Tumors of GI system

Question 1

Drugs used for anal cancer

Answer 1

cisplatin, mitomycin, 5FU

Question 2

Drugs used for CRC

Answer 2

bevacizumab, capecitabine, cetuximab, 5FU

Question 3

Drugs used for esophageal cancer

Answer 3

Cisplatin, Docetaxel, 5FU

Question 4

Drugs used for gastric cancer

Answer 4

cisplatin, docetaxel, 5FU, trastuzumab

Question 5

Drugs used for GI carcinoid

Answer 5

octreotide, interferon

Question 6

Drugs used for GIST

Answer 6

imatinib, sunitinib

Question 7

Drugs used for pancreatic cancer

Answer 7

5FU, erlotinib, gemcitabine

Question 8

Drugs used for liver cancer

Answer 8

5FU

Question 9

What is 1st/2nd line therapy for esophageal cancer?

Answer 9

Cisplatin + 5FU. docetaxel is 2nd line

Question 10

How should you determine gastic cancer therapy

Answer 10

Check Her2 status. If positive, trastuzumab should be added to 5FU/cisplatin therapy

Question 11

How do you determine CRC therapy?

Answer 11

Capecitbine or 5FU + bevacizumab or cetuximab unless KRAS +

Question 12

What drug is associated with tachyphylaxis?

Answer 12

octreotide- duration of treatment is 12 months usually

Question 13

Treatment with conventional chemo is GIST is futile due to ____.

Answer 13

overexpression of P-gp

Question 14

GIST can be categorized into what groups?

Answer 14

KIT-mutant (80%), KIT negative, PDGFRA-mutant, wild-type

Question 15

MOA bevacizumab

Answer 15

rhuMAab-VEGF

Question 16

Bevacizumab issues

Answer 16

bleeding, perforation, wound dehisence, HTN

Question 17

Capecitabine MOA

Answer 17

5FU prodrug

Question 18

Capecitabine issues

Answer 18

DPD deficiency prevents metabolic activation. CI in renal dysfunction. Adverse CV events. Neuro and heme toxicities

Question 19

Cetuximab MOA

Answer 19

EGFR Ab

Question 20

Cetuximab issues

Answer 20

Cardiac arrest, respiratory arrest, sudden death, acneiform, infusion rxn

Question 21

Cisplatin MOA

Answer 21

DNA crosslinks and adducts

Question 22

Cisplatin issues

Answer 22

ototoxicity, NEPHROTOXICITY, BMS

Question 23

Docetaxel MOA

Answer 23

Stabilize microtubule

Question 24

Docetaxel issues

Answer 24

Increased tx related morality in NSCLC; edema, neuropathy, CI in hepatic disease, DLT: neutropenia

Question 25

Erlotinib MOA

Answer 25

EGFR-TKI

Question 26

Erlotinib issues

Answer 26

GI tox, bleeding, LFTs, ocular toxicities, rarely ILD

Question 27

5FU MOA

Answer 27

pyrimidine antimetabolite that inhibits TS and interferes with RNA synthesis and effects DNA

Question 28

5Fu issues

Answer 28

DPD deficiency = enhanced neurotoxicity, severe heme tox and BMS

Question 29

Gemcitabine MOA

Answer 29

DNA polymerase inhibitor, incorporates triphosphate

Question 30

Gemcitabine issues

Answer 30

BMS, infection, sensory peripheral neuropathy, arthralagia, drowsiness, anorexia resolves in 2-3 days

Question 31

imatinib MOA

Answer 31

TKI adjuvant with resection of KIT mutant GIST

Question 32

Imatinib issues

Answer 32

GI tox, CHF, neuro tox, fluid retention, edema

Question 33

Inf-a MOA

Answer 33

enzyme activation following cell surface receptor binding and TK activation

Question 34

inf-a issues

Answer 34

neuropsychiatric events, FLS

Question 35

Mitomycin MOA

Answer 35

alkylating agent

Question 36

Mitomycin issues

Answer 36

BMS, thrombocytopenia, leukopenia, HUS

Question 37

Octreotide MOA

Answer 37

SS, reduce duodenal bicarb, amylase, gastric acidity, gallbladder contractility, bile secretion, inhibits meal induced increases in SMA and portal venous blood flow

Question 38

Octreotide issues

Answer 38

monitor blood glucose, dose-related diarrhea

Question 39

Sunitinib MOA

Answer 39

inhibitor of >80 RTKs

Question 40

Sunitinib issues

Answer 40

Thrombocytopenia, bleeding, QT prolongation, GI complications including perforation

Question 41

Trastuzumab MOA

Answer 41

HER2-neu antibody. Inhibition of Her2--> accumulation of cdk inhibitor p26--> cell cycle arrest. Inhibits constitutive Her2 shedding by MP (correlate with clinical activity)

Question 42

Trastuzumab issues

Answer 42

LVEF dysfunction, cardiomyopathy, anaphylaxis, angioedema, pulmonary toxicity