Principles of Chemo+Cancer

Question 1

Oncogenes (gas pedal) : What are they and what type of alterations can stimulate cancer?

Examples?

Answer 1

Develop from proto-oncogenes that are present in cells and are essential regulators of normal cell functions

-Gain of function alterations stimulate devel of cancer via dysregulation of normal cell growth and proliferation

-HER2, RAS, Myc, Src

Question 2

Tumor Suppressor Genes (Brakes)
-Encode proteins that do what ?
-Genetic alterations are typically ___ and result in ?
-Examples?

Answer 2

1. Inhibit cell proliferation and ensure stability of genome
2. Loss of function, loss of control over normal cell growth
3. P53, Rb, APC

Question 3

General AE’s for radiation ? (4)

Answer 3

1. Fatigue
2. skin toxicities
3. hair loss
4. low blood counts

Question 4

Location specific AE’s of Radiation
1. Brain
2. Abdomen
3. Breast

Answer 4

1. Mouth sores, dry mouth, trouble swallowing, N/Tooth decay, hair loss
2. N/V/D, cramps, constipation
3. Skin irritation, breast swelling/soreness, darkened skin, heart and lung complications

Question 5

ChemoTx terms

1. Induction is chemo given to ?
2. Consolidation ?
3. Maintenance
4. Concurrent (Chemoradiation)

Answer 5

1. Induce remission
2. chemo tx given once remission is achieved, with goal to sustain a remission
3. Chemotx given in lower doses to assist in prolonging a remission
4. Chemotx given along w/radiation to incr sensitivity of radiation therapy

Question 6

ChemoTX AE’s

1. BM suppression –> What happens to WBC,RBC, and platelets
2. GI tract
3. Hair loss –> most common with ?

Answer 6

1. Decr in all
   WBC -> infection, RBC –> fatigue, Platelets –> bleeding
2. N/V/D
3. Alkylating agents, TOPOII inhibs, antimicrotubules

Question 7

What are examples of Targeted Therapies?

Answer 7

1. monoclonal ABX
2. TKIs
3. Immunotherapy
4. HOrmone therapy

Question 8

BSA equation what is it ?

1inch = 2.54 cm

Answer 8

Square root of ((Height in cm * weight (kg))/3600)

Question 9

Normal ANC and Platelets value to continue patient on next cycle of chemotx?

Answer 9

ANC >=1500/mm^3
platelets >= 100,000/mm^3

Question 10

Neutropenia

1. Whats the neutrophil count?
2. WHats the ANC equation?
3. Febrile neutropenia is a temperature of? You would need to start ?

Answer 10

1. Low neutrophil count of ANC < 500/mm^3
2. ANC = [WBC * (%segmented + %banded neuts)] /100
3. > 38.3 C of 100.4 F
   - empiric abx

Question 11

Checking ECHO

1. If a pt’s baseline EF is < 30% which drug can they NOT receive?
2. If baseline EF 30-50% you will need to ____ and discontinue if?
3. WHats the lifetime cumulative max dose for doxorubicin ?

Answer 11

1. Anthracyclines
2. repeat study after each dose , discontinue if EF declines by >=10%
3. 550 mg/m^2

Question 12

Regimens w/incr risk of Hypersensitivity RXNS :

1. Platinums after __ or __
2. Taxanes, and mABs –> ___
3. WHich drug vehicles and what drug do they belong to ?

Answer 12

1. multiple cycles, repeated courses
2. first few doses
3. Polysorbate 80 (docetaxel and fosaprepitant)
   -Cremaphor (paclitaxel)

Question 13

Management of Extravasation

Answer 13

See chart