NAPLEX Oncology I and II
What can you use for low emetic risk?
1 of 3 - 5HT3-RA - Dexamethasone - Metoclopramide
Which weight do you use when calculating BSA?
Actual body weight
What are the three subtypes of CINV?
Acute Delayed Anticipatory
What are the cell cycle non-specific agents?
Alkylating agents Anthracyclines Platinum agents
Name some aromatase inhibitors
Anastrozole Letrozole Exemestane
What can be used for CID?
Antimotility agents - loperamide - diphenoxylate + atropine
Name some PCSK9 inhibitors
Arepitant (Emend) Fosaprepitant (Emend) Netupitant + palonosetron (Akynzeo)
What are the warning signs of melanoma?
Asymmetry Border Color (uneven color) Diameter (>6mm) Evolving
Chemotherapy may be dosed using flat, patient weight, or _______
BSA
What is the Mosteller Equation?
BSA (m2) = ([Ht(cm) x Wt(kg)]/3600)^0.5
What is the DuBois and DuBois Equation?
BSA (m2) = 0.007184 x [ht(cm)]^0.725 x [Wt(kg)]^0.425
What would you use for anticipatory CINV?
Benzodiazepine
What are some FG antiandrogen?
Bicalutamide (Casodex)
Vinblastine and vinorelbine are associated with more...?
Bone marrow suppression
Which side effect is common of many chemotherapy agents?
Bone marrow suppression
What are seven warning signs of cancer?
Change in bowel habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or harseness
What is first line treatment of metastatic prostate cancer?
Chemical castration
Which chemotherapy drugs are of high emetic risk?
Cisplatin
What are some examples of platinum based agents?
Cisplatin (Platinol) Carboplatin (Paraplatin) Oxaliplatin (Eloxatin)
How do alkylating and platinum based agents work?
Cross-linking DNA strands and inhibiting protein synthesis and DNA synthesis
What are some examples of alkylating agents?
Cyclophosphamide (Cytoxan) Ifosfamide (Ifex) Carmustine Dacarbazine Procarbazine
What can you give with doxorubicin to prevent cardiomyopathy?
Dexrazoxane
Which CINV medications can cause EPS?
Dopamine antagonists
What some examples of anthracyclines?
Doxorubicin + liposomal version Daunorubicin Idarubicin
How do you calculate BSA?
DuBois and DuBois, and Mosteller equations
Which breast cancer patients are candidates for adjuvant hormonal therapy?
ER+/PR+
Which medications should you not use for anemia for cancer patients? Why?
ESAs - shorten survival - increase tumor progression or recurrence
What are some SG antiandrogen?
Enzalutamide (Xtandi)
What other ADTs are there?
FG antiandrogens SG antiandrogens Androgen biosynthesis inhibitor
Chemotherapy can be used in pregnant women. Caution is advised True or False
False - avoid
What are the risk factors for nausea and vomiting with chemotherapy?
Female <50 years of age Dehydration Hx of motion sickness Hx N/V
Which chemotherapy drugs can cause diarrhea (CID)?
Fluorouracil Capecitabine Irinotecan
What is filgrastim (Neupogen)?
G-CSF - used as prophylaxis to reduce time in the state of low WBCs and platelet
Some patients with breast cancer can over express which protein?
HER2
What is the common toxicity of ifosfamide and cyclophosphamide?
Hemorrhagic cystitis
Name some topo I inhibitors
Irinotecan (Camptosar) Topotecan (Hycamtin)
What can you give as adjunct with fluorouracil to enhance efficacy?
Leucovorin or levoleucovorin
Name some GnRH agonists
Leuprolide (Lupron) Goserelin (Zoladex)
How do gonadotropin-release hormone (GnRH) agonists work?
Luteinizing hormone releasing hormone agonsts - reduce testosterone synthesis through negative feedback mechanism
Name some 5HT3 antagonists
Ondansetron (Zofran) Granisetrong (Kytril) Dolasetron (Anzemet) Palonosetron (Aloxi)
What can be done to correct hypercalcemia?
Oral or IV hydration IV bisphosphonate (mod-severe) Denosumab (not responding to bisphos) Calcitonin
Name some taxanes?
Paclitaxel (Taxol) Docetaxel (Taxotere) Paclitaxel (Abraxane)
What is hand-foot syndrome?
Patients present with redness, swelling, tenderness, pain, blisters and possibly peeling of the palms and soles
What is the common toxicity of vinca alkaloids (vincristine, vinblastine and vinorelbine) and taxanes (paclitaxel, docetaxel)?
Peripheral neuropathy
How is breast cancer classified?
Presence or absence of hormone receptors -estrogen receptors (ER) -progesterone receptors (PR)
What are some examples of dopamine receptor antagonists?
Prochlorperazine (Compazine) Promethazine (Phenergan) Metoclopramide (Reglan)
Which cancer is the most common in the US?
Skin cancer
Most patients with early stage breast cancer are treated with...?
Surgery Radiation Chemotherapy Hormonal therapy
When are platelet transfusions generally indicated?
WHen platelets drop below 10,000 (or 20,000 if active bleed is present)
When can live vaccines be given to cancer patients?
When it has been at least 3 months after discontinuation of chemotherapy
What is hormone therapy for prostate cancer is referred to as _____?
androgen deprivation therapy (ADT)
What can you give with irinotecan to prevent acute diarrhea?
atropine
What are the three types of skin cancer?
basal, squamous, melanoma
How do topoisomerase II inhibitors work?
block coiling and uncoiling of the dsDNA helix during G2 phase
How do topoisomerase I inhibitors work?
block coiling and uncoiling of the dsDNA helix during S phase
How does aromatase inhibitors work?
block enzyme required for conversion of adrenally produced estrogen precursors to estrogen
How do 5HT3 receptor antagonists work for CINV?
blocking serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone
How do dopamine receptor antagonists work for CINV?
blocks dopamine in the CNS, including the chemoreceptor trigger zone (among other mechanisms)
Hypercalcemia occurs commonly in patients with...?
breast, lung cancer, and multiple myeloma
Which corticosteroid do we use for CINV?
dexamethasone
Which chemotherapy drugs cause hand-foot syndrome?
fluorouracil capecitabine cytarabine liposomal doxorubicin
Which CINV medication should you avoid with apomorphine?
granisetron
Patients receiving cytotoxic chemotherapy are at risk for..?
infections with etneric bacteria and fungi due to alterations in GI mucosa
How do vinca alkaloids and taxanes work?
inhibit the function of microtubules during M phase
How do NK inhibitors work for CINV?
inhibit the substance P/neurokinin 1 receptor, therefore augmenting the antiemetic activity of 5HT3 receptor antagonists and corticosteroids
How does anthracyclines work?
intercalation into DNA, inhibiting topoisomerase II, and creating oxygen-free radicals that damage cells
How does hormonal therapy (selective estrogen receptor modifiers ((SERMs)) work for breast cancer?
interfering with estrogen-stimulated growth of breast cancer cells
Patients with UGT1A1*28 are at risk for what?
irinotecan inreased risk for neutropenia and delayed diarrhea
What is neutropenia?
low neutrophil count - increases infection risk and makes it difficult for the human body
Why can't you do monotherapy with FG antiandrogens?
monotherapy is ineffective due to an up-regulation in the expression of androgen receptors
What is the common toxicity of methotrexate?
mucositis
What is the common toxicity of cisplatin, carboplatin?
nephrotoxicity, ototoxicity
What is the common toxicity of nitrosoureas (lomustine, carmustine)?
neurotoxic (crosses BBB)
Patients who are ___________ should be treated with tamoxifen for 5 years
premenopausal
What is the common toxicity of bleomycin?
pulmonary fibrosis
Name some SERMs
tamoxifen (Nolvadex) fulvestrant (Faslodex)
What does neoadjuvant mean?
therapy given before the primary therapy (usually surgery) to shrink the size of the tumor
The risk of cardiotoxicity is related to the ________________ anthrcycline dose the patient has received _____________
total cumulative ; over their lifetime
If the previous patient with premenopause is still the same after tamoxifen treating, what can you do?
try tamoxifen again
If the previous patient with premenopause is postmenopausal after tamoxifen treating, what can you do?
try tamoxifen again or aromatase inhibitor
Which vinca alkaloid is associated with more CNS toxicity?
vinCristine
The lowest point that WBCs and platelets reach occurs about ___________ after chemotherapy
7-14 days
When chemotherapy is being planned, vaccination should precede the initiation of chemotherapy by >/- ___ weeks
2
What can you use for moderate emetic risk?
2 of 3 - NK1-RA + 5HT3-RA + Dexamethasone
How long does mucocitis resolve after peaking (7 days)?
4- 8 days later
(SERMs/AI) have higher risk of osteoporosis due to decreased bone mineral density
AI
If the patient remains cancer-free for ___ years, it is unlikely that their cancer will recur
5
What would you use for delayed CINV?
NK1 receptor antagonists, corticosteroids
Which CINV medications increase QTc prolongation?
5HT3 antagonists Dopamine antagonists
What would you use for acute CINV?
5HT3 receptor antagonists
Neutropenia is categorized as ANC of ...? (according to American Society of Clinical Oncology)
<1000 cells/mm3
What can you use for high emetic risk?
NK1-RA + 5HT3-RA + Dexamethasone
What are some concerns with cisplatin?
Nephrotoxicity, ototoxicity, highly emetogenic
Why are AIs ineffective in premenopausal women?
Majority of estrogen in premenopausal women is produced in the ovaries, not the adrenal glands
What do you give concurrently with ifosfamide to prevent hemorrhagic cystitis?
Mesna (Mesnex)
What are some medications to help oral complications of chemotherapy?
Mucositis Mucosal barrier gel Lidocaine topical solution Xerostomia - artificial saliva Pilocarpine
What are some general side effects to consider when administering chemotherapy?
Myelosuppression Neutropenia Thrombocytopenia Anemia Nausea/Vomiting Diarrhea Hand-foot syndrome Hypercalcemia
What are used as second line for CINV?
cannabinoids - Dronabinol (Marinol, Sydros) - nabilone (Cesamet)
What is the common toxicity of doxorubicin and other anthracyclines?
cardiotoxic
How do FG antiandrogens work?
competitively bind testosterone to prostate cancer cells
