Oncology Common Cancer Types and Treatment

Question 1

What is the difference between complete response and partial response?

Answer 1

Complete - treatment destroyed all known tumor cells

Partial - at least 30% of the tumor was eliminated

Question 2

What is neoadjuvant therapy

Answer 2

Radiation or chemo given before surgery to shrink tumor

Question 3

What is the most common primary therapy for cancer?

Answer 3

Surgery

Question 4

What is adjuvant therapy?

Answer 4

radiation and/or chemo given after surgery in attempt to eradicate residual disease

Question 5

What do BRCA1 and BRCA2 genes do?

Answer 5

Suppress tumor growth

Mutations prevent cell repair and cause drastic increase in breast cancer incidence

Question 6

What is Klinefelter Syndrome and what cancer does it cause a high incidence of?

Answer 6

When a male has one Y and two or more X chromosomes
Causes men to be infertile and produce more estrogen
Higher risk of breast cancer

Question 7

What hormonal therapy is used in pre and post menopausal women with breast cancer?

Answer 7

Pre - Tamoxifen (first line)

Post - Aromatase inhibitor (anastrozole nad letrozole); tamoxifen second line

Question 8

What SERM is used for breast cancer prophylaxis, not treatment?

Answer 8

Raloxifene

Question 9

What cancer medications are SERMs? What cancers are they used in?

Answer 9

Tamoxifen
Fulvestrant
Breast

Question 10

SERM BBW, CI, SE

Answer 10

BBW: increased risk of uterine or endometrial cancer and thromboembolic events
CI: pregnancy (tamoxifen)
SE: hot flashes/night sweats, vaginal bleeding/spotting, decreased bone density, supplement with calcium/vitamin D with tamoxifen

Question 11

What medications are aromatase inhibitors

Answer 11

Anastrozole (Arimidex)
Letrozole
Exemestane

Question 12

Aromatase SE, CI

Answer 12

CI: pregnancy
SE: hot flashes/night sweats, arthralgia/myalgia, osteoporosis, higher risk of CVD

Question 13

What medication are cyclin-dependent kinasae (CKD4/6) inhibitors

Answer 13

Palbociclib
Abemaciclib
Ribociclib

Question 14

Aromatase inhibitor MOA

Answer 14

inhibits conversion of androgens to estrogens

Question 15

CDK4/6 MOA

Answer 15

inhibits downstream signalling of tumor growth

Question 16

What PSA level indicates prostate cancer?

Answer 16

> 10

Question 17

What medications are hormonal therapies used for prostate cancer? What if hormonal therapy does not work?

Answer 17

Androgen deprivation therapy
GnRH agonist +/- antiandrogen
GnRH antagonist

Castration resistant - use chemo

Question 18

What medications are GnRH agonists?

Answer 18

Leuprolide
Goserelin

aka LHRH agonists

Question 19

GnRH agonist MOA

Answer 19

stimulate production of GnRH (and consequently testosterone) then stop production through negative feedback

Question 20

GnRH agonist SE and notes

Answer 20

SE: hot flashes, impotence, gynecomastia, bone pain
Note: tumor flare - can given with antiandrogen for several weeks

Question 21

What medications are GnRH antagonist

Answer 21

Degarelix

Question 22

GnRH antagonist SE and notes

Answer 22

SE: osteoporosis risk - consider Ca and Vit D supplementation
Note - no tumor flare

Question 23

What medications are antiandrogens?

Answer 23

First generation: bicalutamide, flutamide, nilutamide

Second gen: Apalutamide, darolutamide, enzalutamide

Question 24

What medications are androgen biosynthesis inhibitors?

Answer 24

Abiraterone

Question 25

Abiraterone (Zytiga) MOA

Answer 25

interferes with specific CYP-17 enzyme to decrease testosterone production ***MUST be taken with prednisone to prevent hyperaldosteronism

Question 26

BSA calculation

Answer 26

Square root of: Ht (cm) x Wt (kg) ------------------------- 3600

Question 27

What metabolite of cyclophosphamide and ifosfamide causes hemorrhagic cystitis?

Answer 27

acrolein

Question 28

What chemo medications are alkylating agents?

Answer 28

Cyclophosphamide, ifosfamide, carmustine, busulfan

Question 29

Alkylating agent BBW, SE

Answer 29

BBW: Hemorrhagic cystitis SE: pulmonary toxicity

Question 30

What chemo medications are platinum-based compounds?

Answer 30

Cisplatin | Carboplatin

Question 31

What body fluid discoloration can doxorubicin cause?

Answer 31

Red urine, tears, sweat, and saliva

Question 32

What body fluid discoloration can mitoxantrone cause?

Answer 32

Blue urine and sclera

Question 33

What chemo medications are anthracyclines

Answer 33

Doxorubicin | Mitoxantrone

Question 34

What medications are topoisomerase I inhibitors

Answer 34

Irinotecan | Topotecan

Question 35

What medications are topoisomerase II inhibitors

Answer 35

Etoposide | Bleomycin

Question 36

What medications are vinca alkaloids

Answer 36

Vincristine | Vinblastine

Question 37

What chemo medication is fatal if administered intrathecally?

Answer 37

Vincristine | Must be administered in IV bag to prevent accidental intrathecal administration

Question 38

What chemo medications are taxanes?

Answer 38

Paclitaxel Docetaxel Cabazitaxel Paclitaxel

Question 39

Why does docetaxel need to be premedicated with dexamethasone

Answer 39

To prevent severe fluid retention

Question 40

What chemo meds are pyrimidine analog antimetabolites?

Answer 40

Fluorouracil "5-FU" | Capecitabine (Xeloda)

Question 41

Pyrimidine analog antimetabolites CI adn SE

Answer 41

CI: CrCl <30 SE: hand-foot syndrome, diarrhea, mucositis

Question 42

What chemo meds are folate antimetabolites?

Answer 42

Methotrexate

Question 43

What is the methotrexate antidote?

Answer 43

Glucarpidase (Voraxaze)

Question 44

Methotrexate BBW, SE, and drug interactions

Answer 44

BBW: myelosuppression, renal damage, hepatotoxicity, GI toxicicty, teratogenicity SE: Nephrotoxicity, hepatotoxicity, nausea, mucositis Drug interactions: NSAIDs, salicylates

Question 45

Arsenic trioxide SE

Answer 45

QT prolongation

Question 46

What medications are mTOR inhibitors

Answer 46

Everolimus and temsirolimus

Question 47

mTOR inhibitor MOA

Answer 47

inhibit downstream regulation of vascular endothelial growth factor (VEGF) reducing cell growth, metabolism, proliferation and angiogenesis

Question 48

Everolimus SE

Answer 48

Mouth ulcers/stomatitis, rash, interstitial lung disease, peripheral edema, dislipidemia, increased BP

Question 49

What cancer medications are CAR T-cell gene therapies?

Answer 49

Axicabtagene ciloleucel

Question 50

What cancer medications are Immunomodulators?

Answer 50

Lenalidomide Pomalidomide Thalidomide

Question 51

Immunomodulator BBW

Answer 51

Fetal risk/pregnancy

Question 52

What cancer medications are protease inhibitors

Answer 52

Bortezomib and carfilzomib

Question 53

What medications are VEGF inhibitors?

Answer 53

Bevacizumab (Avastin) | Ramucirumab

Question 54

VEGF inhibitor BBW and SE

Answer 54

BBW: severe/fatal bleeding, GI perforation SE: impaired wound healing, do not give 28 days before or after surgery

Question 55

HER2 inhibitor medications

Answer 55

Trastuzumab (Herceptin) | Pertuzumab

Question 56

EGFR inhibitor medications

Answer 56

Cetuximab | Panitumumab

Question 57

Leuocyte CD antigens medications

Answer 57

Rituximab

Question 58

PD-1 inhibitor medications

Answer 58

Pembrolizumab (Keytruda) Nivolumab Atezolizumab Durvalumab

Question 59

CTLA-4 inhibitor medications

Answer 59

Ipilimumab

Question 60

Tyrosine kinase inhibitor (TKI) medications and common toxicities

Answer 60

``` Lapatinib, neratinib, sorafenib, sunitinib Hypothyroidism QT prolongation Rash HTN Hand-foot syndrome Hepatic toxicity Diarrhea ```