P3 Tp Iii Final Exam

Front 1

Top 3 most common cancers by incidence and deaths per year

Back 1

Incidence- prostate (men) breast (women), lung, colon
Death- lung CA both, prostate (men) breast (woman), then colon both

Front 2

Carcinogenesis steps

Back 2

initiation,
promotion,
transformation,
progression

Front 3

Oncogenes
exs

Back 3

EGFR, HER-2/neu

- overexpressed in CA

Front 4

Tumor suppressor genes
ex

Back 4

p53, BRCA 1 and 2

- mutations increase likiness

Front 5

Metastasis- Common sites for lung, colon and breast cancer

Back 5

- all bone and liver

Lung- brain, adrenal

colon- lungs

breast- lung, brain

Front 6

Angiogenesis

Back 6

vascularization of tumor- leads metastasis

Front 7

Screening
Breast

Back 7

self exam 20 and over monthly

clinical 20-39 q3 years,
or over 40 every year

mammography- over 40 q yr

Front 8

Screening
Colon

Back 8

fecal occult q 1

flexible sigmiodscopy or FIT- q 5 years

colonoscopy- q 10 years

Front 9

Staging
letters...

Back 9

T-size
N-lymph involvement (next worse)
M- metastasis (worst)

Front 10

Staging
numbers...

Back 10

Stage 1- local
Stage 2-3 local/regioonal extension
stage 4- metastasis

Front 11

chemo works best when

Back 11

tumor small

Front 12

Cell cycle agents dose scedule

Back 12

continuous infusions

Front 13

Mitosis agents

Back 13

vinca alkaloids(never intrathecally),

taxanes (both hepatic dose adjust)

(both vesicans)

Front 14

G1 agents

Back 14

nitrosureas, asparaginase

Front 15

G2 agents

Back 15

epidopophyllotoxins, bleomycin

Front 16

S phase agents

Back 16

Antimetabolites- Antifolate(trex), antipyrimidines, antipurines (purine/ guanine)

Front 17

Multiphase acvitiy agents

Back 17

-alkylating agent, anthracycline antibiotics....others cisplatin, mycins

Front 18

Monoclonal antibodies
-target?

Back 18

-target CD markers(allow body to recognize) or target growth factor receptors (block cell growth)

Front 19

Next few tell me the target....

Back 19

iilii

Front 20

Bevacizumab

Back 20

VEGF

Front 21

Brentuximab vedotin

Back 21

CD30

Front 22

Cetuximab

Back 22

EGFR

Front 23

Irbitumomab Tiuxetan

Back 23

radioactive particle CD20

Front 24

Ofatumumab

Back 24

CD20

Front 25

Panitumumab

Back 25

EGFR

Front 26

Rituximab

Back 26

CD20

Front 27

Tositumomab

Back 27

Radioactive particle, CD20

Front 28

Trastuzumab

Back 28

HER2

Front 29

BSA formula *****

Back 29

square root of (height (cm) x weight (kg) / 3600) (verify weight)

Front 30

Calvert Formula

is for and is....

Back 30

for carboplatin

Dose (mg) = AUC x (CrCL +25)

Front 31

Want baseline labs depending on drugs being used

Back 31

WBC, ANC, PLT..

..ECHO for cardiotoxic scan

prolly liver and renal

Front 32

Renal Adjustmented drugs....

Back 32

Carbo
Cisplatin
Bleomycin
Cytarabine
Methotrexate

Lots of others but those are big ones

Front 33

Hepatic dose adjustment

Back 33

vincas and ~anthrcyclines..?

Doxorubicin, daunorubicin

vincristine, vinblastine....

-if elevated LFT nothing to do with cancer then dose adjust if not then possible full dose

Front 34

Factors affecting response

Back 34

-tumor cell heterogeneity

-dose intensity- performance status may determine intensity (ECOG and Karnofsky)

-pt specific factors

Front 35

Response Criteria

Back 35

CR- Complete Response- dissappearance or no new disease least 1 month

PR- Partial Response- 30% or more decrease tumor size or other objective marker

Stable disease- no more diff by 20%

Progression- 20% increase while on tx

Clincal beneficial response- improved QOL

Front 36

Extravasation is

Back 36

-complication of IV chemo admin

-escape of drug from vessel to surrounding tissue

-Vesicant- can cause tissue necrosis, bind irreversibly-- put in syringes!!!

-Irritant- cause local inflammatory rx w/o necrosis-- can be bagged

Front 37

Vesicants- are

Back 37

anthracyclines,

vinca alkaloids,

taxanes,

alkylating agents (sum mitomycin)

Front 38

next we have vesicants and antidotes...

Back 38

so there

Front 39

Anthracyclines

Back 39

- antidote Dexrazoxane w/i 6 hours, COLD PACK

Front 40

Mitomycin

Back 40

antidote DSMO, COLD PACK

Front 41

Vinca Alkaloids, Etoposide, Paclitaxel

Back 41

-Antidote- Hyaluronidase, WARN COMPRESS (COLD FOR PACLITAXEL)

Front 42

Cisplatin, Mechlorethamine

Back 42

Antidote- Sodium Thiosulfate 4%, COLD PACK

Front 43

Hematologic tox which drugs is it DLT

Back 43

Carboplatin

doxorubicin

Fludarabine

Florouracil

Irinotecan

MTX

Mitomycin

Front 44

Neutropenia

colonating stim factors

Back 44

decrease duration of neutropenia, 24h after chemo

Filgrastim- 5mcg/kg SC, until post nadir recovery
also Pegfilgrastim

-Prophylaxis- NCCN recommend CSF for chemo regimens >20% chance FN

Front 45

Thrombocytopenia

Back 45

less than 100,000

transfusion when under 10,000

carboplatin, gemcitabine, mitomycin, procarbazine, vinorelbine

Front 46

ESAs doses

epo

darpo

Back 46

Epoetin Alfa- 150 U/kg SC TIW or 40,000 U SC weekly

Darbepoetin Alfa- 2.25mcg/kg SC wk or 500mcg SC q3wk

Front 47

Anthracycline induced CARDIOTOX

monitoring

Back 47

ECHO or MUGA, baseline , q3 months

NEED ejection fraction

dose related and irreversible

Front 48

Anthracycline induced CARDIOTOX

freq in drugs

Back 48

Doxorubicin > Daunorubicin > Idarubicin > mitoxantrone > Epirubicin

NOT THE DLT for these (BMS is)

Front 49

Trastuzumab tox

Back 49

Cardiotox- not dose related and largely reversible

Front 50

Nephrotoxicity
Cisplatin

Back 50

HYDRATION, hyponatremia, hypomagnesemia

Front 51

Nephrotoxicity

Cyclophosphamide/Ifosfamide

Back 51

Hemorrhagic cystitis


Ifosfamide REQ MESNA!

Front 52

Nephrotoxicity

MTX

Back 52

acute tubular necrosis

alkalanization of urine w/ sodium bicarb want pH 7

no PPIs

Front 53

Nephrotoxicity

Pentostatin

Back 53

dose limiting- increase serum creatinine

Front 54

Peripheral Neuropathy

drugs?

Back 54

Oxaliplatin- DLT !!!!

Paclitaxel- more with shorter infusion

Front 55

Autonomic Constipation

Back 55

:- doesnt resolve

Vinca alkaloids

Front 56

Alopecia

Back 56

Taxanes- lose hair everywhere

7-14 days after tx

Front 57

Hypersensitivity Rxns

Back 57

Bleomycin- test dose

Paclitaxel- excipient
PREMEDICATE- diphenhydramine, dexamethasone, H2 agonist

also Paclitaxel nonPVC bags and tubes

Front 58

Infusion related rxn
Monoclonal abs..
first infusion (not allergic)

Back 58

cytokine release

Rituximab, Alemtuzumab, Trastuzumab, Cetuximab

-Fever, chills, flushing, itching, HR/BP, chest discomfort

Front 59

Pulmonary Tox
Pulmonary fibrosis

Back 59

Pulmonary fibrosis

Bleomycin- max 400 units lifetime

Front 60

Mucositits

Back 60

cant eat cant swallow

Majic mouth wash... lidocaine/diphenhydramine/nystatin

Palifermin (growth factor)- prior transplant

5FU, doxorubicin, MTX, bleomycin

Front 61

Anorexia and Cachexia

Back 61

use:

Megase- optimal 800mg daily (can also use for breast cancer..way smaller)

Dronabinol-less effective but good with NnV and need eating....2.5mg/day

Front 62

Diarrhea

Back 62

F5U, Irinotecan, MTX, cytarabine

Uncomplicated (<6 stools/day) hydration...

Complicated
Loperamide!!! max 16 day 1, max 24 day 2

If persists 48h then octreotide and inpt

Front 63

Emesis
types

Back 63

acute

delayed
anticipatory

breakthrough

Front 64

Delayed emesis drugs

Back 64

Cisplatin, carboplatin, cyclophosphamide, ifosfamide, doxorubicin

Front 65

High emetic risk drugs

Back 65

-Carmustine,
cisplatin,
cyclophosphamide>1500,
dacarbazine,
mechlorethamine

Front 66

High emetic risk

Prop w/

Back 66

Day1- 5-HT3 + Dexamethasone + [Aprepitant or Fosaprepitant (only day 1)]


Day2-4 - Dexamethasone + Aprepitant ....

Front 67

Moderate Emetic Risk

agents

Back 67

-Carboplatin,
cyclophosphamide<1500,
cytarabine>1g,
anthracyclines,
ifosfamide,
irinotecan,
oxaliplatin

Front 68

Moderate Emetic Risk

Prop w/

Back 68

5HT3 and Dexamethasone 3 days (decrease dex day 2-3 to 8)

Front 69

Low emetic Risk

Back 69

-Docetaxel, etoposide, 5 FU, gemcitabine, mitomucin, paclitaxel, topotecan

Prop w/
Day1-4 Dexamethasone or metocloperamide or prochlorperazone

Front 70

FOR ALL EMETIC RISK LORAZEPAM AND ANTACID are +/-

Back 70

fyissss

Front 71

5HT3 antagonists

Back 71

Ondansetron

Dolasetron

Granisetron

Palonosetron- long acting!! preferred agent in mod high, also good delayed

Front 72

Neurokinin 1 Receptor Antag

Back 72

Aprepitant

Fosaprepitant- equivalent

Front 73

Breakthrough NnV

Back 73

use diff class

Lorazepam- anterograde amnesia

Metocloperamide- 3 MOAs- block dopa receptors----EPS at high doses

Prochlorperazine,

Promethazine

Routine 5HT3

also possible: Dronabinol, corticosteroids, olanzapine(just approved)

Front 74

Hypercalcemia of Malignancy...

Back 74

Ca lvl >12 mg/dL

correct for hypoalbuminemia: Corrected Ca = (4 - albumin lvl) * 0.8 + Serum Ca

nausea, polyuria, thirst, dehydration, lethargy, confusion, stupor, coma

Can be local (attaches and breaks down bone) or humoral (associated tumor secretion PTHrP)

Front 75

Hypercalcemia of Malignancy

tx

Back 75

Hydration- NS

Loop Diuretic- flush Ca

Calcitonin- only 48 h until bisphosphonate kicks it, block resorption

Bisphosphonate- chelates
Pamidronate
Zolendronic Acid- preferred- potent, shorter infusion, better w/ PTHrP

Watch osteonecrosis of jaw

Front 76

Superior Vena Cava Syndrome

is
when happens
tx

Back 76

tumor obstructing SVC blood flow

common lung and lymphomas

radiation, glucocorticoids, chemotherapy- SHRINK TUMOR!!

Front 77

Tumor Lysis Syndrome

happens w/
what electrolytes
when prevent

Back 77

like infusion related syndrome

Rituximab...

lysis of cells releases intracellular contents into systemic circulation

hyperkalcemia, hyperphosphatemia, hyperuricemia

prevention in high risk- bulky dx and rapid response

Front 78

Tumor Lysis Syndrome

prevention

Back 78

Hydration

Prop allopurinol- decrease formation uric acid

Rasburicase- increase elimination of uric acid, converts to allantoin

reserved high risk pt- baseline uric high or renal insuff

CI in glucose-6-phosphate dehydrogenase deficiency

single dose

Front 79

Anticoagulation in Cancer pts
drugs
cancers

Back 79

High risk drug- Tamoxifen, thalidomide, lenalidomide, bevacizumab

High risk CA- pancreas, stomach, brain, kidney, ovary, lung, lymphoma, metastasis

Front 80

Anticoagulation in Cancer pts

Prop

Back 80

Hospitalized- LMWH, fondaparinus, UFH
Lenalidomide/Thalidomide- LMWH or findaparinus, Warfarin

Front 81

Tx VTE

Back 81

LMWH or fondaparinux for 6 months...no bridge

Front 82

know ur coag doses

Back 82

bitchin

Front 83

Colon Cancer

Risk Factors- Nonmod

Back 83

Elderly,
Male,
Inflammatory bowel disease
,
hereditary syndromes (FAP)(lynch syn)

Front 84

Colon

Risk Factors-Mod

Back 84

Dietary intake redmeat/ sat fat, tobacco, alcohol, obesity, inactivity

Front 85

colon

Screening

Back 85

Fecal occult blood test or FIT

Flexible Sigmoidoscopy

Annual FOBT or FIT and Flex sig

Colonoscopy- most sensitive and specific

Double Contrast barium enema

Front 86

colon
Presentation

Back 86

change bowel habits, ab pain, fatigue (secondary to anemia)

advanced- jaundice

Front 87

Stage I tx

Back 87

surgery

Front 88

stage II tx

Back 88

surgery +/- chemo (only in high risk- T4, perforation, bowel obstructed, poorly differentiaed)

Chemo- FOLFOX- 5FU + leucovorin + oxaliplatin

Front 89

stage III tx colon

Back 89

surgery + chemo

Chemo- FOLFOX 6 months

Front 90

stage IV tx colon

Back 90

chemo and targeted

Chemo FOLFOX
or FOLFIRI- 5FU + leucovorin + irintoecan

if progession- Cetuximab or Panitumumab

Targeted- Bevacuzimab

Front 91

5FU
about
toxicities

Back 91

antimetabolite, inhib DNA syn via TS

Bolus or continous

Bolus DLT-neutropenia

Continous DLT- hand/ foot syndrome

Front 92

Leucovorin

Back 92

synergistic effect w/ 5-FU, enhancing

Front 93

Oxaliplatin

about
DLT

Back 93

non specific, Platinum derivative

DLT- peripheral neuropathy (dose reduce)

avoid exposure to cold...

Front 94

Stage III if cant tolerate FOLFOX can use

Back 94

capecitabine

oral 5FU

SE- hand foot syndrome

single agent adjuvant in stage III

DI with warfarin

Front 95

Irinotecan

works..
SE and avoiding them

Back 95

block DNA syn

NvN, diarrhea:

early onset- use atropine

late onset- loperamide- with that max 16 -> max 24 -> octreotide regimen

Front 96

Bevacizumab

works on
ADE

Back 96

VEGF inhib- prevent angiogensis

AD- HTN, thromboembolism, proteinuria, wound healing, GI perforation

wait 1 months after surgery

Front 97

Cetuximab

works on
toxicity

Back 97

EGFR inhib- second line salvage as single or w/ irinotecan

infusion related itchy, hypotension, SOB

dermatological tox!!!- mild clinda/hydrocortisone....severe-oral minocyclin

rash shows tumor response

benedryl premed!!!!!!!

Front 98

Panitumumab

works on
toxicity

Back 98

EGFR inhib- third 4th line as monotherapy

ADR- also derma rash ---benedryl premed!!!!!!!

electrolyte disturbance-watch em

Front 99

Prostate Cancer

Risks

Back 99

Age, AA, FHx, high fat intake

Blacks have more testosterone....is that why their...nvm

Front 100

Prostate

Screening

Back 100

Digital rectal exam and prostate specific antigen over 50 q 1 year

PSA lvl >/= 4ng/ml (if on 5 alpha redutase inhib- double number)

AA or first degree relatives - test 45

multiple relatives- tests starting 40

Front 101

Prostate

Local dx

Advanced dx

Dx

Back 101

-asymptomatic, ureteral dysfunction, impotence

back pain, weight loss, anemia, fractures

elevated PSA and abnormal DRE shows
TRUS-ultrasound
Prostate biopsy confirms

Front 102

Localized disease (stage I-II) prostate tx

Back 102

active surveillance- low risk pts

surgery
radical prostatectomy- reserved pts >10yr life expectancy, nerve sparing procedure

radiation- alternative to surgery
external beam..? or brachytherapy

brachytherapy- lil radioactive pellets placed inside prostate

Front 103

Locally Advanced Stage III

Back 103

Radiation +/- short term ADT (4-6 months)

Radical prostatectomy

Androgen deprivation therapy (select pts when not candidates for above)
-LHRH agonists, and antiandrogens, orchiectomy, medical castration=surgical castration.

Front 104

Metastatic Disease Stage IV

Back 104

ADT- when there are tumor related symptoms or overt metastasis

once fail ADT- chemo therapy

Docetaxel + prednisone

Mitoxantrone + prednisone

Cabazitaxel

Sipuleucel T - immuno therapy for less advanced disease

Front 105

LHRH agonists

work on
how
SE

Back 105

decrease FSH and LH release from pituitary gland

advanced III -IV as mono or combo

initial flare during first week

need antiandrogen drugs for that time

Degarelix LHRH antagonist used when rapid androgen suppression needed(no flare)

Front 106

LHRH agonists

Back 106

Goserelin

Leuprolide

Triptolerin

Degarelix antag

Front 107

Androgen receptor blockers

how use and drugs

Back 107

always adjunct for flare up not mono

flutamide
bicalutamide
nilutamide

Front 108

Castrate resistant disease tx

Back 108

Docetaxel
Mitoxantrone
Cabazitaxel

Front 109

Docetaxel
tox
info

Back 109

BMS, hepatic dose adjust, vesicant, alopecia, mucositis

possible dexamethasone prevent edema

nonPVC bag

Front 110

Mitoxantrone
info

Back 110

BMS, mucositis, CARDIOtox

Front 111

Cabazitaxel
info

Back 111

premedicate w/ antihistamine, corticosteroid and H2

if fail docetaxel

Front 112

Bone Metastasis

Back 112

start bisphosphonates IV

-Zolendronic acid, pamidronate IV

or Denosumab- RANKL inhibitor (higher incidence osteonecrosis jaw)