Fancher

Question 1

What enzyme metabolizes Codine to its active form, Morphine?

Answer 1

CYP2D6

Question 2

Who should recieve CYP2D6 genotype testing?

Answer 2

1. treatment is needed in > 2 weeks
2. indicated for procedure

Question 3

What other opioids are affected by CYP2D6 variants due to also being metabolized to a more active form?

Answer 3

1. Tramadol
2. Hydrocodone
3. Oxycodone

Question 4

What gene variation is associated with an increased rate of adverse events with NSAIDs?

Answer 4

CYP2C9

Question 5

What CYP2C9 phenotypes are associated with decreased clearance and increased half life?

Answer 5

1. Intermediate Metabolizer
2. Poor Metabolizer

Question 6

What is a germline mutation?

Answer 6

inherited mutation

Question 7

What is a somatic mutation?

Answer 7

mutation in tumor tissue

Question 8

What are germ line oncology mutations?

Answer 8

1. TMPT
2. DPYD
3. UGT1A1
4. CYP2D6

Question 9

What does decreased TMPT activity put patients at greater risk of?

Answer 9

increased risk of life-threatening toxicities with Thiopurines (bone marrow suppression)

Question 10

What does decreased activity of DPYD put patients at greater risk for when taking Fluoropyrimidines?

Answer 10

increased risk of life-threatening toxicities (bone marrow suppression, mucositis, diarrhea

Question 11

What is the active metabolite that causes acute cholinergic diarrhea with Irinotecan?

Answer 11

SN-38

Question 12

What gene is associated with decreased metabolism of the SN-38 metabolite?

Answer 12

UGT1A1*28

Question 13

What SEs are more common in those with homozygous UGT1A1*28 taking Irinotecan?

Answer 13

1. severe diarrhea
2. neutropenia

Question 14

Who should be tested for UGT1A1*28 before starting Irinotecan?

Answer 14

everyone; standard of care

Question 15

What gene metabolizes Tamoxifen to several active metabolites?

Answer 15

CYP2D6

Question 16

What is the outcome of CYP2D6 poor metabolizers taking Tamoxifen?

Answer 16

decreased response to drug; more likely to have breast cancer recurrence

Question 17

What are somatic mutations in oncology?

Answer 17

1. Her2 neu in breast cancer
2. KRAS in colon cancer
3. EGFR in lung cancer
4. BRAF in metastatic melanoma
5. NTRK in cancer

Question 18

What is a prognostic marker?

Answer 18

how the patient’s disease will behave, expected survival

Question 19

What is a predictive marker?

Answer 19

if a patient will respond to a given drug

Question 20

Is Her2 predictive or prognostic?

Answer 20

both

Question 21

What medications are used if Her2 positive?

Answer 21

Trastuzumab HERCEPTIN
Pertuzumab PERJETA

Question 22

IS KRAS predicted or prognostic?

Answer 22

both

Question 23

What medications are used if KRAS is wild type?

Answer 23

Cetuximab ERBITUX
Panitumumab VECTIBIX

Question 24

What does EGFR mutation indicate?

Answer 24

mutation results in activation of tyrosine kinase resulting in constant proliferation of malignant cells

Question 25

Is EGFR mutation prognostic or predictive?

Answer 25

predictive

Question 26

What medications are added to chemo if EGFR mutation?

Answer 26

Erlotinib TARCEVA Gefitnib LRESSA Afatinib GILOTRIF

Question 27

What medication can be given if EGFRT790M mutation is present?

Answer 27

Osimertinib TAGRISSO

Question 28

When do we test for EGFR mutation?

Answer 28

stage 4 metastatic cancer

Question 29

What is the outcome of BRAF mutation?

Answer 29

activation of protein results in constant proliferation of mailgnant cells

Question 30

Is BRAF predictive or prognostic?

Answer 30

predictive

Question 31

What medications are used if BRAF mutated?

Answer 31

Vemurafenib ZELBORAF Dabrafenib TAFINLAR

Question 32

When are patients tested for BRAF?

Answer 32

everyone with metastatic cancer

Question 33

Is NTRK predictive or prognostic?

Answer 33

predictive

Question 34

What medication can be used for NTRK mutation?

Answer 34

Larotrectinib VITRAKVI