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11 Cards in this Set

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Describe the dose of adjuvant and combined chemotherapy-rt for NSCLC
Adjuvant chemo alone for patients with negative resection margins who are getting sequential chemo-rt:
cisplatin 100 mg/m2 and Etoposide 100 mg/m2
Repeat q 4 wks for 4 cycles
Concurrent chemo/rt dosing: cisplatin 50 mg/m2 and Etoposide 50mg/m2
What chemo doses are used in anal cancer and what is the scheduling (directly from NCCN 2012)?
5-FU + Mitomycin + RT
Continuous infusion 5-FU 1000 mg/m /d IV days 1-4 and 29-32
Mitomycin 10 mg/m IV bolus days 1 and 29
What is standard chemotherapy for concurrent chemo-rt for esophageal ca (2012 NCCN)?
Cisplatin and fluoropyrimidine
Cisplatin 75-100 mg/m IV on Day 1
5-FU 750-1000 mg/m IV continuous infusion
over 24 hours daily on Days 1-4

OR:
Paclitaxel and carboplatin
Paclitaxel 50 mg/m IV on Day 1
Carboplatin AUC 2 IV on Day 1
Weekly for 5 weeks
Cycled every 28 days for 2-4 cycles for 2 cycles with
radiation followed by 2 cycles without radiation
What is the chemotherapy of choice for rectal cancer with radiation? How is it given?
5-FU (225 mg/m2) is given concurrently with RT via continuous infusion as NCCTG 86-47-51/Intergroup trial (O’Connell MJ et al., NEJM 1994) showed improved 4 yr OS when compared to bolus administration in the adjuvant CRT setting (70% vs. 60%).
What is the mechanism of action and side effect profile for gemcitabine?
Chemically gemcitabine is a nucleoside analog . The following side effects are common (occurring in more than 30%) for patients taking Gemcitabine:

Flu-like symptoms such as muscle pain, fever, headache, chills, and fatigue
Fever (within 6–12 hours of first dose)
Fatigue
Nausea (mild)
Vomiting
Poor appetite
Skin rash
What is your approach to managing diarrhea for a pt being treated with pre-op 5-FU/xrt
low residue diet to start, then immodium. When maxed, start lomotil then tincture of opium. If diarrhea is severe, electrolytes should be managed and pt potentially admitted to the hospital. The 5-FU can be held and xrt potentially continued. If improves, bring back 5-FU at reduced dose.
Mechanism of Mitomycin C
Mitomycin C is a potent DNA crosslinker
You say you would follow the MacDonald Regimen for adjuvant treatment of gastric cancer. What is your chemo?
Bolus 5-FU (425 mg/m2/d) + LV (20 mg/m2/d) x 1 cycle, followed by concurent chemo-RT one month later. Chemotherapy given on first 4 and last 3 days of RT (5-FU 400 mg/m2 + LV 20 mg/m2). Adjuvant chemo one month following RT with two 5-day cycles of 5-FU/LV given one month apart.
Adjuvant regimen for pancreatic cancer.
Gem 1000 mg/m2 x 3 wks then CI 5FU 250 mg/m2 with xrt then additional Gem 1000 mg/m2


The use of gemcitabine-based chemotherapy is frequently combined, sequentially, with 5-FU based chemoradiotherapy. (as was done in RTOG 97-04 / Intergroup (1998-2002) -- sandwich 5-FU vs. gemcitabine) gemcitabine (1000 mg/m2) x3 weeks -> chemo-RT -> gemcitabine (1000 mg/m2) x12 weeks. Chemo-RT was (RT 50.4 Gy + concurrent 5-FU 250 mg/m2), 1-2 weeks after induction chemo.
FOLFIRINOX has shown a survival benefit over Gem in metastatic pancreatic ca. What is in FOLFIRINOX?
It includes the drugs leucovorin calcium, fluorouracil, irinotecan hydrochloride, and oxaliplatin. Also called FOLFIRINOX
What enzyme deficiency may make 5-FU more toxic?
5-Fluorouracil and capecitabine are two of the most frequently prescribed
chemotherapeutic drugs for patients with cancers of the gastrointestinal
tract, breast, and head and neck. In most patients, nearly 85% of 5-FU
administered is metabolized by dihydropyrimidine dehydrogenase (DPD),
rendering about 15% of the dose active. However, individuals with complete or partial DPD deficiency have a
strongly reduced capacity to metabolize 5-FU and therefore experience
severe, and sometimes life-threatening, toxic effects from the increased
levels of active drug. Several sources indicate DPD Deficiency affects from three to eight percent of the population.