Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHAR359 > Oncology 2 > Flashcards

Oncology 2 Flashcards

(89 cards)

Start Studying
1
Q

What is targeted drug therapy?

A

targeted cancer therapies block the growth and spread of cancer by interfering with specific molecules involved in tumor growth and progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is personalized medicine?

A

development and use of targeted therapy specifically in individuals known to have the mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the impact of gonadal hormones on some cancers?

A

some cancer cell growth is stimulated by gonadal hormones
-breast cancers (test for E and P receptors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cornerstone of managing prostate cancer?

A

androgen deprivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which cancers are hormone treatments used in?

A

breast cancer
endometrial cancer
ovarian cancer
uterine sarcomas
prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the hormonal treatments used for breast cancer?

A

tamoxifen
-oral SERM
anastrozole, exemestane, letrozole
-oral aromatase inhibitors
goserelin acetate
-SC GnRH agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the MOA of tamoxifen?

A

SERM
-E antagonist in breast tissue
-E agonist in endometrium
cancer cell proliferation is prevented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In which cancer settings is tamoxifen used?

A

adjuvant (curative) and metastatic (not curative) settings for hormone receptor (ER or PR) positive breast cancers
-also used for breast cancer in men
-also used in gynecological cancers
-also used in sarcomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In which women is adjuvant tamoxifen used?

A

premenopausal women
-systematic overviews of RCTs evaluating the effects of adjuvant tamoxifen for early breast cancer have shown increases in 10 yr survival and DFS survival rates in pts receiving 20-40 mg daily for 1-5 yrs or longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the evidence for tamoxifen dosages exceeding 20 mg daily?

A

no indication that dosages exceeding 20 mg daily were more effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the dose for tamoxifen?

A

20 mg po once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the magnitude of benefit from extended tamoxifen therapy in women with lower-stage breast cancer?

A

because the risk for breast cancer recurrence following 5 yrs of therapy is low in pts with small tumors compared to those with large tumors, the magnitude of benefit derived from the extended therapy is expected to be lower in pts with lower-stage disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is tamoxifen used in the palliative setting for breast cancer?

A

palliative setting of metastatic breast cancer
-used in premenopausal women at 20 mg once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When are aromatase inhibitors used for breast cancer?

A

postmenopausal women with breast cancer
-consistently shown to improve outcomes vs tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side effects of tamoxifen?

A

flushing, hot flashes (take AM)
hypertension
skin rash
fluid retention
nausea (hs, gets better, metoclopramide)
mood changes
arthralgia, arthritis
vaginal dryness or discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the serious adverse effects of tamoxifen?

A

DVT, PE, stroke
uterine cancer
risk increased in women 50 yrs and older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is tamoxifen metabolized to its active moiety?

A

metabolized to active moiety (endoxifen) via CYP 2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the drug interactions of tamoxifen?

A

2D6 inhibitors
-ex: bupropion, fluoxetine, paroxetine, quinidine
-decreased [ ] of active metabolite
anticoagulants
-potentiates bleed risk with warfarin
grapefruit juice
-inhibits 3A4 metabolism of tamoxifen = toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the MOA of aromatase inhibitors?

A

potent and selective nonsteroidal aromatase inhibitor
-prevents conversion of androstenedione to estrone and conversion of testosterone to estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In which cancer settings are aromatase inhibitors used?

A

postmenopausal women in both adjuvant and metastatic breast cancer settings
-treatment of choice for adjuvant hormonal therapy to lower risk of breast cancer recurrence in postmenopausal women with early stage HR+ breast cancer
-also used in gynecological cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

True or false: there is a clinically meaningful difference between the aromatase inhibitors

A

false

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the adverse effects of aromatase inhibitors?

A

hot flashes and flushing
hypertension
osteopenia and osteoporosis
weakness, arthralgia
fatigue
less risk for DVT than tamoxifen
nausea/vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the use of goserelin acetate for adjuvant breast.

A

ovarian function suppression for premenopausal women at high risk for a new breast primary with HR+ disease to combine with an aromatase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe use of goserelin acetate for metastatic breast.

A

use as a bride to oophorectomy in premenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which agent is used for women not at a high risk of breast cancer recurrence?
tamoxifen
26
What is the most commonly diagnosed cancer in men?
prostate cancer -responsible for < 10% of cancer deaths -incidence is strongly correlated with age
27
What are the symptoms of prostate cancer?
difficulty urinating dribbling after finishing urinating need to urinate often pain and blood during urination difficulty having or maintaining erection unplanned wt loss and appetite pain or stiffness in lower back, hips, pelvis
28
What are the risk factors for prostate cancer?
older age (65+) African American > Caucasian family history obesity
29
What are the treatment options for prostate cancer?
watchful waiting -no tx and physician monitors growth with blood tests, rectal exams, biopsies radiation therapy -external beam RT or internal RT (brachytherapy) radical prostectomy -surgery to remove the whole prostate gland hormone therapy chemotherapy
30
What are the hormonal treatment options for prostate cancer?
GnRH agonists -leuprolide acetate (IM), goserelin acetate (SC), relugolix (oral) GnRH antagonist -degarelix (SC) CYP17 inhibitor -abiraterone (oral) antiandrogens -apalutamide, darolutamide, enzalutamide, bicalutamide (oral)
31
What is the cornerstone of prostate cancer therapy?
hormone therapy -androgen deprivation therapy
32
What is the goal of hormonal therapy for prostate cancer?
reduce serum testosterone to castrate levels -testosterone causes the prostate tumor to grow -objective tumor response 80-90% -duration of response is highly variable
33
What is the MOA of leuprolide and goserelin in prostate cancer?
down regulation of hypothalamus-pituitary axis -reduce serum testosterone almost as much as bilateral orchiectomy
34
What is seen initially with leuprolide or goserelin in prostate cancer?
initial "flare" response -coprescribe bicalutamide for initial 14-30 days
35
In which prostate cancer settings is leuprolide or goserelin used?
either as neo-adjuvant and/or adjuvant treatment with a maximum duration of 3 yrs indefinitely in prostate cancer for metastatic setting
36
What is the MOA of degarelix in prostate cancer?
blocks receptors in pituitary decreasing secretion of LH and FSH = rapid decrease in testosterone production -reduces testosterone level more rapidly than LHRH agonists
37
What is the difference between degarelix and leuprolide/goserelin at the initiation of prostate cancer treatment?
degarelix does not have the initial flare -no need for bicalutamide
38
What are the adverse effects of androgen deprivation therapy?
urinary symptoms gynecomastia hot flashes decreased libido erectile dysfunction fatigue, wt gain, loss of muscle mass osteopenia and osteoporosis MI, prolonged QT
39
What is the indication for abiraterone?
metastatic castration-sensitive prostate cancer in combination with prednisone and ADT -may continue until disease progression or unacceptable toxicity metastatic castration-resistant prostate cancer in combination with prednisone
40
What is the MOA of abiraterone?
selectively inhibits CYP17 -blocks androgen production in testes, adrenal glands and tumor -decreases cortisol production which increases ACTH leading to accumulation of mineralocorticoids (HTN, hypokalemia, edema)
41
Why does abiraterone need to be co-administered with prednisone?
to prevent compensatory rise in ACTH
42
What is the MOA of androgen receptor blockers?
bicalutamide, flutamide: -competitively inhibit androgen binding to receptor enzalutamide and apalutamide: -competitively inhibit androgen binding to receptor -also inhibit nuclear translocation of the AR and inhibit AR-mediated binding to DNA
43
What is the difference between the prefix, substem, and suffix in the nomenclature of mAbs?
prefix: random = gives unique name substem: designate the target suffix: for all mAbs = mab *name = prefix + substem + suffix
44
Differentiate the different substems for mAbs.
-ci(r)- : circulatory system -li(m)- : immune system -t(u)- : tumor -os :bone
45
Differentiate the source of the mAb based on the suffix.
-ximab: chimeric -zumab: humanized -mumab: fully human
46
Differentiate humanized and chimeric mAbs.
humanized: -small but critical parts of the CDR are from non-human sources but larger constant regions of the heavy and light chains are human-derived -generally > 90% human sequence chimeric: -Fc part of the Ig molecule is of a human sequence -generally > 65% human sequence
47
What is the pro of a mAb being more similar to human sequence?
less likely it is to elicit an immune reaction (decrease infusion reactions)
48
What are the targets of mAbs in cancer?
cell surface antigen: -CD20 -EGFR -HER2 plasma protein: -VEGF
49
What are the indications for mAbs in cancer?
hematological malignancies solid tumors
50
How are mAbs best administered?
mAbs are proteins, so generally best administered parenterally -some IV (bevacizumab) -some SC and IV (rituximab, daratumumab)
51
Is it possible to co-administer more than one mAb?
it is possible although this should only be done in situations in which the combination has been demonstrated to have greater efficacy -pertuzumab + trastuzumab in HER2+ breast cancer along with a taxane
52
What is the most common type of reaction to IV-administered mAbs?
infusion reactions
53
When do infusion reactions typically develop to mAbs?
within 30 min-2hrs after the initiation of drug infusion -sx may be delayed for up to 24h majority of rxns occur after the 1st or 2nd exposure to the agent
54
What are the signs and symptoms of infusion reactions?
fever and/or shaking chills flushing and/or itching alterations in HR and BP dyspnea or chest discomfort back or abdominal pain NVD skin rashes
55
What is the second most common type of non-Hodgkin lymphoma?
follicular lymphoma
56
What is the typical response to therapy in follicular lymphoma?
the vast majority of pts treated for FL will have an initial response to therapy with 40-80% demonstrating a complete response -however, conventional therapy for FL is not curative and most will develop progressive disease
57
What is used in the treatment of relapsed or refractory FL?
anti-CD20 mAbs in combo with different chemo regimens -numerous studies demonstrated superior response rates when rituximab was added to conventional chemotherapy
58
Which anti-CD20 mAbs are used in relapsed or refractory FL?
rituximab or obinutuzumab
59
What is the MOA of anti-CD20 mAbs?
complement-dependent cytotoxicity antibody-dependent phagocytosis direct cell death antibody-dependent cellular cytotoxicity
60
When is obinutuzumab used for indolent lymphomas?
when there is resistance to rituximab
61
What is rituximab resistance?
failure to respond to, or progression during, any previous rituximab-containing regimen or progression within 6 months of the last rituximab dose
62
Which mAb is a bifunctional antibody?
blinatumomab
63
What is the MOA of blinatumomab?
binds to CD19 present on precursor B-cell ALL cells AND binds to CD3 on T cells -potentially recruiting cytotoxic T cells to kill the ALL cells
64
Which cancers see the overexpression, dysregulation, or mutations in members of the HER family?
colorectal head and neck small cell lung cancers *EGFR has become of one of the most popular cancer treatment targets*
65
What are examples of EGFR inhibitor mAbs?
cetuximab panitumumab
66
What is the MOA of EGFR mAbs?
inhibit dimerization -stops proliferation, angiogenesis, metastasis, and inhibition of apoptosis
67
What are the indications for cetuximab?
locally advanced unresectable or metastatic, non-mutated all RAS colorectal cancer as a single agent or in combo with irinotecan -also combined with radiation in head and neck squamous cell cancer
68
Which EGFR mAb is better for colon cancer?
it is not clear which drug is better
69
What is the indication for panitumumab?
single agent or in combo with irinotecan for tx of pts with non-mutated RAS
70
What is the main difference between cetuximab and panitumumab?
cetuximab is a chimeric mAb panitumumab is a completely human mAb -lower incidence of hypersensitivity rxns (no predmedication needed)
71
What is the MOA of VEGF mAbs?
bind to and neutralize VEGF to decrease VEGF signaling in pts with malignancy
72
What is an example of a VGEF mAb?
bevacizumab
73
What are the indications for bevacizumab?
advanced colorectal advanced ovarian and cervical recurrent glioblastoma combo with atezolizumab in advanced liver
74
What are the adverse effects of bevacizumab?
hypertension bleeding cerebral and myocardial infarction proteinuria
75
What is a notable property of bevacizumab?
extremely long half-life of 17-21 days after IV infusion
76
Which mAb has high affinity for VEGFR2?
ramucirumab
77
What are the indications for ramucirumab?
advanced gastric cancer and gastroesophageal adenocarcinomas
78
What are adverse effects of ramucirumab?
infusion reactions are common hypertension bleeding diarrhea
79
What is overexpressed in many breast cancers?
~ 20% of breast cancers overexpress HER2
80
What criteria should be used to select patients for HER2-targeted agents?
either 3+ staining by IHC or evidence of HER2 gene amplification by FISH is a strong predictive factor for sensitivity to HER2-targeted agents
81
What are the anti-HER2 mAbs?
trastuzumab pertuzumab
82
Differentiate the MOA of trastuzumab and pertuzumab.
trastuzumab blocks HER2 dimerization pertuzumab blocks heterodimerization
83
What is used for HER-2 positive breast cancer?
trastuzumab and pertuzumab
84
What is an adverse effect of HER2 mAbs?
decreased LVEF
85
What are antibody-drug conjugates?
mAbs can be used to deliver a drug or a toxin to a specific site, which may be especially useful for cell killing in cancer therapy -drugs or toxins are typically attached to the Ig molecule using covalent binding to prevent premature dissociation before reaching the target cell
86
What is an example of an ADC using trastuzumab?
trastuzumab emtansine (T-DM1) -ADC composed of trastuzumab, a thioether linker, and the antimicrotubule agent DM1 -DM1 = cytotoxic (no chemo needed)
87
What is the use of T-DM1?
early stage (adjuvant) and metastatic HER2+ breast cancer
88
What is the MOA of T-DM1?
emtansine released in cell and inhibits microtubule polymerization
89
What is an ADC that is used for advanced bladder cancer?
enforumab vedotin

PHAR359 (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions