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148 Cards in this Set
- Front
- Back
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Surgery - Localized or Systemic Treatment?
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Localized
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Radiation - Localized or Systemic Treatment?
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Localized
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Biologic Tx - Localized or Systemic Treatment?
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Systemic
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Chemotherapy - Localized or Systemic Treatment
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Systemic
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What does Adjuvant mean?
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Means treating secondary to surgery.
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What is Neoadjuvant therapy and what does it entail?
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It is shrinking the tumor prior to removal and entails reducing the tumor burden.
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What is Adjuvant Chemotherapy and what does it entail?
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It is eradicating micrometastases following a localized treatment. Potentially cures the patient.
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Vincristine, vinblastine, vinorelbine, paclitaxel, docetaxel work during which phase of the cell cycle?
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M - Mitosis
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Mustard agents such as carmustine, lomustine work during which phase of the cell cycle?
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G0 - Dormant phase
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Methotrexate, Cytarabine, 5-FU, Fludarabine, hydroxyurea affect which part of the cell cycle?
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S phase - DNA synthesis
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CCS agents have which type of cytotoxicity, dose dependent or schedule dependent?
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Schedule dependent
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CCNS agents have ______ dependent cytoxicity.
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Dose
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Which phase of the cell cycle is the shortest?
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M phase (Mitosis)
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What are the two purine bases?
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Adenine and Guanine
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How do anti-metabolites work?
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Replacing metabolites in DNA/RNA replication molecules to inhibit DNA/RNA function or synthesis.
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5-FU: Class?
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Fluorinated Pyrimidine: Antimetabolite
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5-FU: MOA
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Converts to FdUMP which binds to thimydilyate synthase, which is required for DNA synthesis.
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Purpose of Leucovorin for 5-FU?
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Stabilizes FdUMP-TS complex.
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5-FU ADR (4 major)
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Mucositis, Diarrhea, stomatitis, Hand and foot syndrome.
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What happens when you give a bolus dose of 5-FU ADR wise?
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Neutropenia, less of the other ADRs
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Cepecitabine- Class
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Fluorinated Pyrimidine -Antimetabolite
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Cepectitabine - MOA
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Prodrug of 5-FU, therefore same as 5-FU
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Cepecitabine - ADR
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Diarhea, mucositis, stomatitis, hand-foot syndrome
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How is Capecitabine/Xeloda dosed?
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Dosed every 12 hours to produce similar profile as 5-FU continuous
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Cytarabine - Class
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Cytidine Analog-Antimetabolite
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Cytarabine- MOA
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Penetrates cells via carrier, is phosphorylated to ara-CTP that inhibits DNA polymerase (strang elongation)
Also encorporates and acts as chain terminator. |
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Cytarabine- ADR
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Neurotoxicity, Conjunctivitis but only with 2-3g/m3 high dose Tx
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How do you manage the ADR's associated with high dose Cytarabine
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Assess w/ neuroexam and Px with steroids for chemical conjunctivitis (2 drops OU BID)
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Gemcitabine/Gemzar - Class?
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Cytidine Analog- Antimetabolite
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Gemcitabine/Gemzar- MOA
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Inhibits DNA Polymerase
Inhibits Ribonucleotide reductase to prevent conversion to deoxy form Penetrates cells better than Ara-C Protected from strand excision |
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Azacitidine-Class
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Cytidine analogs-antimetabolites
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Azacitidine/Vidaza-MOA
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Promotes hypomethylation of DNA causing direct toxicity, promotes maturation of normal cells.
Used for Myelodysplastic syndrome. |
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Gemcitabine major ADR
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Thrombocytopenia
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Fludarabine/Fludara-Class
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Purine antimetabolite
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Fludarabine ADR
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Myelosuppression/Immunosuppression
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How do you manage the side effects associated with Fludarabine?
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Px as though they are HIV+
Give PCP px, Anti-viral Px and Fungal Px |
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Methotrexate/MTX - MOA
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Inhibits DHFR
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What is the rescue for MTX?
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Leucovorin.
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How do you prevent leucovorin from saving cancer cells from the MTX Tx?
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Delay about 24 hours, monitor levels closely.
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MTX-ADR's
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Mucositis, Neurotoxicity, NEPHROtoxicitiy (Give IV hydration, Alk urine)
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Pemetrexed-MOA
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Inhibits TS, DHFR, GARFT, AICARFT
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Primary use of Pemetrexed
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Lung and Mesothelioma
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Pemetrexed-ADR
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Skin Rash, Fatigue, Myelosupression
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How do you combat the Skin rash associated with Pemetrexed?
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Dex 4mg BID x 3 days, beginning day prior to the dose.
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What other regimens are necessary to combat ADR's of Pemetrexed besides Dex?
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Folic acid or MVI with folic acid 350mcg to 1000mcg QD 5-7 days before treatment, during and for 21 days after treatment as well as Vit B12 1000mcg IM q 9 weeks
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What drugs should be avoided while using Pemetrexed?
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Aspirin, NSAIDs due to bleeding risk
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Vinblastine, Vincristine and Vinorelbine are considered what type of agents?
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Vinca Alkaloids, or Spindle poisons
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Vinca Alkaloids - MOA
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Bind to tubulin, disrupt normal balance of polymerization of microtubules, inhibts formation of spindle causes arrest in M phase
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MAJOR MAJOR Administration restriction regarding Vinca Alkaloids
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NO INTRATHECAL!
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ADR's common to all Vinca Alkaloids (4)
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Extravasation, Myelosuppression, constipation, alopecia
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Major ADR associated with Vinblastine in particular?
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Bone toxicity (Myelosuppression)
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Major ADR associated with Vincristine in particular?
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Neurotixicity/Constipation (C for CNS)
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Major ADR associated with Vinorelbine in particular?
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Middle of road on most ADR's common to vinca alkaloids, however significant myelosuppression.
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Paclitaxel-Class
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Taxane
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Docetaxel-Class
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Taxane
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Taxane MOA
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Bind to tublin without interfering with assembly, however intereres with dissassembly by causing polymerization--> FORMS STABLE BUT NONFUNCTIONAL MICROTUBULES
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Px for Taxanes
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Benadryl, APAP, Steroid, H2RA
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ADR associated with Taxanes
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Hypersensitivity, Peripheral neuropathy, Nail changes, Fluid retention
We are are SENSITIVE to Taxes which cause us to bite our NAILS because of the NEUROlogical strain. We also hold WATER. |
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Etopioside- Class
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Topoisomerase inhibitor
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Teniposide-Class
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Topoisomerase inhibitor
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Which drug class is particularly associated with secondary leukemias?
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Topoisomerase inhibitors
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How do topoisomerase inhibitors work?
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They prevent strand rejoining after breakage.
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Are Topoisomerase inhibitors CCS or CCNS
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CCS
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Predominant use of Irinoectan?
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Colorectal Cancer
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Irinoectan MOA
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Inhibits Topo Iso 1
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Irinotecan ADR
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Diarrhea, Mucositis
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Irinotecan ADR Management
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Acute diarrhea (50% of patients): Cholinergic rxn, give Atropine.
Late diarrhea (90% of patients), give loperamide. Late phase takes 11 days for onset. |
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Doxorubicin, Daunorubicin, Idarubicin- Class
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Anthracyclines
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Anthracycline MOA
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Intercalation, Interfere with Topo 2, Free radical formation
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Anthracycline ADR
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Extravasation, Red secretions, secondary leukemias, CARDIOTOXICITY
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What are the risk factors for cardiotoxicity with anthracyclines?
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Previous heart irradiation, elderly, very young, females, preexisting uncontrolled HTN, cardiac disease, peak concentrations
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What doses of Anthracyclines are associated with Cardiomyopathy, rhythm disturbances for life?
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>500mg/m2
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Dexrazoxane - MOA
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Chelates divalent ions, ferric ion--> prevents free-radical formation, reduces cardiotoxicity associated with AC
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What should you consel patients to avoid while taking an Anthracycline?
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Antioxidants
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Mitoxantrone-MOA
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Similar to AC, includes intercalation, less free radical however
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Mitoxantrone-ADR
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Blue/green secretions, extravasation, myelo, muco... less CARDIO TOXICITY!
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Are Alkylating agents considered CCS or CCNS?
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CCNS
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What 3 drug classes can cause secondary leukemias?
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Topo inhibitors, Anthracyclines and Alkylating agents
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Why is the fact that alkylating agents are CCNS considered significant?
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Cause they only target rapidly reproducing cells.
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Cyclophosphamide-Class
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Alkylating agent
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Cyclophosphamide-MOA
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Activated to alkylating metabolites by liver. Forms Acrolein
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What is Acrolein and what causes its production and how is it handled?
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Acrolein is a inactive metabolite formed by Alkylating agents that causes hemorrhagic cystitis. It is managed by administering MESNA.
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Describe the dosing difference between cyclophosphamide and ifosfamide
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Ifosfamide is metabolized to active form much slower therefore requires much higher doses, thus has a higher risk of hemorrhagic cystitis.
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Cyclophosphamide/Ifosfamide ADR
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Neurotoxicity, Hemorrhagic cystitis
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How is the neurotoxicity associated with ifofsamide handled?
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Give methylene blue
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When is MESNA given for ifosfamide?
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Given before and at 4 and 8 hours following ifosfamide dose in doses 60-100% of ifosfamide dose. MUST HAVE AT LEAST 60%!!!
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Carmustine/Lomustine MOA
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Alkylating agents that are lipophilic thus can cross BBB and can be used for tumors of the brain.
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Carmustine/Lomustine ADR
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Delyaed myelosuppression, phlebitis (Car), NV (Lom), Pulmonary (car)
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Cisplatin-MOA
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Forms crosslinking between DNA causing distorition, prevents normal base line up.
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Cisplatin-ADR
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Nephrotoxicity, NV, Ototox, Neuropathy
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Treatment and Risk factors for Nephrotoxicity associated with Cisplatin
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IVFs and electrolyte replacement (for K,Mg wasting)...
Risk factors: High single dose, Cumulative dose, dehydration, prexisting renal Dz, concurrent renal toxic doses. |
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Carboplatin-MOA
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Same as cisplatin:Forms crosslinking between DNA causing distorition, prevents normal base line up.
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Dosing for Carboplatin
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Dose=(CrCl+25)xAUC
Typical AUC target 4-8 |
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Carboplatin- ADR
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Thrombocytopenia, neutropenia, NV delayed, Nephro (less than cisplatin)
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Oxaliplatin-Approval
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2nd line metastatic colorectal cancer
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Oxaliplatin-ADR
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Neurotoxicity (dose limiting, laryngopharyngeal spasms exacerbaetd by cold), NVD
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Which agents bind to the extracelluar Tyrosine kinase receptor to prevent binding of a ligand?
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Trastuzumab
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Which agents are tyrosine kinase inhibitors that prevent transfer of phosphate to prevent cellular proliferation?
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Imatininib
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Which agent are antibodies that directly induce apoptosis?
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Rituximab, alemtuzumab
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Whcih agents are antivbodies that are conjugated with toxins/chemotherapy?
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Gemtuzumab
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CML?
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Chronic myeloginous leukemia
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Imatinib-MOA
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Binds to ATP binding site to inhibit TK, inhibits cellular proliferation and causes apoptosis
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Imatinib-Selectivity
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BCR-ABL and C-KIT
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Major use of Imatinib
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CML
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Dasatinib-MOA
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Similar to Imatinib:Binds to ATP binding site to inhibit TK, inhibits cellular proliferation and causes apoptosis
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Imatinib-ADR
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Generally well tolerated, myelosuppression
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Dasatinib-ADR
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Generally well tolerated, myelosuppression
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Which agents could be used for Philadelphia chromosome positive ALL?
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Imatinib, Dasatinib
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Major use of dasatinib
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CML/Philadelphia Chromosome positive ALL
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Erlotinib MOA
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Inhibits EGFR TK, inhibits proliferation and causes apoptosis
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Erlotinib use
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Lung cancer
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Erlotinib-ADR
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Rash, pruritis, dry skin, Diarrhea, Conjunctivitis
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Sorafenib Use
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Renal cancer
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Sorafenib MOA
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Multikinase inhibitor (Raf kinases and cell surface kinase receptors VEGFR,PDGFR, cKIT)
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Sorafenib ADR
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Diarrhea, fatigue, HF syndrome
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Sunitinib MOA
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Multikinase inhibitor
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Sunitinib ADR
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Fatigue, rash and hair changes, diarrha, decreased LVEF
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Sunitinib USE
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Renal cell carcinoma and GIST, AML
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xxxxNIB usually denotes which class?
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Tyrosine kinase inhibitors
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Sora and Suni help what?
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Renal cancer
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Ima and Dasa help what?
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CML/Philadelphia
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ErLO helps what?
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Lung cancer
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Trastuzumab/Herceptin MOA
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Targets HER2; proto-oncogene that encodes for recepotr protein related to EGFR--> inhibits proliferation of cells that overexpress HER2, aslo stops intracellular signlalling, causes apoptosis
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Trastuzumab/Heceptin USE
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Metastatic Breast cancer
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Trastuzumab ADR
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Infusion reactions
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Rituximab MOA
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Targets CD20 on B-lymphocytes to stop cell cycle
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Rituximab USE
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Non-hodgkins lymphoma
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Rituximab ADR
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Hypersensitivity, Infusion rxn (use APAP/Benadryl), hypotension
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Ibrotumomab-MOA
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Anti-CD20 like Rituximab, however has ytrrium radiotag
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Ibrotumomab ADR
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Same as rituximab but with 7-9 week delay on myelosuppression
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Tositumomab ADR
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Same as rituximab but with 7-9 week delay on myelosuppression AND HYPOTHYROID
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Tositumomab- MOA
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ANTI-CD with radioactive Iodine
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Gemtuzumab- MOA
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Antitumor ABx attached to humanized anti-CD33 Antibody, causes double strand breaks and inhibits synthesis
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Gemtuzumab - USE
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AML
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Gemtuzumab - ADR
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Myelosuppression, HEPATIC DYSFUNCTION
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Alemtuzumab- MOA
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Targets CD52 on T/B lymphocytes, cause cell lysis
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Alemtuzumab USE
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CLL
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Alemtuzumab ADR
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Infusion rxn (APAP/Diph), Immunosuppression requiring Px Abx
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Cetuximab-MOA
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Binds to EGFR to prevent ligand binding
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Cetuximab- USe
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Colorectal cancer
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Cetuximab-ADRs
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Acneform rash. infusion reaction
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Bevacizumab/Avastin-MOA
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MAB that binds VEGF TO PREVENT ANGIOGENSISI
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beVACizumab VACuums up blood vessels preventing__________________
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Angiogenesis
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Major use of Bevacuzumab
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Colorectal cancer
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Bevacuzumab ADR
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Thromboembolic events, hypertension
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How do you calculate BSA in English units?
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Square root of: (Ht in x Wt lbs)/3131
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How do you calculate BSA in metric units
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Square root of: (ht cm x Wt kg)/3600
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For which drug is AUC used for dosing
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Carboplatin
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