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
What drugs can be used to tx gastric cancer?
- Glutamic acid
What drugs can be used to tx carcinoid tumors?
What drugs can be used to tx GIST?
What drug can be used to tx pancreatic cancer?
What drug can be used to tx liver cancer?
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
What are the cancer, mechanism, and issues with Bevacizumab?
- ISSUES: bleeding, GI perforation, wound dehiscence, HTN, hypersensitivity
What are the cancer, mechanism, and issues with Cetuximab?
- ISSUES: cardiac arrest, respiratory arrest, and/or sudden death
1. Infusion reactions
2. Acneiform rash common, and severe in 17% of pts
What are the cancer, mechanism, and issues with Erlotinib?
- ISSUES: GI toxicity (N/V, diarrhea), prolonged bleeding, elevated LFT's, ocular toxicities
1. rarely interstitial lung disease
What are the cancer and mechanism for glutamic acid?
- Nutritional supplement; used to counterbalance deficiencies of HCl in gastric juice
- Taken orally before meals
What are the cancer, mechanism, and issues with Imatinib?
- 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
What are the cancer, mechanism, and issues with Leucovorin?
- Used with 5-FU
- Reduced folate that synergizes with 5-FU
- Diarrhea and dehydration
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
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
- 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
- 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
- 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