Oncology: Oncology II: Common Cancer Types & Treatment Flashcards
(145 cards)
1
Q
Complete response is when
A
treatment has destroyed all known tumors
2
Q
Partial response is when
A
at least 30% of tumor has been eliminated
3
Q
BRCA1 and BRACA2 Gene mutations
A
normally genes suppress tumor growth
mutations prevent cell repair and inc breast cancer mutations
4
Q
Klinefelter syndrome
A
Men with 1 Y, and multiple X
higher risk of breast cancer
5
Q
Hormone-sensitive cancer treatment
A
treated with adjuvant (endocrine) therapy for 5-10yrs to suppress cancer recurrence
6
Q
1st line adjuvant txm for premenopausal females with hormone-sensitive cancer
A
tamoxifen
7
Q
SERM for breast cancer prevention in post menopausal females at risk for cancer?
A
Raloxifene
also inc bone density, indicated for osteoporosis prevention but not 1st line due to hot flashes/risk of blood clots
8
Q
Why are Aromatase inhibitors not useful in premenopausal women
A
AIs reduce estrogen production by blocking aromatase enzyme, but dont block ovarian estradiol production
9
Q
HER2 overexpression
A
oncogene that promotes breast tumor growth
20% of breast tumors over express HER2 on cell surface
10
Q
SERMs Boxed warnings
A
inc risk of uterine or endometrial cancer
inc risk of thromboembolic events
QT prolongation
11
Q
SERMs Contraindications
A
Dont use w/ warfarin = tamoxifen
Hx of DVT/PE = tamoxifen/raloxifene
pregnancy/breast feeding = raloxifene
QT prolongation = tamoxifen
12
Q
SERMs side effects
A
Hot flashes
night sweats
vaginal bleeding/spotting
vaginal discharge/dryness/itchy
dec libido
weight gain
Dec bone density, supplement with calcium/vit D
Tamoxifen = teratogenic
13
Q
Selective Estrogen Receptor Degrader (SERD)
A
Fulvestrant (Faslodex)
14
Q
Fulvestrant (Faslodex) SE
A
SE: inc LFTS, hot flashes, injection site pain
15
Q
Aromatase inhibitors
A
Anastrazole
Letrozole
Exemestane
16
Q
Aromatase inhibitors info
A
Higher risk of osteoporosis
higher risk of CVS compared to SERMs
17
Q
Aromatase inhibitors CI and SE
A
CI: pregnancy
SE: hot flashes/night sweats, arthralgia/myalgia
18
Q
CDK4/6 inhibitors
A
Palbociclib
Abdemaciclib
Ribociclib
19
Q
CDK4/6 inhibitors warnings & SE
A
Warnings: interstitial lung disease
SE: Neutropenia, anemia, nausea, diarrhea, fatigue, alopecia, blurred vision
Risk of TE events
20
Q
Prostate Specific Antigen levels
A
> 4 = might be prostate cancer
4 - 10 = overlaps with BPH too
10 = prostate cancer likely
21
Q
tumor flare in prostate cancer
A
When giving GnRH agonist, causes initial inc of T so its given with anti androgen, after awhile T drops and anti androgen can be stopped
due to negative feedback loop
22
Q
GnRH agonists
A
Leuprolide (Lupin)
Goserelin (Zoladex)
Histrelin (Supprelin)
Triptorelin (Trelstar)
23
Q
GnRH agonist Contraindications
A
Pregnancy
breastfeeding
24
Q
GnRH agonist side effects
A
Hot flashes
impotence
gynecomastia
bone pain
QT prolongation
25
GnRH antagonist
Degarelix (Firmagon)
Relugolix (Orgovyx)
26
GnRH antagonist unique concerns
Osteoporosis. risk, consider vit D/calcium supp
No tumor flare, dont need anti androgen
27
GnRH antagonist CI and SE
CI: pregnancy
SE: similarly to GnRH agonist, Hot flashes, impotence, gyno, bone pain etc
28
1st gen anti androgen boxed warnings
Hepatotoxicity (Flutamide)
interstitial pneumonitis (nilutamide)
29
1st gen anti androgen meds
Bicalutamide
Flutamide
Nilutamide
30
1st gen anti androgen side effects
hot flashes
gyno
31
2nd gen anti androgen meds
Apalutamide (Erleada)
Darolutamide (Nubeqa)
Enzalutamide (Xtandi)
32
2nd gen Anti androgen warnings
seizures
myocardial ischemia
QT prolongation
can cause fetal harm
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2nd gen Anti androgen side effects
HTN
peripheral edema
hot flashes
fatigue
34
Androgen Biosynthesis inhibitor
Abirateron (Zytiga)
35
Abirateron (Zytiga) side effects
mineralocorticoid excess
hepatotoxicity
36
Which patients body weight should be used for chemo dosing
their actual body weight
37
Cell cycle independent agents
Alkylating agents
platinum based compounds
Anthracyclines
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Alkylating agents work by.....
cross-linking DNA strands and inhibiting protein synthesis and DNA synthesis
can cause DNA mutations and lead to secondary malignancies
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Alkylating agents
Cyclophosphamide
Ifosfamide (Ifex)
Carmustine/Lomustine
Busulfan (Myleran)
Mitomycin
40
Cyclophosphamide and Ifosfamide unique concerns
Hemorrhagic cystitis = adequate hydration and use Mesna
Mesna given prophylactically with Ifosfamide and high dose cyclophosphamide
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Alkylating agent boxed warnings
Myelosuppresion
Hemorrhagic cystitis
pulmonary toxicity = carmustine
neurotox = ifosfamide
hepatic necrosis = dacarbazine
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Alkylating agents warnings
severe skin reactions, SJS/TEN
reactivation of infections = HBV, CMW, TB, HSV
hepatotoxicity
43
Alkylating agent side effects
Pulmonary toxicity = busulfan, carmustine/lomustine
Mod-high emetic potential
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Mitomycin unique concerns
vesicant, antidote is DMSO and cool compresses
IV = hazy blue and make piss blue/green
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Mitomycin Boxed warnings
bone marrow suppression
hemolytic uremia syndrome
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Mitomycin CI
thrombocytopenia
coagulopathy
bleeding
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Mitomycin SE
N/V
fatigue
alopecia
mucos membrane toxicity
leukopenia
48
Platinum based therapies
Cisplatin
Carboplatin
Oxaliplatin
49
Platinum based therapies common side effects
peripheral sensory neuropathy
ototoxicity
nephrotoxicity
50
Which platinum based therapy has highest risk of nephrotoxicity and CINV
Cisplatin
51
Cisplatin unique concerns
Nephro/Ototoxicity = cumulative
Amifostine = chemoprotectant used to prevent nephrotoxicity
highly emetic
52
Cisplatin boxed warnings
Anaphylactic like reactions, inc with repeated exposures, caution when > 6 cycles used
Cisplatin doses > 100mg/m2/cycle = check by provider
myelosuppresion
53
Oxaliplatin unique concerns
cold sensitivity = drinking cold beverages, eating ice cream etc
54
Platinum based therapies side effects
peripheral neuropathy
inc LFT
N/V
QT prolongation = oxaliplatin
55
Anthracyclines
Doxorubicin (Adriamycin)
Doxorubicin liposomal
Mitoxantrone
56
Doxorubicin unique concerns
potent vesicant
drug is red = discoloration of sweat, tears, urin
total lifetime dose not to exceed 450-550mg/m2
Dexrazoxane = for extravasation/chemoprotectant
57
Doxorubicin, other - ubicins boxed warnings
myocardial toxicity
vesicant
myelosuppresion
secondary malignancy
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Doxorubicin, other -ubicins side effect
N/V - use antiemetics
59
Doxorubicin liposomal boxed warning and side effects
Boxed warning: myocardial toxicity
SE: hand-foot syndrome
60
Is liposomal doxorubicin interchangeable with regular?
no
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Mitoxantrone boxed warning
myocardial toxicity
62
Cell-cycle specific agents
Topoisomerase I & II inhibitor,Vinca alkaloids, Texans, Pyrimidine Analog Antimetabolites, folate antimetabolites
63
Topoisomerase I inhibitors work by.....
block the coiling and uncoiling o the double stranded DNA helix during the S phase of the cell cycle
64
Topoisomerase I inhibitors
Irinotecan
Topotecan
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Irinotecan boxed warnings
myelosuppresion
use only when ANC > 1500 and platelets > 100K
Diarrhea (Early and Late)
66
Irinotecan side effects
N/V/D
alopecia
diarrhea
abdominal pain
67
Topoisomerase II inhibitors
Etoposide
Bleuomycin
68
Topoisomerase II inhibitors work...
same as Topo I inhibitor, just work on Topo II
69
Etoposide unique concerns
Infusion rate related hypotension, give over atleast 30-60min
IV prep < 0.4 mg/ml to avoid precipitation
70
Etoposide boxed warnings
myelosuppression
71
Etoposide Side effects
Hypersensitivity reactions
anaphylaxis
secondary malignancies
72
Bleomycin unique concerns
max lifetime dose of 400 units due to pulmonary toxicity
not myelosuppresive
premedication used
73
Bleomycin boxed warnings
Pulmonary fibrosis
anaphylaxis
74
Bleomycin side effects
hypersensitivity reaction
pulmonary reactions
N/V
Chills
Fever
75
Vinca alkaloids work by....
inhibiting function of microtubules during the M phase of cell cycle
76
VinCrisitine is associated with....
more CNS toxicity than other vinca alakaloids
77
vinBlastine and vinorelBine are associated with....
more bone marrow suppression than vincristine
78
Vinca Alkaloids
Vincristine
Vinblastine
79
Vincristine is often capped at what dose?
2mg/dose
80
Vinca Alkaloid boxed warnings
Vesicants
IV admin only
81
Vinca Alkaloid side effects
peripheral sensory neuropathy
autonomic neuropathy
82
Taxanes work on.....
inhibit the function of microtubules during the M phase of the cell cycle
83
Taxanes include....
Paclitaxel (Abraxane)
Docetaxel
Cabazitxel (Jevtana)
84
Docetaxel unique concerns
premeditate w/ steroids for 3 days starting 1 day prior
severe fluid retention
85
Taxane boxed warnings
Severe hypersensitivity reactions = not Paclitaxel
myeliosuppresion
86
Pyrimidine analog antimetabolite mechanism
inhibits pyrimidine synthesis during the S phase of the cell cycle
87
Pyrimidine analog antimetabolites meds
Fluorouracil 5-FU
Capecitabine (Xeloda)
Gemcitabine
88
Fluorouracil, 5-FU unique concerns
Leucovorin given with to inc efficacy
89
Capecitabine Boxed warnings
Significant inv in INR and up to 1 month after treatment
90
Capecitabine contraindications
severe renal impairment, CrCl < 30
91
Pyrimidine analog antimetbolite side effects
Hand-foot syndrome
diarrhea
mucosities
caridotox
photosensitivtiy
dementia
92
Folate antimetabolites work by
interfering with enzymes involved in the folic acid cycle, blocking purine and pyrimidine biosynthesis during the S phase
93
Folate antimetabolite medications
Methotrexate (Trexail)
Pemetrexed (Alimta)
Pralatrexate (Folotyn)
94
Methotrexate Boxed warnings
myelosuppressio
renal dmage
hepatotoxicity
GI toxicity
teratogenic
95
Methotrexate side effects
Nephrotoxicity = dose related
hepatotoxicity
nausea
diarrhea
stomatitis
mucositis
96
Levoleucovorin vs Leucovorin dosing
Levoleucovorin is given at 1/2 the dose of Leucovorin
97
Methotrexate antidote
Glucarpidase
98
Methotrexate drug interactions
all dec clearance of methotrexate
NSAIDs
Salicylates
Beta lactase
PPI
sulfonamide ABX
probenacid
99
MAbs that target VEGFs
"ci"
Bevacizumab
Ramucirumab
100
MAbs that target EGFR
"Tu"
Cetuximab
Panitumumab
101
MAbs that target HER2
"Tu"
Trastuzumab
Pertuzumab
102
MAbs that target CD20/CD30
"Tu"
Rituximab
Brentuximab
103
MAbs that target immune system (PD-1, PD-L1, CTLA-4)
"li"
Ipilimumab
Pembrolizumab
104
Bevacizumab (Avastin) unique concerns (VEGF)
impairs wound healing, dont give 28 days prior or after surgery
105
Bevacizumab (Avastin) boxed warnings (VEGF)
Severe/fatal bleeding
GI perforation
106
Trastuzumab (Herceptin) unique concerns (HER2)
test for HER2 expression
monitor LVEF
107
Trastuzumab (Herceptin) boxed warnings (HER2)
HF
embryo-fetal death = avoid preg 7 months after txm
severe infusion related reasons
108
Cetuximab (Erbitux) unique concerns (EGFR)
test for EGFR expression and KRAS
KRAS wildtype = poor response colorectal cancer
109
Cetuximab (Erbitux) boxed warnings
Severe/fatal infusion related reactions
cardiac arrest
110
Cetuximab (Erbitux) side effects
acneiform rash
SJS/TEN
ocular toxicities
N/V/D
111
Cetuximab (Erbitux) notes
rash occurs in 1st 2 weeks of treatment, patient expected to have better response
avoid sunlight, use sunscreen
112
Rituximab (Rituxan) unique concerns
premeditate with Tylenol, Benadryl, steroid
113
Rituximab (Rituxan) boxed warnings
Hep B reactivation
SJS/TEN
severe/fatal infusion reactions
114
PD-1 inhibitors
Keytruda = Pembrolizumab
Opdivo = Nivolumab
115
PD-1 inhibitor unique concerns
immune mediated toxicities
116
PD-1 side effects
immune mediated toxicities
117
CTLA-4 inhibitor
Yervoy = ipilimumab
118
Ipilimumab (Yervoy) unique concerns
REMS program
119
Ipilimumab (Yervoy) boxed warnings & side effects
Boxed warning: fatal immune mediated reactions
SE: pneumonitis, nephrotoxicity, ocular toxicity
120
Tyrosine kinase info info
oral admin
have to before pharmacogenomic testing prior to starting
some TKIs have specific targets, others are multi-targeted
121
TKI used in Chronic myelogenous leukemia (CML) drugs
BCR-ABL inhibitors
Imatinib (Gleevec)
Dasatinib (Sprycel)
Nilotinib (Tasigna)
122
TKI used in Chronic myelogenous leukemia (CML) unique concerns
must be Philadelphia chromosome (BCR-ABL) positive for use
123
Imatinib, Dasatinib, Nilotinib boxed warnings
QT prolongation = nilotinib
vascular occlusions, HF
124
Imatinib, Dasatinib, Nilotinib Side effects
myelosuppression
N/V/D
QT porlongation
fluid retention
edema
skin rash
inc LFTs
HF
125
TKIs used in Melanoma
BRAF inhibitors
Vamurafenib (Zelboraf)
Dabrafenib (Tafinlar)
126
Vamurafenib, Dabrafenib unique concerns
Must be BRAF V600E or V600K mutation positive to use
127
Vamurafenib, Dabrafenib warnings
new malignancies
QT prolongation
128
MEK1 and 2 inhibitors
Cobimetinib (Cotellic)
129
Cobimetinib (Cotellic) unique concerns
used in combo with BRAF n patients with V600E/V600K mutations
130
Cobimetinib (Cotellic) side effects
HTN
HF
Hepatotoxicity
Hand-foot syndrome
Visual impairment
131
EGFR inhibitors, used in non-small cell lung cancer (NSCLC)
Afatinib (Gilotrif)
Erlotinib (Tarceva)
132
EGFR inhibitor unique concerns
must be EGFR mutation positive to use
133
EGFR inhibitor side effects
acneiform rash
dry skin
pruritus
N/V/D
mucositis
stomatitis
134
Acneiform rash from EGFR inhibitors indicates that patient will have what kind of response?
expected to be better
135
Anaplastic Lymphoma Kinase (ALK) inhibitors
Alectinib (Alecensa)
Brigatinib (Alunbrig)
136
ALK inhibitor unique concerns
must have ALK mutation to use
137
ALK inhibitor warnings and side effects
warning: QT prolong, hepatotoxicity, bradycardia, interstitial lung disease
Side effects: Skin rash N/V/D, edema
138
Lapatinib (Tykerb) Info, Warnings, Side effects
Info: HER2 inhibitor
Warning: Hepatotoxicity, GI toxicity, cardiotoxicity
Side effect: N/V/D, hand-foot syndrome
139
Neratinib (Nerlynx) Info, Warnings, Side effects
Info: HER2 inhibitor
Warning: Hepatotoxicity, GI toxicity = req premeditate w/ antidiarrheal meds
Side effect: N/V/D, hand-foot syndrome
140
Sorafenib (Nexavar) Info, Warning, Side effects
Info: TKI, multiple targets
Warnings: Hepatotoxicity, cardiac toxic, hen, SJS/TEN, impaired wound healing
Side effect: QT prolong, skin changes, hand-food syndrome, N/V/D, thyroid dysfunction
141
Sunitinib (Sutent) Info, Warnings, Side effects
Info: TKI, multiple targets
Boxed warning: Hepatotoxicity
Side effect: QT prolong, skin changes, hand-food syndrome, N/V/D, thyroid dysfunction
142
Common toxicities for TKIs
Hypothyroidism
QT prolongation
Diarrhea
Hepatic toxicity
Rash
Hand-foot syndrome
143
Which oral agents should be taken with food or within 1 hr after meal
Imatinib = Gleevec
Capecitabine = Xeloda
Thalidomide = Thalomid
Exemestane = Aromasin
144
Which oral agents should be taken on empty stomach, 1hr before or 2hrs after food
Nilotinib = Tasigna
Erlotinib = Tarceva
Sorafenib = Nexavar
Temozolomide = Temodar
Abiraterone = Zytiga
Pomalidomide = Pomyalyst
145
