656 - Breast Cancer (Set 3)

Front 1

What is the mechanism of action for cyclophosphamide?

Back 1

Akylating agent that prevents cell division by cross-linking DNA strands and decreasing DNA synthesis.

Front 2

What are the indications for cyclophosphamide?

Back 2

Leukemias, Lymphomas, Multiple Myeloma, & Breast Cancer

Front 3

What are the common off label uses of cyclophosphamide?

Back 3

Ovarian Cancer & Testicular Cancer

Front 4

What dosing adjustments are required for cyclophosphamide?

Back 4

Dosing is adjusted for renal or hepatic impairment. Dosing is also adjusted for compromised bone marrow.

Front 5

What is (are) the contraindication(s) for cyclophosphamide?

Back 5

Hypersensitivity, Severe Bone Marrow Suppression

Front 6

What are the common adverse effects of cyclophosphamide?

Back 6

Neutropenia, NVD, Hemorrhagic Cystitis, Alopecia, Impaired Fertility, & Immunosuppression

Front 7

What rare but serious adverse effects are associated with cyclophosphamide?

Back 7

Cardiotoxicity, Hypersensitivity, & Pneumonitis

Front 8

What drug interactions are associated with cyclophosphamide?

Back 8

Cyclophosphamide is a prodrug, requiring CYP2B6 for activation, avoid inducers and inhibitors. Immune stimulants, decreased efficacy, avoid. Vaccines, avoid.

Front 9

Which is the most concerning of the common adverse effects of cyclophosphamide and how it it managed?

Back 9

Cystitis occurs with high dose, manage with fluids and potentially Mesna.

Front 10

What is the cardiotoxicity of cyclophosphamide related to and how are the symptoms managed?

Back 10

Cardiotoxicity is related to endothelial capillary damage; symptoms may be managed with diuretics, ACE inhibitors, beta-blockers, or inotropics.

Front 11

What is the mechanism of action for trastuzumab?

Back 11

Monoclonal antibody which binds to the extracellular domain of the human epidermal growth factor receptor 2 protein (HER-2).

Front 12

What are the indications for trastuzumab?

Back 12

HER2 overexpressing breast cancer, adjuvant and metastatic.

Front 13

What is of interest with respect to dosing of trastuzumab?

Back 13

A loading dose is required.

Front 14

What dosing adjustments are required for trastuzumab?

Back 14

None

Front 15

What is (are) the contraindication(s) for trastuzumab?

Back 15

None

Front 16

What are the black box warnings for trastuzumab?

Back 16

Cardiotoxicity, Infusions Reactions, Pregnancy, Pulmonary Toxicity

Front 17

What are the common adverse reactions of trastuzumab?

Back 17

Infusion Reactions, Rash, Decreased LVEF, & NVD

Front 18

What rare but serious adverse effects are associated with trastuzumab?

Back 18

Acute Respiratory Distress, Cardiac Arrest, & Hypotension

Front 19

What drug interactions are associated with trastuzumab?

Back 19

Concurrent cardiotoxins, avoid (doxorubicin for instance). Immune stimulants, decreased efficacy, avoid.

Front 20

What precaution is taken to decrease infusion reactions with trastuzumab? How are patients who are to receive trastuzumab premedicated?

Back 20

Slow infusion. Premedicate with diphenhydramine & acetominophen.

Front 21

What monitoring is required for trastuzumab?

Back 21

Monitor LVEF, reduce dose or discontinue depending on severity.

Front 22

With what two other chemotherapeutic agents is trastuzumab not coadministered?

Back 22

Do not administer concurrently with doxorubicin or cyclophosphamide.

Front 23

What is the mechanism of action of pertuzumab?

Back 23

Recombinant humanized monoclonal antibody which targets the extracellular human epidermal growth factor receptor 2 protein (HER2) dimerization domain. Pertuzumab binds to a different HER2 epitope than trastuzumab so that when pertuzumab is combined with trastuzumab, a more complete inhibition of HER2 signaling occurs.

Front 24

What is the indication for pertuzumab?

Back 24

HER2 overexpressing breast cancer, metastatic in combination with trastuzumab and docetaxel.

Front 25

What dosage adjustments are required for pertuzumab?

Back 25

None

Front 26

What is (are) the contraindication(s) for pertuzumab?

Back 26

None

Front 27

What are the black box warnings for pertuzumab?

Back 27

Pregnancy

Front 28

What are the common adverse effects of pertuzumab?

Back 28

Infusion Reactions, Rash, Decreased LVEF, & NVD

Front 29

What rare but serious adverse effects are associated with pertuzumab?

Back 29

Acute Respiratory Distress, Cardiac Arrest, & Hypotension

Front 30

What drug interactions are associated with pertuzumab?

Back 30

Concurrent cardiotoxins, avoid. Immune stimulants, decrease efficacy, avoid.

Front 31

What precaution is taken to decrease infusion reactions?

Back 31

Slow infusion.

Front 32

What monitoring is required for pertuzumab?

Back 32

Monitor LVEF, if LVEF declines to <40%, or LVEF between 40% to 45% declines greater than or equal to 10% absolute decrease from pretreatment values, discontinue.

Front 33

Is pertuzumab continued if trastuzumab is discontinued?

Back 33

No. Discontinue both.

Front 34

Considering doxorubicin, paclitaxol, and docetaxel for the treatment of metastatic breast cancer, which is generally considered the best?

Back 34

Docetaxel, because it has better survival than paclitaxol and most patients have already had too much doxorubicin by the time they reach metastatic disease.