Oncology - Select Cancers

Question 1

Gene mutation that causes breast cancer

Answer 1

BRCA gene mutation that prevent the suppression of tumor growth from BRCA1 and 2 genes

Question 2

What is Klinefelter syndrome

Answer 2

1 Y and 2 X chromes → more estrogen production

Question 3

Indication for tamoxifen

Answer 3

SERM that ↓ breast cancer risk in pre- and postmenopausal women

Question 4

Indication for raloxifene

Answer 4

Breast cancer risk reducer in postmenopausal women only

Question 5

Identifying breast caner

Answer 5

Self-exam
Mammogram QY in high-risk females
Biopsy

Question 6

How long is treatment in HR+ breast cancer

Answer 6

5-10 years to suppress cancer recurrence

Question 7

First line for HR+ in premenopausal females

Answer 7

Tamoxifen

Question 8

Indication and MOA of aromatase inhibtors

Answer 8

Inhibits aromatase that peripherally converts androgens to estrogen.

Don’t block ovarian estrogen production → not useful for monothreapy in premenopausal women unless its induced

Question 9

Agents to induce menopause

Answer 9

Ovarian suppression, ablation
Surgery, radiation
Gonadotropin-relasing hormone agonist

Question 10

MOA of GnRH agonist

Answer 10

Decreases overian estrogen production by suppressing FSH and LH

Question 11

Treatment for HR+ in postmenopausal females

Answer 11

Tamoxifen or AIsM

Question 12

MOA of tamoxifen

Answer 12

Bind to estrogen receptor (competes with endogenous estrogen)

Question 13

Metabolism of tamoxifen

Answer 13

Prodrug of CYP2D6

Question 14

Treating hot flashes while on tamoxifen

Answer 14

Venlafaxin

Question 15

BBW of tamoxifen

Answer 15

Uterine and endometrial cancer
Thromboembolic events
Teratogenic

Question 16

ADR of tamoxifen

Answer 16

Hot flashes, night sweats, vaginal bleeding/discharge, ↓ bone density (calcium and vit D)

Question 17

What is Fulvestrant

Answer 17

IM injection of SERD → estrogen receptor antagonist that causes receptor down regulation

Question 18

ADR of Fulvestrant

Answer 18

Increased LFTs, injection site pain, hot flashes

Question 19

Anastrozole

Answer 19

Arimidex

Question 20

ADR of Anastrozole

Answer 20

Osteoporosis → ↓ BMD (Calcium and Vit D)
Higher CVD risk compared to SERMs

Hot flashes, night sweats, arthralgia, myalgia

Question 21

Letrozole MOA

Answer 21

AI

Question 22

What is HER2

Answer 22

Amplifies cancer cell growth and survival

Question 23

Tx for HER2 breast cancer

Answer 23

Trastuzamab (Herceptin_
Other mAbs

Drug bind to HER2 and prevents growth signals from dimerizing with HER2

Question 24

Triple negative breast cancer treatment

Answer 24

Taxane
Anthracycline

Question 25

How to identify prostate cancer

Answer 25

DRE and PSA

Question 26

Drugs used for prostate cancer

Answer 26

GNRh agonist and antagonist Antiangrogens

Question 27

MOA og GnRH agonsit

Answer 27

LHRH agonist → surge in testosterone followed by gradual reduction due to feedback inhibition

Question 28

GnRH agonist

Answer 28

Leuprolide Goserelin

Question 29

Leuprolide

Answer 29

Lupron Depot

Question 30

Goserelin

Answer 30

Zoladex

Question 31

ADR of leuprolide

Answer 31

Osteoporosis (Ca and Vit D) Tumor flare (concurrent use with antiangrogen) Hot flashes, impotence, gyenocomastia, bone pain, QT prolongation

Question 32

Drug that doesn't cause tumor flare

Answer 32

GnRH antagonist

Question 33

Antiangrogen 1st gen

Answer 33

Biclutiamide Flutamide Nulutamide

Question 34

ADR of antiangrogen 1st gen

Answer 34

Hot flashes, gynecomastia Avoid in females (Bicalutamide)

Question 35

Signs of TLS

Answer 35

Hyperkalemia → arrhythmias Hyperphosphatemia Hypocalcemia Hyperuraciema (damage kidneys) Acute renal failure

Question 36

Tx of TLS

Answer 36

IV hydration with normal saline Urate lowering therapies (Allopurinol) Rasbiricase (but CI in G6PD deficiency)

Question 37

Cause of hypercalcemia in malignacy

Answer 37

Leaching from bones

Question 38

Sx of hypercalcemia

Answer 38

NV, fatigue, dehydration, confusion

Question 39

Tx of hypercalcemia

Answer 39

1. Hydration with NS 2. IV bisphosphonates (Zoledronate, Pamidronate) 3. Calcitonin 4. Denosumab (Xgeva)

Question 40

Prolia vs Xgeva

Answer 40

Prolia: osteoporosis Xgeva: hypercalcemia

Question 41

Limit to calcitonin spray

Answer 41

48 hrs

Question 42

Recast vs Zometa

Answer 42

Zometa: hypercalcemia Reclast: osteoporosis