Lung Cancer Pharm

Question 1

EGFR mutations are evident in a significant number of what types of cancer?

Answer 1

Adenocarcinoma

Question 2

High risk of bleeding in squamous cell lung cancer associtated with what drug?

Answer 2

Bevacizumab

Question 3

What is the significance of activating a tyrosine kinase receptor in a cancer cell

Answer 3

If the ligand is bound by the receptor, transphosphorylation of two tyrosine residues occurs and this signal can be transduced to the nucleus where it effects transcription that can cause uncontrollable growth/avoidance of apoptosis.
TKIs try to prevent this

Question 4

Resistance to Tyrosine Kinase Inhibitors can occur how

Answer 4

Via EGFR mutation which leads to

• Change in binding site receptor
• compensatory phosphorylation of the Tyr Kinase binding site via MET, HGFR
• or HGF taking assuming an independent role in signaling

Question 5

What are some other ways that cells can be insensitive to TKI

Answer 5

Via proliferative signals arising from downstream events via KRAS or BRAF mutations

Question 6

EML4-ALK Translocation

Answer 6

Fuses the EML4 and ALK genes leads to activation of the Mek/Erk pathway and cell proliferation

Question 7

Why is VEGF a good drug target?

Answer 7

Prevents good vasculature from reaching the tumor site

Question 8

Genetic testing for KRAS, EGFR, and ALK rearrangement have become necessary for adherence to treatment guidelines

Answer 8

truth

Question 9

EGFR and ALK testing only recommended for ppl with what type of tumors

Answer 9

Adenocarcinoma

Question 10

The US preventative service task force recently suggested what

Answer 10

smokers age 55-80 with over 30 pack year history of smoking should receive low dose CT scans to look for possible tumors

Question 11

What process is sued to test for EGFR mutations

Answer 11

DNA sequencing

Question 12

What process is used to test for ALK gene rearrnagement

Answer 12

FISH

Question 13

ALK rearrangements are more common in smokers or non-smokers

Answer 13

non-smokers

Question 14

Treatment plan for SCLC

Answer 14

Metastasis ocurs early in small cell lung cancer to chemotherapy is the only option

Question 15

NSCLC treatment

Answer 15

surgical resection if there has been no metastasis. Use chemo in adjuvant role when you need to reduce the bulk of the tumor prior to surgery and eradiate micrometastasis
Prevent growth and metastasis

Question 16

Standard chemo for SCLC

Answer 16

Etoposide + Cisplatin or Carboplatin

Question 17

NSCLC treatment

Answer 17

Cisplatin and Paclitaxel

AND EGFR TKI’s for pts with +EGFR genetic test

Question 18

Maintenance therapy for NSCLC pts who have responsive tumors

Answer 18

Pemetrexed

Question 19

What are the two nitrogen mustards?

Answer 19

Cyclophosphamide and Ifosfamide

Question 20

Mechanism of action for cyclophosphamide/Ifosfamide

Answer 20

Bind to the N7 of Guanine and Alkylate DNA producing inter/intra strand crosslinks that prevent DNA replication

Question 21

Ifosfamide differs from cyclophosphamide in regards to adverse effects how?

Answer 21

No risk of pulmonary fibrosis and less renal toxicity

Question 22

WHAT MUST BE GIVEN WITH Cyclophosphamide

Answer 22

Mesna…protects against acrolein product and prevents bladder tumors and urotoxicity

Question 23

Platinum drugs are

Answer 23

Cisplatin and Carboplatin

Question 24

Platinum drugs MOA

Answer 24

Same as Nitrogen Mustards (cyclophosphamide and Ifosfamide)

Question 25

Cisplatin Toxicity

Answer 25

Renal, ototoxic, peripheral neuropathy

Question 26

Carboplatin toxicity

Answer 26

myelosuppresive, ANEMIA, INFECTION

Question 27

Folic Acid Analogs

Answer 27

Methotrexate, Pemetrexed

Question 28

How do methotrexate and pemetrexed work?

Answer 28

Dihydrofolate reductase inhibition, inhibits DNA synthesis

Question 29

Give what with methotrexate and pemetrexed?

Answer 29

Leucovorin- causes metabolic rescue

Question 30

What kind of drug is Gemcitabine and how does it work>

Answer 30

Pyrimidine analog, DNA polymerase inhibitor causing inhibition of chain elongation

Question 31

Toxicity associated with Gemcitabine?

Answer 31

“Hand-Foot” syndrome

Question 32

The two vinca alkyloids are

Answer 32

Vincristine and Vinorelbine

Question 33

Vinca alkyloids MOA

Answer 33

bind to beta tubulin to cause metaphase arrest and apoptosis. Prevent microtubule assembly.

Question 34

Vincristine adverse effects

Answer 34

GI stasis, impaction

Intrathecal admin can be fatal, neurotoxicity

Question 35

Camptothecin analogs

Answer 35

irinotecan and topoteca

Question 36

How do irinotecan and topotecan work?

Answer 36

They stabilize DNA topoisomerase I cleavable complex causing single and double strand DNA breaks

Question 37

Toxicity of Camptothecin analogs

Answer 37

extrvasational toxicity (fluid leaking), GI toxicity,

Question 38

Etoposide mechanism

Answer 38

form complex with topoisomerase II and DNA

Question 39

BBW for Etoposide

Answer 39

myelosuppression, bleeding, opportunistic infection

Question 40

Paclitaxel

Answer 40

Bind to beta tubulin to prevent microtubule disassembly.

Question 41

Bevacizumab

Answer 41

anti-VEGF, binds to VEGF, prevents receptor activation, anti angiogenesis/neovascularization

Question 42

Big side effect for Bevacizumab

Answer 42

hemorrhage (can be life threatening esp with squamous cell

Question 43

Erlotinib

Answer 43

Reversible inhibitor for EGFR

Question 44

WHat do you always give with Doxorubicin to relieve cardiotoxicity

Answer 44

Dexroxazone…iron chelator

Question 45

What do you give with Cisplatin and carboplatin q

Answer 45

Amifostine