2.18 Questions

What agents should be monitored for electrolyte abnormalities, fluid retention, and changes in liver function tests?

Abiraterone acetate

The toxicity most commonly associated with EGF is:

Acne

What factor predicts a favorable chance to respond to erlotinib?

Activating EGFR mutations present

MC is a 68 y.o. female newly diagnose with stage IV non-small cell lung cancer (NSCLC). She is mutation positive for epidermal growth factor receptor (EGFR) and mutation negative (wild type) for anaplastic lymphoma kinase (ALK). ECOG score is 1, CBC/LFT WNL. SCr = 1. Which targeted therapy should be used for 1st line treatment?

Afatinib

What group of men would be eligible for PSA screening at the age of 40 years old?

African American ancestry

What are risk factor for developing breast cancer?

Age, hormone replacement therapy, first pregnancy after 30 years old

What is the trade name of pemetrexed?

Alimta

What treatment options for prostate cancer is considered to have the most potential complications?

All are considered to be similar in potential complications

This drug is used as chemo and radio protectant to reduce xerostomia and renal toxicity during treatment:

Amifostine

An adjuvant endocrine therapy regimens is most appropriate for a postmenopausal woman with early stage breast cancer is

Anastrozole for 5 years

Monitoring for liver function tests in patients receiving abiraterone acetate is recommended:

At baseline, every 2 weeks for first 3 months, and then monthly thereafter

What is the trade name of bevacizumab?

Avastin

A 68-year-old man with recently diagnosed adenocarcinoma of the lung is found to have stage IV disease (liver metastases). He tests negative for ALK and EGFR mutations. At home, he is bedridden due to severe chronic obstructive pulmonary disease that requires home ¬oxygen. His social history is significant for an 80-pack year history. What chemotherapy regimens would be rational?

Best supportive care

BP is a 62 y.o. male receiving treatment for advanced colorectal cancer with FOLFOX and beacizumab. You counsel him by saying

Bevacizumab is an inhibitor of VEGFR on cancer cells

DI is a 69 y.o. male who is to receive androgen deprivation therapy for metastatic prostate cancer with luteinizing hormone-releasing hormone (LHRH) agonist and antiandrogen. What could be used as an antiandrogen?

Bicalutamide

ST is a 67 y.o. male who will be receiving androgen deprivation therapy (ADT) for metastatic prostate cancer with lutenizing hormone-release hormone (LHRH) agonist as part of his regimen. What agent would be used to counteract the "tumor flare" effects?

Bicalutamide

What is considered the primary site of metastases for prostate cancer?

Bone

CB is a 35y.o. woman with a known BRCA1 mutation. According to the American Cancer Society, which screening modalities would be recommended for her annually?

Breast MRI and mammogram

BB is a 69 y.o. with metastatic prostate cancer who is receiving chemotherapy and a bisphosphonate, zoledronic acid. What tests should be monitored while this patients is on zoledronic acid?

CHEM-7 panel. Monitor SCr. If Creatinine Clearance is 35, avoid zoledronic acid

SG is a 74 y.o. male with a diagnosis of metastatic castration recurrent prostate cancer (CRPC). He has been receiving docetaxel and prednisone for the past 2 months, but his disease is progressing with an increasing PSA and testosterone level. What is the best treatment at this time?

Cabazitaxel with prednisone

What therapy would be appropriate in a metastatic castrate-resistant prostate cancer patient who failed docetaxel?

Cabazitaxel, abiraterone acetate, or enzalutamide

This agent, a prodrug for 5-FU, is used as an adjuvant treatment for colorectal cancer:

Capecitaine

Dr. Jones would like to include Cetuximab in the treatment of a patient with metastatic colorectal cancer. He inquires information about the drug. You tell Dr. Jones:

Cetuximab is an EGFR inhibitor effective for KRAS/NRAS wild type only

MR is a 42 y.o. female with newly diagnosed inflammatory right breast cancer. What is the best option for primary therapy at this time?

Chemotherapy

What agent can cause peripheral neuropathy when cumulative doses exceed 400 mg/m2?

Cisplatin

What is the best treatment option for a 61-year-old man who is chemotherapy naive and was recently diagnosed with extensive-stage small-cell lung cancer?

Cisplatin PLUS etoposide

A 61-year-old woman presents to clinic with newly diagnosed squamous cell carcinoma of the lung which metastasize to the liver and bone. The patient tests negative for relative mutations in ALK and EGFR. All of her laboratory values are within normal limits, and reports that she is extremely active. Based upon this information, what treatment would be rational?

Cisplatin PLUS gemcitabine

MN is seeing his oncologist today and receives a prescription for both leuprolide and flutamide. The use of an antiandrogen and an LH-RH agonist together is called:

Combined androgen blockade

A 59-year-old man with recently diagnosed limited-stage small-cell lung cancer comes to clinic for treatment. What would be a rational therapy for this gentleman?

Concurrent thoracic radiation therapy, cisplatin, and etoposide

VJ is a 67 y.o. female diagnosed with stage IV NSCLC. She is anaplastic lymphoma kinase (ALK) gene rearrangement positive and epidermal factor receptor (EGFR) mutation negative. CBC and LFTs are WNL. SCr = 1. Her oncologist would like to use a targeted therapy as first-line treatment. What agent should you recommend?

Crizotinib

What 5 drugs have an adverse effect of osteonecrosis of the jaw?

Denosumab Prolia Xgeva Pamidronate Aredia

In a patient with hormone refractory prostate cancer that has spread to the bone, what treatment may help decrease skeletal related events and pain?

Denosumab 120 mg subcutaneously every 4 weeks

When comparing breast conserving therapy (BCT) to a modified radical mastectomy

Despite slightly higher local recurrence rates, BCT is associated with similar survival outcomes

LB is a 63-year-old man with metastatic castrate-resistant prostate cancer. He has several other comorbid diseases including CHF, diabetes, and hypertension. What chemotherapy or systemic agents is the most appropriate for this patient?

Docetaxel PLUS prednisone

An adjuvant chemotherapy combination that is most appropriate for the treatment of early stage breast cancer is

Docetaxel, doxorubicin, cyclophosphamide (TAC)

LJ is a 43 y.o. woman with newly diagnosed breast cancer. Her tumor was 4 cm in size, with 6 positive lymph nodes upon axillary dissection, and she has no other sites of cancer. Her tumor is ER/PR negative, HER2 positive by FISH. What regimen would be most appropriate to treat her early-stage breast cancer?

Doxorubicin + Cyclophosphamide (AC) (Adriamycin + Cytoxan) → Paclitaxel + Trastuzumab (PH)

TP is a 44 y.o. female with newly diagnosed breast cancer. Her tumor was 4 cm in size with 6 positive axillary lymph nodes upon dissection. No other sites of the cancer have been found. Her tumor is HER2 positive by FISH. What would be the most appropriate to treat her early stage breast cancer?

Doxorubicin + Cyclophosphamide (AC), Paclitaxel, Trastuzumab

What androgen deprivation therapy is associated with an increase risk of seizures?

Enzalutamide

Based on current NCCN guidelines, the agent is 1st line in patients with advanced non-small cell lung cancer, with sensitizing EGFR mutations regardless of performance:

Erlotinib

What agent is used in the treatment of non-small cell lung cancer (NSCLC) should be taken on an empty stomach, 1 h prior to or 2 h after meals?

Erlotinib

What is the best recommended treatment for a 60 y.o. female with newly-diagnosed extensive-stage small cell lung cancer (SCLC) with an ECOG score of 1?

Etoposide and cisplatin

TP is a 66 y.o. female diagnosed with Stage II hormone receptor positive breast cancer. She has undergone total mastectomy and would require hormone treatment as adjuvant therapy. There are no contraindications to her treatment. What drug would most likely be recommended for TP?

Exemestane

Administered via intramuscular injection for the treatment of metastatic estrogen receptor positive breast cancer is

Faslodex (Selective ER down-regulator) stage IV which means metastatic

The brand name for letrozole is

Femara

What most accurately describes adverse events associated with cabazitaxel?

Fluid retention, mucositis, hypersensitivity reactions, bone marrow suppression

PZ is a 55 y.o. female, diagnosed with lung cancer who is receiving pemetrexed as part of her therapy. What drug should be recommended to minimize a common toxicity of pemetrexed (what is the toxicity)?

Folic acid and Vitamin B

What is the mechanism of action of degarelix?

GnRH antagonist

What is a side effect associated with antiandrogen use?

Gynecomastia

A patient taking capecitabine for metastatic breast cancer describes to you the development of tenderness on her hands and feet that is make it difficult for her to be on her feet. What would be the most appropriate recommendation for this patient?

Her symptoms describe the onset of a known side effect of capecitabine. You recommend she call her physician and describe the onset of these symptoms before taking any more doses of capecitabine.

Digital rectal exam when used in combination with PSA is recommended for the detection of prostate cancer due to:

High specificity

What is considered the most important prognostic criteria when staging prostate cancer?

Histologic grade

What condition would be a contraindication to administration of tamoxifen for the prevention of breast cancer in a "high-risk" premenopausal patient?

History of deep venous thrombosis

As part of prophylactic treatment of tumor lysis syndrome that occurs during the treatment of non-bulky hodgkins lymphoma (NHL), what is an appropriate recommendation?

Initiate allopurinol 2-3 days before chemotherapy and rasburicase at the first sign of uric acid elevation

This agent, used for the treatment of metastatic colorectal cancer, produces GI toxicity with severe diarrhea in up to 90% of patients which requires treatment with antidiarrheal drugs:

Irinotecan

DB is a 35 y.o. premenopausal woman with newly diagnosed metastatic breast cancer (triple negative). She completed adjuvant chemotherapy (anthracycline- and taxane-containing regimen) for a locally advanced breast cancer approximately 7 months ago. She now has widespread lung metastases with shortness of breath and coughing at rest. What regimen would be most likely to provide symptomatic relief for this patient at this time?

Ixabepilone with capecitabine (ixempra with xeloda)

In the management of castration naïve metastatic prostate cancer, what are preferred agents based on current NCCN guidelines?

LHRH agonist like Gosereline, Leuprolide, Triptorelin, or Histrelin, PLUS testicles

SW is a 66 y.o. postmenopausal woman with newly diagnosed metastatic breast cancer to the liver (ER/PR positive; HER2-negative). This was found on routine blood work (elevated transaminases) and was confirmed by CT scan and biopsy. She is otherwise asymptomatic from her cancer and feels well. What regimen would be best to treat her cancer at this time?

Letrozole plus palbociclib

A patient is receiving high-dose methotrexate and the nurse is about the start administering leucovorin rescue therapy. For administration of leucovorin,

Leucovorin should not be administered at a rate >160 mg/min

MG is a 60 y.o. male diagnosed with locally advanced prostate cancer. He recently underwent prostatectomy and is to receive adjuvant treatment which includes an LHRH analog. What agent should be considered?

Leuprolide

What LHRH agonist contains coated pellets and is administered IM to allow sustained levels throughout the dosing interval?

Leuprolide depot (Lupron)

What LHRH agonist is given SC every 12 months?

Leuprolide implant (Viadur)

What side effect is more common with carboplatin rather than cisplatin?

Lowered platelet count

CB is a 70 y.o. male receiving cisplatin and MTX for treatment of non-squamous non-small cell lung cancer (NSCLC). After 6 cycles, it is decided to continue treatment as maintenance therapy. Based on current NCCN guidelines, what agent should you recommend?

Pemetrexed

BD is a 45-year-old African American man with a family history of prostate cancer who presents to his primary care physician for his annual examination. He asks about prostate cancer screening. What of the following is the most appropriate course of action?

Perform a digital rectal examination and draw a PSA level.

What agent prevents HER2 protein dimerization and subsequent cell signaling?

Pertuzumab (Perjeta)

What condition would be a contraindication for prescribing an aromatase inhibitor?

Premenopausal patient

You are asked to provide in-service education on prostate cancer to other healthcare professionals. What about prostate cancer screening should you include?

Prostate specific antigen (PSA) testing should be offered to healthy, well-informed men 45-75 y.o. with or without a digital rectal exam (DRE)

Patient is receiving treatment for prostate cancer, comes in for follow-up at 8 months with symptomatic bone pain, PSA increase over last 2 months, extensive worsening bone metastasis, ECOG performance score 1. What is the best treatment?

Radium 223

For a patient receiving erlotinib, you should counsel them about which side effect?

Rash

What dietary factors have been associated with an increased risk in prostate cancer?

Retinol

This drug is recently approved for metastatic breast cancer in females with hormone receptor positive, HER2 negative breast cancer

Ribociclib

AF is a 63 y.o. female receiving treatment for metastatic colorectal cancer with oxaliplatin and irinotecan. Each agent carries emetogenic potential. What recommendation is appropriate regarding the selection of agents for prophylaxis against chemotherapy-induced N/V (CINV) in this patient?

She should receive agents for prophylaxis of CINV for high emetogenic risk medications

LG is a woman with newly diagnosed breast cancer. Her tumor was 3 cm in size, with 5 positive lymph nodes upon axillary dissection, and she has no other sites of cancer spread. According to the TNM staging system for breast cancer what stage of breast cancer does LG have?

Stage IIIA

What stages of breast cancer is generally considered incurable?

Stage IV

A 65-year-old patient brings in her tamoxifen prescription for a refill. Upon reviewing her medication profile, you discover that she began taking tamoxifen 20 mg daily in June 2000 for the prevention of breast cancer and she has been having it refilled regularly since then. What, if anything, should you discuss with the patient's physician?

Switching this patient to an AI based on recent studies that have documented improvement in efficacy and tolerability with AIs.

What endocrine therapy associated with an increase incidence of endometrial cancer?

Tamoxifen

What hormonal therapy is most appropriate for adjuvant treatment in premenopausal women?

Tamoxifen

What is the trade name of erlotinib?

Tarceva

A 69-year-old woman is taking anastrozole for ER +/PR+, HER2-negative stage 4 breast cancer. Upon returning for her third refill she tells you that she has noticed increased stiffness and joint pain in knees. She started taking ibuprofen 400 mg four times a day without much benefit for the past week. Your recommendation is to:

The symptoms of joint and muscle pain are likely caused by anastrozole. You offer to call her physician to discuss switching to letrozole or exemestane.

What is an effective method to attempt to decrease a rising PSA in patient who initially received combined androgen blockade with an LHRH agonist?

Withdraw antiandrogen therapy

A patient presents a new prescription to you for tamoxifen. Her doctor said he was prescribing it as adjuvant treatment for breast cancer following her surgery last month. You review her medication profile and document that she is also taking metoprolol, hydrochlorothiazide, and fluoxetine. What is the appropriate assessment of potential drug interactions for this patient?

You explain that a number of SSRIs including fluoxetine decrease the effectiveness of tamoxifen by interfering with its metabolism to an active metabolite. You will call the patient's physician to consider alternative antidepressant options.

A patient asks you if you could recommend a dietary supplement that has been proven effective in decreasing the risk of breast cancer. What would you recommend?

You explain that there are not any dietary supplements that have been proven effective in lowering the risk of breast cancer.

Most women with breast cancer present with:

a painless lump in the breast

A supportive care medication that is associated with the development of mood swings is

dexamethasone

A 60-year-old woman comes into your pharmacy to pick up her prescription for hydrochlorothiazide for hypertension. She asks you about taking vitamin supplements to decrease her risk of lung cancer. Her social history is significant for smoking a pack of cigarettes a day for 25 years, but she stopped a year ago. Based upon this information, you should recommend

no supplement is recommended

A 55 y.o. man was recently diagnosed with prostate cancer.His oncologist tells him that his prostate cancer has a Gleason score of 4 + 4 or 8.A prostate cancer with a Gleason score of 8 is considered:

poorly differentiated

Cigarette smoking is a _____ risk factor for lung cancer.

preventable

This drug is used as part of a combo regimen for treatment of pts with HER2+ breast cancer

Trastuzumab

PB is a 54 y.o. female diagnosed with HER2+, ER+, PR-ve breast cancer. She will be treated with the regimen of AC + trastuzumab. What 2 drugs would most likely cause cardotoxicity?

Trastuzumab Doxorubicin

A premenopausal woman with ER negative, node positive breast cancer is starting doxorubicin and cyclophosphamide adjuvant treatment. What would you recommend to determine the severity of the most -common toxicity associated with this treatment regimen?

A complete blood count including platelets 1 week after administration of the chemotherapy

Sipuleucel-T is indicated for treatment of prostate cancer in:

A patient with minimally symptomatic metastatic castrate-resistant prostate cancer

QM is a 72 y.o. female with a diagnosis of stage 4 non-small cell lung cancer (NSCLC). She is currently receiving carboplatin and etoposide. The desired AUC of carboplatin is 5. CrCl is 55 mL/min. Which dose of carboplatin do you recommend?

400 mg

You receive the following order for a patient with stage 4 breast cancer. Albumin-bound paclitaxel 470 mg is administered as an IV infusion at a rate of 10 mg/min. You verify that an appropriate dose is 260 mg/m2 -administered over 30 minutes. The patient has a BSA of 1.81 m2. Is this dose and infusion rate ordered correctly?

No, the order is incorrect because the dose is correct, but the infusion rate should be 15 mg/min.

For a patient receiving bevacizumab, you should closely monitor the patient for what side effects?

Hypertension, thromboembolic events, and proteinuria

According to the NSABP Tamoxifen Prevention Trial (P1), tamoxifen given for 5 years (compared to placebo) is associated with

Increased risk of thromboembolism and endometrial cancer.

In a patient treated with androgen deprivation therapy (ADT) and a gonadotropin-releasing hormone (GnRH) agonist for prostate cancer, what complications is this patient more likely to experience?

New-onset diabetes

What agent is classified as a checkpoint inhibitor and exerts its action by targeting PDL-1 receptors on cancer cells?

Nivolumab

For a patient receiving etoposide, you should counsel the patient about what side effect?

Myelosuppression about 1 week after receiving etoposide

In regards prostate cancer that is staged as: T3b, Gleason score 8 and a PSA of 40:

These have a high risk of recurrence and proper management includes immediately starting combined androgen deprivation therapy.

A 64-year-old man with a performance status of 1 returns to clinic with relapsed small-cell lung cancer (SCLC), new bone, and liver metastases. He completed his previous chemotherapy of carboplatin and etoposide 5 months ago and reports no other medical problems. He and his wife request further treatment if it is reasonable. Based upon this information, what treatment would be rational?

Topotecan