In which medication is a test dose often recommended?
L-Asparaginase
What are the toxicities associated with L-asparaginase?
Hypersensitivity
Hyperglycemia
Pancreatitis
CNS effects
Hydroxyurea: PO or IV?
PO
What are the toxicities associated with arsenic trioxide?
Increased QTc
Peripheral neuropathy
Musculoskeletal pain
Hyperglycemia
Which drugs are known to have p450 interactions?
Imatinib
Erlotinib
Lapatinib
Nilotinib
Dasatinib
Name the AEs associated with imatinib
D/N/V
Rash
Fluid Retention
Myalgias
CHF
What AEs are associated with erlotinib?
Rash
Diarrhea
Anorexia
Interstitial Lung Disease
What are the AEs of Lapatinib?
D/N/V
Rash
QT prolongation
What are the AEs of nilotinib?
QT prolongation
Myelosuppression
Electrolyte abnormalities
LFT alterations
Rash
Myalgia
Hyperthyroidism
Toxicities associated with everolimus include:
Hyperglycemia
Hydroxyurea is used as treatment for ________
sickle cell disease
L-asparaginase is used as treatment for ________
Leukemia
Elspar: will be D/C in December of 2012
Arsenic Trioxide is used as treatment for ________
Acute promyelocytic leukemia (APL)
Imatinib is used as treatment for what cancers?
Leukemia
GI stromal tumors (GIST)
Myelodysplastic diseases
What cancers are treated with erlotinib?
Lung
Advanced Pancreatic
What medication is used in the treatment of breast cancer after failure with other therapies?
Lapatinib
Dasatinib is used as treatment for ________
Leukemia
Everolimus is used for treatment in what type of cancer after failure with sunitinib or sorafenib?
Renal cell carcinoma
What drug was approved in 2012 for combination treatment with exemestane in advanced breast cancer?
Everolimus
What is the major toxicity associated with interferon alpha-2B?
Flu like syndrome: fever, myalgia, weakness, headache
What do you monitor in a patient receiving interferon alpha-2B?
LFT
CBC
Thyroid function
Which drug has a black box warning for potential to "cause or exacerbate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, or infections"
Interferon alpha-2b
What are the AEs associated with interferon alpha-2B?
Bone marrow suppression
CNS & neurological effects
Thyroid changes
Hepatotoxicity
What is the MOA of Interleukin-2 (aldesleukin)?
Enhances the proliferation and activation of T-cells and NK cells
What are the major toxicities associated with interleukin-2?
Flu like syndrome
Capillary leak syndrome
N/V
Diarrhea
Bone marrow suppression
CNS effects
What is the black box warning for interleukin-2?
Patients should have normal cardiac and pulmonary function
What are the monitoring parameters for interleukin-2?
BP
EKG
CBC
SCr
Ins/Outs
Signs of pulmonary edema
Name the Estrogen Receptor antagonists
Tamoxifen
Toremifene
Raloxifene: selective-estrogen receptor modulator
What is the MOA of tamoxifen and toremifene?
Inhibit nuclear binding of the estrogen receptor, blocking estrogen stimulation of hormone
What is the MOA of raloxifene?
Activation and inhibition of various estrogen pathways
What are the AEs associated with estrogen receptor therapy?
Hot flashes
N/V
Thromboembolic events
Which class of drug may have decreased efficacy if combined with SSRIs?
Tamoxifen and toremifene
True or False: Raloxifene can be used in premenopausal women
False
Anastrozole, letrozole, and exemestane belong to which class of drugs?
Aromatase inhibitors
What is the MOA of aromatase inhibitors?
Inhibit conversion of androgens to estrogens
List the AEs associated with aromatase inhibitors
Hot flashes
Weight gain
Edema
Fatigue
Bone/joint pain
Potential for increased fracture risk
Give an example of a GnRH agonist
Goserelin
What is the ultimate goal of GnRH agonists?
Decrease testosterone and estrogen concentrations
What are two examples of LHRH agonists?
Leuprolide
Triptorelin
What is the intial AE associated with Goserelin?
A tumor flare
Antiandrogenic effects common with GnRH and LHRH agonists include:
Hot flashes
Decreased libido
Gynecomastia
GI disturbances
Injection site pain
Decreased bone density
What type of drugs can be used to treat prostate cancer?
GnRH
LHRH
Antiandrogens
Name the antiandrogen medications
Bicalutamide
Flutamide
Nilutamide
What is the MOA of bicalutamide?
Inhibits testosterone and dihydrotestosterone uptake and binding
Blocks testosterone surge
AEs associated with antiandrogens
Hot flashes
Gynecomastia
CNS
Elevated liver enzymes
Diarrhea
Trastuzumab is a ______.
Anti HER-2
AEs associated with trastuzumab include:
Infusion related reactions: Fever, Chills, Rigors, hypotension
Hypersensitivity
What premedications are required with anti-HER2 therapy?
Antihistamines
APAP +/- corticosteroids
An example of an anti CD 20 medication
Rituximab
Ofatumumab
CD20 surface antigens are found on what types of cells
B-lymphocytes
What is the MOA of rituximab?
Activate complement system by binding to CD20
AEs associated with anti-CD20 therapy
Infusion related rxns: fever, chills, rigors, hypotension
Hypersensitivity
Rituximab is used to treat what type of cancer?
Lymphoma
Alemtuzumab is a _______
anti CD-52
What drug binds to CD-52 antigens present on leukemic lymphocytes and induces cell lysis and death?
Alemtuzumab
AEs of Alemtuzumab include:
Infusion like rxns
Neutropenia
Lyphopenia
Infections
Are pre-medications required for alemtuzumab?
Yes
Antihistamine
APAP +/- corticosteroid
Which drug is currently used to treat leukemia however may be taken off the market and reformulated for MS treatment?
Alemtuzumab
Name a VEGF inhibitor
Bevacizumab
List the major toxicities associated with bevacizumab
GI perforation
Impaired wound healing
Hemorrhage
Thrombotic events
Hypertension
Nephrotic syndrome
Which medication cannot be given within 28 days of surgery?
Bevacizumab: AE includes impaired wound healing
Bevacizumab is indicated for what type(s) of cancer?
Colon
Lung
Cetuximab is what type of drug?
EGFR
Major toxicites of cetuximab include:
Rash
Infusion rxns
Nausea
Diarrhea
Hypomagnesemia
Cetuximab is indicated for what type of cancer(s)?
Colon
Head/neck
AEs associated with ofatumumab
Infusion reactions
Cytopenias
Progressive multifocal leukoencephalopathy
What drug is indicated as second-line for chronic lymphocytic leukemia?
Ofatumumab
What drug binds to HER-2 extracellulary and blocks it from binding to other signaling factors?
Pertuzumab
List the major toxicities associated with pertuzumab
Fetal toxicity
LV dysfunction
Infusion reactions
True or False: Pertuzumab is used for patients with HER-2 local breast cancer in combination with trastuzumab and docetaxel in patients who have failed previous chemotherapy regimens
False:
Indicated in metastatic chemotherapy naive patients