Pharm-Skin Cancer Flashcards
(69 cards)
1
Q
Carmustine indication
A
melanoma
2
Q
Cisplatin indication
A
Basal, squamous
3
Q
Cyclophosphamide indication
A
basal
4
Q
Cyclophosphamide indication
A
basal
5
Q
Dacarbazine indication
A
melanoma
6
Q
Dactinomycin indication
A
melanoma
7
Q
docetaxel indication
A
melanoma
8
Q
Doxorubicin indication
A
basal
9
Q
Fluorouracil indication
A
basal, actinic keratosis
10
Q
lomustine indication
A
melanoma
11
Q
MTX indication
A
basal
12
Q
Vinblastine indication
A
Basal, melanoma
13
Q
Aldesleukin indication
A
melanoma
14
Q
diclofenac indication
A
ak
15
Q
imiquimod indication
A
basal, ak
16
Q
interferon indication
A
melanoma
17
Q
ipilimumab indication
A
melanoma
18
Q
sorefenib indication
A
melanoma
19
Q
trametinib indication
A
melanoma
20
Q
trichloroacetic acid indication
A
ak
21
Q
vemurafenib indication
A
melanoma
22
Q
vismodegib indication
A
basal
23
Q
Which drug is most likely to be used against SCC?
A
Cisplatin
24
Q
Most drugs are used for these cancers
A
BCC and melanoma
25
Most popular chemo drug for SCC?
cisplatin
26
Most popular chemo drugs for melanoma?
D drugs (exc doxo)
27
Describe the treatment algorithm of basal cell carcinoma
1) Topical 5-FU or Imiquimod
| 2) Cisplatin chemo for metastases and Vismodegib (HH) targeted therapy
28
Imiquimod MOA
TLR7 and 8 activator and adenosine blockage that upregulates Nf-kB -> cytokine up regulation (immunostimulant)
ALSO HH pathway repression by modulating "GLI"
29
Imiquimod is also used for these non-cancers
AK, HPV
30
Imiquimod route
topical, limited systemization
31
Imiquimod AEs
Photosensitivity, compromised birth control when used for HPV
32
HH pathway inhibitors target this protein
Smoothened (SMO)
33
HH pathway goes awry most commonly in this skin cancer
Basal
34
Vismodegib MOA
SMO inhibitor
35
Vismodegib AEs
3 BLACK BOX WARNINGS:
Intrauterine fetal death
Male-mediated teratogenicity
Pregnancy
alopecia, GI common
36
Which drug does NOT act as a teratogen?
Imiquimod
37
Describe the treatment for squamous cell carcinoma?
Surgery/radiation, not drugs; Cisplatin-based regimen for metastatic/advanced disease
38
Describe the different drug modalities and their comparative effectivness in treating melanoma
Conventional chemo - bad ~7%
Immunotherapy - better but very toxic
Signal transduc inhibitors - best, BRAF mut target
39
What are the signal transduction inhibitors used in melanoma?
Sorafenib, trametinib, vemurafenib
40
Aldesleukin MOA
IL-2 receptor binder -> proliferation of B and T cells, monos, macros, and CTLs inc NK
41
Aldesleukin black box warnings
CNS, cardiac, pulmonary disease
42
IL-2 activation drawback
Also stimulates Tregs which diminish benefits
| Can cause capillary leak syndrome
43
IFN-alpha MOA
RTK activation->antiviral, antiproliferative, cytokine induction, HLA expression...
44
IFN-alpha C/Is bbw
Autoimmune, cardiac disease, depression (suicidal ideations)
45
IFN common AEs
Flu-like, leukopenia, anemia
Liver issues
Pulmonary issues
46
Ipilimumab MOA
Stimulate T cell function by binding CTLA4, a T cell repressor (cytotoxic lymphocyte-associated antigen)
It's an "indirect" action on melanoma?
47
Ipilimumab serious AEs
Severe immune-mediated AEs inc dermatitis and toxic necrolysis;
MANY BBWS: adrenal, hepatitis, hyperthryoid, hypopituitary, hypoT, MG, peri neurop, preg, rash
48
Ipilimumab common AEs
Fatigue, diarrhea, itching, rash
49
Sorafenib MOA
Multikinase inhibitor:
VEGF, PDGFR, KIT, RAFK
Blocks both 1)proliferative and 2)angiogenic signaling
50
Sorafenib AEs
Severe rash, hepatic dys, hematologic
Common: hand/foot, anemia, rash
Prego - cat D
fatal bleeding possible
51
Combining these two drugs demonstrated increased progress-free survival in melanoma patients but not overall survival
Dacarbazine plus sorafenib
52
Which drugs require genotyping?
Trametinib and vemurafenib (for BRAF, for melanoma)
53
Trametinib MOA
MEK inhibitor for patients with BRAF V600E or V600K mutations
54
Trametinib AEs
Severe skin toxicity in 12%
GI, diarrhea
Dec LVEF!, HTN, Hemorrhage
Rarely: cardiomyopathy, ILD, EYE stuff
55
Both of these drugs block MEK
Trametinib and Vemurafenib
56
How does resistance develop to BRAF targeted drugs?
Proliferative signaling by a parallel, unaffected pathway
E.g., RAS-driven proliferation
57
Vemurafenib Aes
Inc risk of cutaneous SCC
Liver, cardiac, EYE
Most common: arthralgia, fatigue, rash, photosensitivity
58
Describe the common toxicity profile for BRAF inhibitors
```
RASH
Liver
Heart
Eye
2ndary maligs
```
59
Carmustine MOA
Alkylation and carbamoylation of amino acids
60
Dactinomycin MOA
DNA intercalator
61
Lomustine MOA
alkylating agent
62
Carmustine AEs
myelosuppression
63
Dacarbazine AE
myelosuppression
64
Dactinomycin AE
Myelosuppression
65
Which drugs are used for actinic keratosis?
5-FU, Imiquimod
Diclofenac - PGE2 inhibitor
Tri-Chlor - peel
all are topical so no systemic toxicity
66
Diclofenac MOA
Inflammation inhib inc PGE2
67
Diclofenac AEs
Itchy rash, dry skin, peeling, redness
68
Trichlor MOA
Chemical peel that penetrates and cauterizes skin and keratin
69
Trichlor AEs
burning, inflammation, tenderness
