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Flashcards in Sweatman - GI Cancer Deck (18):
1

What drugs are used to tx colorectal cancer?

- 5-FU + Leucovorin + Oxaplatin combo = FOLFOX

1. Can sub Irinotecan for Oxaplatin (FOLFIRI)

2. Can also sub Capecitabine for 5-FU

- Targeted agents: Bevacizumab (VEGF INH), Cetuximab (EGFR INH)

1. Improve outcomes, except in pts with KRAS mutations

 

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2

What drugs can be used to tx gastric cancer?

- Glutamic acid 

- Trastuzumab

3

What drugs can be used to tx carcinoid tumors?

- Methysergide 

- Octreotide

4

What drugs can be used to tx GIST?

- Imatinib 

- Sunitinib

5

What drug can be used to tx pancreatic cancer?

- Erlotinib

6

What drug can be used to tx liver cancer?

- Sorafenib

7

What is the tx for anal cancer?

- Radiation tx alone may lead to a 5-year survival rate in excess of 70%

- Radiation + Cisplatin, 5-FU, Mitomycin = improved outcomes 

8

What are the cancer, mechanism, and issues with Bevacizumab?

- Colorectal 

- rhuMAB-VEGF 

- ISSUES: bleeding, GI perforation, wound dehiscence, HTN, hypersensitivity 

9

What are the cancer, mechanism, and issues with Cetuximab?

- Colorectal

- rh/mMAB-EGFR 

- ISSUES: cardiac arrest, respiratory arrest, and/or sudden death 

1. Infusion reactions 

2. Acneiform rash common, and severe in 17% of pts

10

What are the cancer, mechanism, and issues with Erlotinib?

- Pancreas

- EGFR-TKI 

- ISSUES: GI toxicity (N/V, diarrhea), prolonged bleeding, elevated LFT's, ocular toxicities 

1. rarely interstitial lung disease 

11

What are the cancer and mechanism for glutamic acid?

- Gastric 

- Nutritional supplement; used to counterbalance deficiencies of HCl in gastric juice 

- Taken orally before meals 

12

What are the cancer, mechanism, and issues with Imatinib?

- GIST 

- Oral TKI as adjuvant tx after complete resection of Kit (CD117) + GIST 

- ISSUES: GI toxicities -> pain, bloating, N/V, constipation, stomatitis, dyspepsia, etc. common

1. CHF reported in some pts 

2. Neuro toxicity 

3. Fluid retention and edema 

13

What are the cancer, mechanism, and issues with Leucovorin?

- Used with 5-FU

- Reduced folate that synergizes with 5-FU 

- Diarrhea and dehydration

14

What are the cancer, mechanism, and issues with Methysergide?

- GI carcinoid; also used for migraine therapy 

- Serotonin INH in GI tract

- ISSUES: vasoconstrictor of large and small arteries

15

What are the cancer, mechanism, and issues with Octreotide?

- GI carcinoid

- Somatostatin analog -> reduces duodenal bicarb, amylase, and gastric acidity, INH gallbladder contractility and bile secretion, and INH meal-induced INC in SMA and portal venous blood flow 

- ISSUES: monitor blood glucose b/c INH insulin and glucagon

1. Dose- related diarrhea 

16

Sorafenib

- Liver 

Oral multi-kinase INH targeting serine/threonine and receptor tyrosine kinases in tumor and vasculature

1. Targeted kinases incl: Raf kinase, VEGFR-2 and VEGFR-3, PDGFR-β, KIT, fms-like tyrosine kinase 3 (FLT-3), and RET 

- ISSUES: hand-foot skin reaction characterized by redness, pain, swelling, or blisters on the palms of the hands or soles of the feet -> generally appears in first 6-weeks of treatment

17

Sunitinib

- GIST 

- INH of > 80 receptor tyrosine kinases (RTKs), incl PDGFRα & PDGRFβ, VEGFR1, VEGFR2, VEGFR3, KIT, Fms-like tyrosine kinase-3 (FLT3), colony stimulating factor receptor Type 1 (CSR-1R), glial cell-line derived neurotrophic factor receptor (RET) 

- ISSUES: thrombocytopenia and bleeding

1. QT prolongation, sometimes fatal

2. GI complications including GI perforation have occurred rarely in pts w/intraabdominal malignancies 

18

Trastuzumab

- Gastric

- HER-2/neu antibody; HER2 is downregulated, cyclin-dependent kinase inhibitor p27 accumulates, and cell cycle arrest occurs. Also inhibits the constitutive HER2 cleavage/shedding mediated by metalloproteases, which may correlate with the clinical activity 

- ISSUES: LVEF dysfunction and cardiomyopathy

1. Severe infusion-related reactions including anaphylaxis, angioedema, and pulmonary toxicity; pulmonary toxicity worse in pts with intrinsic lung disease, e.g., COPD, asthma, respiratory insufficiency