADRs: interstitial lung dx, HTN, hemorrhagic events, liver toxicity, wound healing impairment, HTN, edema, TLS, bone marrow suppression, electrolyte abnormalities, increased CK, edema

-empty stomach
-many 3A4 interactions

266
Q

Vandetanib (Caprelsa)

A

Multi kinase inhibitor (VEGF, EGFR, RET)

Thyroid- mainly MTC

ADR: cardiotoxicity, HTN, HF, dermatological toxicity, GI toxicity, bleeding risk, hypothyroidism
-REMS: d/t QTc risk

267
Q

Benzydamine

A

Mucositis prevention in RT

Not approved in United States

268
Q

RAI

A

Papillary and follicular thyroid cancer

NOT for MTC or anaplastic

-stop levoxyl and do iodine free diet beforehand
-N/V
-xerostomia
-infertility (especially men) no preganancy x1 yr after
-risk of secondary cancer
-there is a max lifetime dose

269
Q

Memantine

A

Give in BC concurrently with WBRT and x6 months after to delay cognitive decline

270
Q

Adagrasib (Krazati)

A

KRAS inhibitor

-NSCLC- KRAS G12C mutation after 1 prior line of therapy
-biliary tract and pancreatic cancers (KRAS G12C mutated)
-colorectal (KRAS G12C, usually with EGFR-I)

ADRs: significant nausea, diarrhea, QTc
Others: edema, hepatotoxicity

Penetrates CNS

271
Q

Afatinib (Gilotrif)

A

EGFR inhibitor

NSCLC-advanced/metastatic- preferred first line if EGFR S768I, L861Q, or G719x

ADRs: rash, diarrhea,, alopecia, dry skin, conjunctivitis, paronchymia, pneumonitis, hepatotoxicity, GI perforation, ocular disorders

-empty stomach
-renal dose adjustment

272
Q

Alectinib (Alecensa)

A

ALK inhibitor

NSCLC- ALK

ADRs: fatigue, constipation, edema, myalgia, visual disturbance, pneumonitis, GI toxicity, hepatotoxicity, bradycardia, QTc

-with food
-anemia
-weight gain

273
Q

Amivantamab (Rybrevant)

A

Bispecific antibody targeting: EGFR and MET inhibitor

NSCLC- exon 20 insertion mutation after failure of platinum based chemo
NCCN preferred for 1L in combo with chemo

Premeds: dex (prior to wk 1 d1-2, then optional), diphen, APAP- still everyone reacts!- can rechallenge on day 2

ADRs: Rash, paronychia, MEK pain, dyspnea, nausea, fatigue, edema, stomatitis, cough, constipatin, vomiting

Give via peripheral line for first 2 cycles (infusion rxns), then can do central after that

274
Q

Capmatinib (Tabrecta)

A

MET inhibitor

NSCLC- MET exon 14 skipping mutation

ADRs: edema (hallmark), photosensitivity, hematologic toxicity, inc scr, significant nausea, ILD, hepatotoxicity

-bottle only good for 6 weeks after opening
-DDI: 3A4, PPI (unlike tepotinib)
-BID (shorter half life)
-likely has CNS penetration

275
Q

Cemiplimab (Libtayo)

A

PD-1 inhibitor

-NSCLC- first line locally advanced or metastatic dx with PD-L1 50%+, also in combo with chemo for 1L (no PD-L1 requirement)
-locally advanced basal cell carcinoma after hedgehogs pathway inhibitor (sonidegib) or if hedgehog inhibitor is not appropriate
-SCC (skin cancer): locally advanced or metastatic not candidates for surgery or RT

276
Q

Ceritinib (Zykadia)

A

ALk inhibitor, ROS1

ADRs: fatigue, constipation, edema, myalgia, visual disturbance, pneumonitis, GI toxicity, hepatotoxicity, bradycardia, QTc

-450 mg WITH FOOD
-moderately emetogenic
-more GI ADRs
-CNS penetration
-

277
Q

Dacomitinib (Vizimpro)

A

EGFR inhibitor

NSCLC- EGFR

ADRs: rash, diarrhea,, alopecia, dry skin, conjunctivitis, paronchymia, pneumonitis, hepatotoxicity, GI perforation, ocular disorders

-more toxicity compared to others
-DDI: PPI/H2

278
Q

Encorafenib (Braftovi)

A

BRAF inhibitor

-NSCLC- BRAFV600E (with binimetinib)
-colorectal (BRAFV600E- in combo with cetuximab or panitumumab)

Specific guidelines for dose reductions with CYP3A4 inhibitors

279
Q

Erlotinib (Tarceva)

A

EGFR inhibitor

-NSCLC-EGFR- -can be combined with bevacizumab or ramucirumab (unlike others)
-pancreatic (not used in clinical practice)

ADRs: rash, diarrhea,, alopecia, dry skin, conjunctivitis, paronchymia, pneumonitis, hepatotoxicity, GI perforation, ocular disorders

-increased AC with warfarin
-DDI: PPI/H2
-inc clearance with smoking
-empty stomach

280
Q

Gefitinib (Iressa)

A

EGFR inhibitor

NSCLC- EGFR

ADRs: rash, diarrhea,, alopecia, dry skin, conjunctivitis, paronchymia, pneumonitis, hepatotoxicity, GI perforation, ocular disorders

-increases AC with warfarin
-more diarrhea
-mail changes

281
Q

Lurbinectedin (Zepzelca)

A

Alkylating agent

SCLC- subsequent lines

Very well tolerated despite PI highlighting hepatotoxicity and myelosuppression

282
Q

Necitumumab (Portrazza)

A

EGFR- inhibitor

NSCLC- squamous (in combination with gem-cis)

Removed from NCCN guidelines

283
Q

Osimertinib (Tagrisso)

A

EGFR inhibitor

NSCLC- EGFR exon 19 deletion or L858R
-IB-IIIA COMPLETELY RESECTED (negative margins) who received prior adjuvant chemo
-advanced/metastatic: first line- preferred over others
-advanced/metastatic: second line if T790M and not already used

ADRs: rash, diarrhea,, alopecia, dry skin, conjunctivitis, paronchymia, pneumonitis, hepatotoxicity, GI perforation, ocular disorders

-Less ADRs than others overall
-increases QTc
-decrease LVEF
-high CNS penetration
-hematologic toxicity (transient decrease in plts)
-increased pneumonitis if given after ICI

284
Q

Ramucirumab (Cyramza)

A

VEGF inhibitor

-NSCLC
-HCC: AFP >400 and child Pugh A only
-gastric/esophageal- second line adeno only
-colorectal (less data than bevacizumab)

Considerations:
-high risk VTE and upper GI bleed for pts with upper GI cancers
-HTN and Diarrhea

285
Q

Sotorasib (Lumakras)

A

KRAS inhibitor (RAS GTPase family inhibitor)

-NSCLC- KRAS G12C mutation- locally advanced or metastatic after 1+ line of prior therapy
-colorectal (off label, KRASG12C, give with EGFR-I if able)

ADRs: hepatotoxicity, diarrhea, inc urine protein, hematologist toxicity, ILD

DDI: PPI/antacids, 3A4

286
Q

Tremelimumab (Imjudo)

A

CTLA4 inhibitor

-NSCLC- in combo with Durvalumab + chemo
-unresectable HCC- in combo with Durvalumab

287
Q

Tepotinib (Tepmetko)

A

MET inhibitor

NSCLC- MET exon 14 skipping mutation

ADRs: edema (more than capmatinib and not responsive to diuretics), hypoalbuminemia, hematologic toxicity, hepatotoxicity

-with food! (Unlike capmatinib)
-daily (longer half life)

288
Q

Mobocertinib

A

EGFR inhibitor

NSCLC- EGFR exon 20 insertion mutation
-oral (unlike amivantamab)

ADRs: nausea, QTC, ILD, classic EGFR ADRs, edema, HF

WITHDRAWN FROM MARKET

289
Q

Which drugs that are also MET inhibitors?

A

Crizotinib and Cabozantinib

We know capmatinib and tepotinib are

290
Q

Futibatinib (Lytgobi)

A

FGFR inhibitor

Cholangiocarcinoma with FGFR2 fusion or rearrangement

Hyperphosphatemia

291
Q

Liposomal irinotecan (Onivyde)

A

Topo-I inhibitor

-Pancreatic with 5FU
-Biliary tract cancer with 5FU

Rates of diarrhea and myelosuppression are pretty similar to regular irinotecan, so no huge toxicity benefit

Not a 1:1 dose conversion with conventional

More expensive

292
Q

Pemigatinib (Pemzayre)

A

FGFR inhibitor

Cholangiocarcinoma with FGFR2 fusion or rearrangement

Hyperphosphatemia

293
Q

Uridine triacetate

A

Antidote for 5FU and capecitabine (competes for intervention into RNA)

Give within 8-96 hours

Interferes with RNA false base pair activity

  1. Can use for catastrophic overdose (not just finishing a bit early) more for pump malfunction of capecitabine suicide attempt, or
  2. immediately found to have DPD deficiency (severe ADR with FIRST exposure)

Q6h for 20 doses (5 days)

294
Q

Lanreotide (Somatuline depot)

A

Somatostatic analog

Pancreatic cancer- used in PNET for symptom and tumor control

295
Q

Octreotide (Sandostatin depot)

A

Somatostatin analog

Pancreatic cancer- used in PNET for symptom and tumor control

For chemo diarrhea
-grade III-IV or persistent despite loperamide
-100-150 mcg TID (up to 500 TID) or continuous infusion 25-50 mcg/hr
-wean off, don’t stop abruptly (biliary colic)

296
Q

Trifluridine/tipiracil (Lonsurf)

A

Antimetabolite (pyramidine analog)/thymidine phosphorylase inhibitor

-gastric/esophageal- third line adeno only
-colorectal (may use with bevacizumab)

ADR: myelosuppression, fatigue

Consider barriers to taking in a pt with upper GI cancer (crush-ability, absorption)

Dose based on trifluridine component (round down)

Need CBC on day 1 and 15 of each cycle (dose adjust based on neutrophil count)

297
Q

Vismodegib

A

Locally advanced or metastatic basal cell carcinoma that has recurred after surgery or is not a candidate for surgery or RT

-taste changes, weight loss, muscle spasms, fatigue, GI

298
Q

Sonidegib

A

Hedgehog pathway inhibitor

Locally advanced basal cell carcinoma that has recurred after surgery or is not a candidate for surgery or RT

-taste changes, muscle spasms, inc CK, weight loss, fatigue, GI

299
Q

Fruquintinib (Fruzaqla)

A

VEGF- TKI

Colorectal cancer- metastatic dx after fluoropyrimidine, Oxaliplatin, and irinotecan based chemo, and anti-VEGF therapy and and EGFR therapy (if RAS wildtype)

-VEGF toxicities
-increased triglycerides/cholesterol, thrombocytopenia, infections
-more selective than regorafenib (and probably less toxicities)

300
Q

Panitumumab (Vectibix)

A

EGFR inhibitor

Colorectal cancer (only if KRAS wildtype)

-Skin/hair/nail toxicities are most common especially acniform rash
-diarrhea
-hypomagnesemia!!
-paronychia, mucositis

301
Q

Ziv-aflibercept

A

VEGF inhibitor

Colorectal cancer- only given with irinotecan based regimen

Most people use bevacizumab for the VEGF, this is an option but is more expensive and there is less data)

302
Q

Vorinostat

A

Cutaneous T-cell lymphoma

His tone deacetylase inhibitor

-GI (n/v/d), anemia, thrombocytopenia

303
Q

Romidepsin

A

Cutaneous T-cell lymphoma and peripheral T-cell lymphoma

Histone deacetlyase inhibitor

QTc prolongation, -GI (n/v/d), anemia, thrombocytopenia

Withdrawn from US market for PTCL but still somehow available for CTCL and listed in NCCN

304
Q

Pralatrexate

A

Antimetabolite

Peripheral T cell lymphoma and cutaneous T cell lymphoma

305
Q

Belinostat

A

Peripheral T cell lymphoma

Histone deacetylase inhibitor

306
Q

Ibritumomab tiuxetan

A

“Other” regimen for subsequent line follicular lymphoma

307
Q

Epflapegrastim and efbemalenograstim

A

Single dose G-CSF

There should be at least 14 days between dose and next chemo cycle (unlike pegfilgrastim which is 12 days)

308
Q

Methylene blue

A

Reversal agent for ifosphamide neurotoxicity

309
Q

Methylene blue

A

Reversal agent for ifosphamide neurotoxicity

310
Q

Repotrectinib

A

NSCLC- ROS-1 positive

With or without food

Good activity against G2032R and D2033N mutations in ROS1

Dizziness, dysgeusia, peripheral neuropathy, constipation, dyspnea, ataxia, fatigue, cognitive d/o, MSK weakness

Warnings: CNS effects, interstitial lung dx, hepatotoxicity, myalgia and CK elevation, hyperuricemia, fractures, embryo fetal tox

3A4 substrate AND inducer
Pgp substrate

BCOP- Joey (10 decks)

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