Cancer and Chemotherapy Overview

Which drug is part of the Anthracycline class that we need to know?

a. Docetaxel

b. Degarelix

c. Doxorubicin

d. Denosumab

c. Doxorubicin

What is the mechanism of action of Anthracycline?

a. Intercalation of the drug molecule between DNA base pairs by inhibition of topoisomerase II and by steric obstruction

b. Prevents cell replication by damaging DNA

c. Interfere with DNA and RNA by substituting for the natural building blocks of RNA and DNA

d. Induce DNA strand breaks to unwind double-helix structure and allow transcription/replication

a. Intercalation of the drug molecule between DNA base pairs by inhibition of topoisomerase II and by steric obstruction

What types of cancer is Doxorubicin commonly used to treat? SATA

a. Solid Tumors

b. Lymphoma

c. Leukemia

d. Multiple Myeloma

a. Solid Tumors

b. Lymphoma

c. Leukemia

What is the main key toxicity to watch for in Doxorubicin?

a. Neurotoxicity

b. Peripheral Neuropathy

c. Nephrotoxicity

d. Cardiotoxicity

d. Cardiotoxicity

According to the chemo man diagram, what are the key toxicities to watch for in patients on Anthracyclines? SATA

a. Myelosuppression

b. Hemorrhagic Cystitis

c. Mucositis

d. Cardiotoxicity

a. Myelosuppression

d. Cardiotoxicity

What drug is an antitumor antibiotic clinically used in Hodgkin Lymphoma and Testicular cancer?

a. Busulfan

b. Bleomycin

c. Bevacizumab

d. Blinatumomab

b. Bleomycin

What is the key toxicity to watch for in patients taking Bleomycin?

a. Hemorrhagic Cystitis

b. Bone Marrow Suppression

c. Ototoxicity

d. Pulmonary Fibrosis

d. Pulmonary Fibrosis

What is the MOA of antitumor antibiotics?

a. Intercalation of the drug molecule between DNA base pairs by inhibition of topoisomerase II and by steric obstruction

b. Disrupts microtuble function

c. Inhibits synthesis of DNA; binds to DNA, leading to single and double-strand breaks; inhibits RNA and protein synthesis to a lesser extent

d. Interfere with DNA and RNA by substituting for the natural building blocks of RNA and DNA

c. Inhibits synthesis of DNA; binds to DNA, leading to single and double-strand breaks; inhibits RNA and protein synthesis to a lesser extent

Which drug is a Topoisomerase I inhibitor?

a. Irinotecan

b. Etoposide

c. Doxorubicin

d. Epirubicin

a. Irinotecan

Which drug is a Topoisomerase II inhibitor?

a. Topotecan

b. Etoposide

c. Campothecin

d. Irinotecan

b. Etoposide

What is the MOA of Topoisomerase Inhibitors?

a. Induce DNA strand breaks to unwind double-helix structure and allow transcription/replication

b. Inhibits synthesis of DNA; binds to DNA, leading to single and double-strand breaks; inhibits RNA and protein synthesis to a lesser extent

c. Intercalation of the drug molecule between DNA base pairs by inhibition of topoisomerase II and by steric obstruction

d. Prevents cell replication by damaging DNA

a. Induce DNA strand breaks to unwind double-helix structure and allow transcription/replication

Which two specific solid tumors is Irinotecan commonly used to treat? SATA

a. GI Tract

b. Small Cell Lung Cancer

c. Prostate

d. Breast

e. Melanoma

a. GI Tract

b. Small Cell Lung Cancer

What are the key toxicities of Irinotecan? SATA

a. Myelosupression

b. Hypotension

c. Diarrhea

d. HSR

e. Cholinergic Syndrome

c. Diarrhea

e. Cholinergic Syndrome

If a patient has developed irinotecan-induced early-onset diarrhea, what is the recommended treatment?

a. Loperamide

b. Atropine

c. Octreotide

d. Lomotil

b. Atropine

What is the recommended treatment if a patient has developed irinotecan-induced late-onset diarrhea?

a. Loperamide

b. Atropine

c. Octreotide

d. Lomotil

a. Loperamide

What are the clinical pearls for Etoposide? SATA

a. IV or PO (1:3)

b. IV or PO (1:2)

c. IV or PO (1:1)

d. Hypotension with faster infusion rates

e. Hypertension with faster infusion rates

b. IV or PO (1:2)

d. Hypotension with faster infusion rates

Which of the following is NOT a key toxicity of Etoposide?

a. Myelosuppression

b. Hypotension

c. Secondary AML

d. HSR

e. SIADH

e. SIADH

Etoposide is used to treat all except

a. Solid Tumors

b. Langerhans Cell Histiocytosis

c. Leukemias

d. Lymphomas

e. Hematopoietic Stem Cell Transplantation (HSCT)

b. Langerhans Cell Histiocytosis

Which of the following is not part of the Anti-Microtuble Agents?

a. Carmustine

b. Docetaxel

c. Paclitaxel

d. Vinblastine

e. Vincristine

a. Carmustine

Of the antimitotics, which drugs are examples of vinca alkaloids? SATA

a. Vinblastine

b. Docetaxel

c. Paclitaxel

d. Vincristine

a. Vinblastine

d. Vincristine

Of the antimitotics, which drugs are examples of taxanes? SATA

a. Vinblastine

b. Docetaxel

c. Paclitaxel

d. Vincristine

b. Docetaxel

c. Paclitaxel

Both Paclitaxel and Docetaxel are used to treat patients with solid tumors.

a. True

b. False

a. True

What key toxicity is consistent throughout all of the antimitotics?

a. Fluid retention

b. HSR

c. Thrombocytopenia

d. Vocal cord paresiss

e. Peripheral neuropathy

e. Peripheral neuropathy

What anti-microtuble agent is used for pediatric malignancies?

a. Vinblastine

b. Vincristine

c. Paclitaxel

d. Docetaxel

b. Vincristine

A patient receiving Docetaxel is experiencing fluid retention. What premedication should have been administered to prevent this?

a. Diphenhydramine

b. Dexamethasone

c. Ranitidine

d. Ondansetron

b. Dexamethasone

Besides peripheral neuropathy and fluid retention, what is another key toxicity of Docetaxel?

a. Neutropenia

b. Jaw pain

c. SIADH

d. Constipation

a. Neutropenia

Which antimitotic does not have a key toxicity of neutropenia?

a. Vinblastine

b. Vincristine

c. Paclitaxel

d. Docetaxel

b. Vincristine

Why would we need to premedicate a person on dexamethasone if they are on Paclitaxel?

a. Prevention of thrombocytopenia

b. Prevention of fluid retention

c. Prevention of SIADH

d. Prevention of hypersensitivity reactions

d. Prevention of hypersensitivity reactions

What is a clinical pearl that is for both Vinblastine and Vincristine? SATA

a. Different dosing schedules and sequence dependency

b. CYP3A4 substrate

c. Fatal if given intrathecally

d. Extravasation risk

e. Doses typically cap at 2 mg

c. Fatal if given intrathecally

d. Extravasation risk

A patient receiving a Vinca Alkaloid experiences extravasation. What is the appropriate management?

a. Apply a cold compress and administer Dexrazoxane

b. Apply a warm compress and administer Hyaluronidase

c. Apply a cold compress and administer Sodium Thiosulfate

d. Apply a warm compress and administer Dimethyl Sulfoxide

b. Apply a warm compress and administer Hyaluronidase

Vincristine is used to help treat Acute Lymphoblastic Leukemia, Langerhans cell histiocytosis, and pediatric malignancies.

a. True

b. False

b. False

What other key toxicities are associated with Vincristine that are not associated with any other drug in the anti-microtuble agents? SATA

a. Jaw pain

b. Constipation

c. SIADH

d. Vocal cord paresis

e. Peripheral neuropathy

a. Jaw pain

b. Constipation

d. Vocal cord paresis

Vinca Alkaloids can cause SIADH.

a. True

b. False

a. True

What key toxicity is associated with Vinblastine that is not associated with any other antimitotic?

a. Neutropenia

b. HSR

c. Fluid retention

d. Thrombocytopenia

d. Thrombocytopenia

What types of cancer is Vinblastine commonly used to treat? SATA

a. Hodgkin lymphoma

b. Acute Lymphoblastic Leukemia

c. Langerhans cell histiocytosis

d. Solid tumors

e. Pediatric malignancies

a. Hodgkin lymphoma

c. Langerhans cell histiocytosis

d. Solid tumors

Vincristine is a CYP3A4 inducer.

a. True

b. False

b. False

What is the MOA of antimitotics?

a. Intercalation of the drug molecule between DNA base pairs by inhibition of topoisomerase II and by steric obstruction

b. Disrupts microtuble function

c. Inhibits synthesis of DNA; binds to DNA, leading to single and double-strand breaks; inhibits RNA and protein synthesis to a lesser extent

d. Interfere with DNA and RNA by substituting for the natural building blocks of RNA and DNA

b. Disrupts microtuble function

Antimetabolite drugs are split up into 3 subclasses. Which drugs are a part of the antifolate subclass? SATA

a. Methotrexate

b. Mercaptopurine

c. Fluorouracil

d. Pemetrexed

e. Cytarabine

a. Methotrexate

d. Pemetrexed

Which drug is not in the pyrimidine analogue subclass?

a. Cytarabine

b. Busulfan

c. Fluorouracil

d. Capecitabine

b. Busulfan

Which statement is false about antimetabolites?

a. Interferes with DNA and RNA by substituting for the natural building blocks of RNA and DNA.

b. Commonly used to treat leukemia, breast and ovarian cancer, and intestinal tract.

c. It affects the M phase in the cell cycle.

d. Causes inability of DNA to make copies and cell cannot reproduce

c. It affects the M phase in the cell cycle.

The antimitotics affect the S Phase of the cell cycle.

a. True

b. False

b. False

What key toxicity is associated with all of the antimetabolites?

a. Mucositis

b. Diarrhea

c. Hepatotoxicity

d. Myelosuppression

d. Myelosuppression

What types of cancer is Cytarabine used to treat? SATA

a. Solid tumors

b. Osteosarcoma

c. Acute Myeloid Leukemia (AML)

d. CNS tumors

e. Lymphomas

c. Acute Myeloid Leukemia (AML)

e. Lymphomas

How can Cytarabine be administered? SATA

a. PO

b. IM

c. IT

d. IV

e. SC

f. SL

c. IT

d. IV

e. SC

Which medication may be used to prevent conjunctivitis in a patient receiving Cytarabine?

a. Artificial tears

b. Steroid eye drops

c. Antibiotic eye drops

d. Antihistamine eye drops

b. Steroid eye drops

What are the main key toxicities to look for in a patient that is taking Cytarabine? SATA

a. Pulmonary toxicity

b. Chemical conjunctivitis

c. Coronary vasospasm

d. Cerebellar toxicity

e. Mucositis

b. Chemical conjunctivitis

d. Cerebellar toxicity

e. Mucositis

Fluorouracil, Capecitabine, and Pemetrexed have a toxicity of hand-foot syndrome.

a. True

b. False

a. True

Which type of solid tumors are commonly treated with Fluorouracil?

a. Breast

b. Lung

c. GI tract

d. Prostate

c. GI tract

Which medication can enhance the response of Fluorouracil when given as a bolus dose?

a. Leucovorin

b. Dexamethasone

c. Ondansetron

d. Mesna

a. Leucovorin

What should you watch for when giving a patient Fluorouracil as a bolus dose? SATA

a. Myelosuppression

b. Diarrhea

c. Constipation

d. Flu-like symptoms

e. Thrombotic microangiopathy

a. Myelosuppression

b. Diarrhea

Which antimetabolite pyrimidine analogue is an oral 5-FU prodrug?

a. Cytarabine

b. Gemcitabine

c. Fluorouracil

d. Capecitabine

d. Capecitabine

When should a person take Capecitabine?

a. Within 15 minutes after meal

b. Within 30 minutes after meal

c. Within 45 minutes after meal

d. Within 60 minutes after meal

b. Within 30 minutes after meal

Which types of solid tumors are commonly treated with Capecitabine?

a. GI and prostate

b. GI and ovarian

c. GI and breast

d. GI and lung

c. GI and breast

Which of the following is not a key toxicity associated with Capecitabine?

a. Hand-foot syndrome

b. Diarrhea

c. Myelosuppression

d. Fever/rash

d. Fever/rash

Which antimetabolite can be used to treat graft vs. host disease (GVHD)?

a. Mercaptopurine

b. Methotrexate

c. Pemetrexed

d. Gemcitabine

b. Methotrexate

Using Leucovorin with Methotrexate can increase toxicity.

a. True

b. False

b. False

According to the chemo man, what is the key toxicity that needs to be watched for when a patient is on Methotrexate?

a. Pulmonary Fibrosis

b. Cardiotoxic

c. Mucosisits

d. Peripheral neuropathy

c. Mucosisits

What can Pemtrexed be used to treat? SATA

a. Osteosarcoma

b. NSCLC

c. Non-Hodgkin lymphomas

d. Mesothelioma

e. ALL

f. GVHD prophylaxis

b. NSCLC

d. Mesothelioma

What should be given to a patient on Pemetrexed to reduce toxicity?

a. Folic acid and vitamin B12

b. Leucovorin and dexamethasone

c. Ondansetron and diphenhydramine

d. Mesna and prednisone

a. Folic acid and vitamin B12

Which medication should be given to a patient receiving Pemetrexed to help minimize cutaneous reactions?

a. Dexamethasone

b. Diphenhydramine

c. Leucovorin

d. Vitamin B12

a. Dexamethasone

Which class(es) affects the G2 Phase? SATA

a. Antimicrotuble Agents

b. Interferons

c. Topoisomerase II Inhibitors

d. Folate Antagonists

c. Topoisomerase II Inhibitors

Which class(es) affects the M Phase? SATA

a. Steroid hormones

b. Anthracyclines

c. Topoisomerase I Inhibitors

d. Antimicrotuble Agents

d. Antimicrotuble Agents

Which class(es) affects the S Phase? SATA

a. Antimetabolites

b. Taxanes

c. Anthracyclines

d. Topoisomerase Inhibitors

e. Asparaginase

a. Antimetabolites

c. Anthracyclines

d. Topoisomerase Inhibitors

Which of the following does not affect the G1 Phase?

a. Asparaginase

b. Interferons

c. Vinca Alkaloids

d. Steroid hormones

c. Vinca Alkaloids

Benign

tumor that is non-cancerous

Malignant

tumor that is cancerous

Recurrence

cancer that returned after a period during which it could not be detected

Remission

disappearance of the signs and symptoms of cancer but not necessarily the presence of the entire disease; cancer can be present but undetectable

Terminal

cancer that cannot be cured and leads to death

Adjuvant

treatment given after the primary therapy or concurrent with other therapy to eradicate residual disease and decrease recurrence

Biopsy

excision of tissue for microscopic examination to determine if it is cancerous; used to make definitive diagnosis

Curative

intent is to achieve disease resolution, complete remission, and prevent cancer recurrence

Disease Control

intent to stop or slow the progression of disease and reduce disease symptoms as long as possible

Lesion

an area of abdominal tissue; typically, an area of concern that needs to be biopsied

Metastasis

spreading of cancer to a different part of the body from the primary tumor location

Neoadjuvant

treatment given before the primary therapy as a first step to shrink a tumor to make the surgery more effective

Palliative

intent to relieve symptoms of cancer and improve quality of life

Tumor Markers

substances at higher-than-normal levels in the blood, urine, or body tissue that identities cancer

Which of the following is not a toxicity of alkylating agents?

a. Myelosuppression

b. Nausea/Vomiting

c. Cardiotoxicity

d. Gonadal toxicity

e. Secondary malignancy risk

c. Cardiotoxicity

What does AML stand for?

Acute Myelogenous Leukemia

What does ALL stand for?

Acute Lymphoblastic Leukemia

What does CML stand for?

Chronic Myelogenous Leukemia

What does CLL stand for?

Chronic Lymphocytic Leukemia

Which alkylating agents are nitrogen mustards? SATA

a. Carmustine

b. Cyclophosphamide

c. Ifofamide

d. Cisplatin

e. Lomustine

b. Cyclophosphamide

c. Ifofamide

What is the key toxicity associated with cyclophosphamide and ifosfamide?

a. Cardiotoxicity

b. SIADH

c. Immunosuppression

d. Hemorrhagic cystitis

e. Neurotoxicity

d. Hemorrhagic cystitis

At a high dose, nitrogen mustards should be used with mesna.

a. True

b. False

a. True

What formulations does cyclophosphamide come in? SATA

a. PO

b. IM

c. SQ

d. IV

a. PO

d. IV

What is a clinical pearl that is associated with Lomustine but not Carmustine?

a. Delayed pulmonary toxicity

b. Delayed neurotoxicity

c. Delayed cardiotoxicity

d. Delayed nephrotoxicity

d. Delayed nephrotoxicity

Nephrotoxic/Ototoxic

Cisplatin, Carboplatin

Neurotoxicity

Lomustine, Carmustine

Mucositis

Methotrexate

Pulmonary Fibrosis

Bleomycin, Busulfan, Lomustine, Carmustine

Cardiotoxicity

Doxorubicin, anthracyclines

Hemorrhagic Cystitis

Ifosfamide, Cyclophosphamide

Peripheral Neuropathy

Vinka Alkaloids, Taxanes