Exam 3 - Colorectal Cancer

Question 1

List risk factors for colorectal cancer?

Answer 1

PMH of polyps, IBD (IC, CD), family history, genetics (FAP, HNPCC/Lynch syndrome), smoking, heavy alcohol use (decreases folic acid stores), physical inactivity

Question 2

List socieconomic/age risk factors for colorectal cancer?

Answer 2

diabetes, obesity, diet (high in red/processed meats), increasing age, race

Question 3

List signs/symptoms of colorectal cancer?

Answer 3

bright red or dark blood in stool, change in bowel habits, abdominal discomfort, N/V

Question 4

What is the MOA of leucovorin (folinic acid)?

Answer 4

stabilizes fdUMP binding to thymidylate synthase

Question 5

What is the MoA of capecitabine (Xeloda)?

Answer 5

prodrug of 5-FU

Question 6

What is the MoA of 5-fluorouracil?

Answer 6

inhibits thymidylate synthase

Question 7

What are AEs of capecitabine (Xeloda)?

Answer 7

renal impairment dose adjustments, hyperbilirubinemia, diarrhea, Hand-foot syndrome, mucositis

Question 8

What is a CI for capecitabine (Xeloda)?

Answer 8

dihydropyrimidine dehydrogenase (DPD) deficiency

Question 9

What is the MoA of oxaliplatin (Eloxatin)?

Answer 9

platinum analog, non cell-cycle specific alkylating agent

Question 10

What are AEs of oxaliplatin (Eloxatin)?

Answer 10

peripheral neuropathy, cold intolerance/sensitivity, myelosuppression

Question 11

What are treatments for oxaliplatin-induced neuropathy? (3)

Answer 11

eating/drinking at room temp, GABA analogues, SNRIs (duloxetine)

Question 12

What is the MoA of irinotecan (Camptosar)?

Answer 12

topoisomerase-1 inhibitor

Question 13

What are AEs of irinotecan (Camptosar)?

Answer 13

DIARRHEA, fatigue, alopecia, myelosupression (neutropenia)

Question 14

What are treatments for acute phase irinotecan-induced diarrhea?

Answer 14

atropine, diphenoxylate/atropine

Question 15

What is treatment for delayed phase irinotecan-induced diarrhea?

Answer 15

loperamide

Question 16

What is the MOA of bevacizumab (Avastin)?

Answer 16

recombinant, humanized MoAb to VEGF-A

Question 17

What is the MOA of Ziv-aflibercept (Zaltrap)?

Answer 17

fusion protein that inhibits VEGF-A/B

Question 18

What are AEs of bevacizumab (Avastin)?

Answer 18

HTN, delayed wound healing, proteinuria, hemorrhage (epistaxis), VTE

Question 19

What is a CI for bevacizumab (Avastin)?

Answer 19

uncontrolled HTN

Question 20

What is the MOA of ramucirumab (Cyramza)?

Answer 20

VEGF-R2 inhibitor

Question 21

What are AEs of ramucirumab (Cyramza)?

Answer 21

similar to other VEGF inhibitors

Question 22

List EGFR inhibitors? (2)

Answer 22

cetuximab (Erbitux), panitumumab (Vectibux)

Question 23

What are AEs of EGFR inhibitors?

Answer 23

infusion-related reactions, hypomagnesemia, paronchyia, aceniform rash

Question 24

What is the MOA of regorafenib (Stivarga)?

Answer 24

multikinase inhibitor

Question 25

What are AEs of regorafenib (Stivarga)?

Answer 25

fatigue, weight loss, diarrhea, hand-foot syndrome, HTN, infection

Question 26

List anti-HER2 therapies?

Answer 26

trastuzumab + pertuzumab or lapatinib

Question 27

What is the MOA of trifluridine + tipiracil (Lonsurf)?

Answer 27

interferes with DNA synthesis and inhibits cell proliferation by incorporation into DNA

Question 28

What are AEs of trifluridine + tipiracil (Lonsurf)?

Answer 28

myelosuppression, anemia, fatigue, N/V/D

Question 29

List immunotherapy options for colorectal cancers? (2)

Answer 29

nivolumab (Opdivo), pembrolizumab (Keytruda)

Question 30

What are AEs of nivolumab (Opdivo) and pembrolizumab (Keytruda)? (6)

Answer 30

rash, colitis, hepatitis, nephritis, pneumonitis, thyroid disorders

Question 31

What are treatments used for a BRAF mutation? (2)

Answer 31

cetuximab (Erbitux), encorafenib (Braftovi)

Question 32

What is treatment for Stage I colorectal cancer?

Answer 32

surveillance

Question 33

What is treatment for Stage II colorectal cancer?

Answer 33

surgery and consider adjuvant therapy in high risk (FOLFOX, CapeOX, capecitabine, 5-FU/leucovorin)

Question 34

What is treatment for Stage III colorectal cancers?

Answer 34

surgery with chemotherapy (FOLFOX, CapeOX (preferred); capecitabine, 5-FU/leucovorin)

Question 35

What is the duration of FOLFOX therapy in high risk Stage III colorectal cancers? Low risk?

Answer 35

6 months; 3-6 months

Question 36

What should NOT be used in Stage III colorectal cancers? (2)

Answer 36

targeted therapies, irinotecan

Question 37

What is treatment for Stage IV colorectal cancers?

Answer 37

chemotherapy (FOLFOX or FOLFIRI or CapeOx with additional drugs depending on cytogenetics)