Chemotherapy, immunotherapy, targeted therapy, oh my...
Name three common adverse effects associated with cytotoxic agents
Common adverse effects
Myelosuppression, CINV, diarrhea, constipation, mucositis, loss of appetite, infertility, fatigue, rash, alopecia
Drug or class of chemotherapy known for cardiotoxicity
Anthracyclines
- doxorubicin
- daunorubicin
- idarubicin
A patient presents complaining of constipation. They are not interested in adding another medication to their ever-growing list. What would you recommend for non-pharmacologic management?
Hydration, exercise, or fiber
Dogs are
A. Always right-pawed
B. Always left-pawed
C. Can be either right-pawed or left pawed
C. can be either right-pawed or left pawed
What is cancer?
“Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body.”
Name the three most common adverse effects associated with immune checkpoint inhibitors
Diarrhea, rash, hepatotoxicity
What class of cytotoxic agents are known for causing constipation?
A patient presents with worsening mucositis. They have been doing bland oral rinses (using salt, baking soda, and water) to no avail. What would you recommend they try next?
Biotene
Magic Mouthwash
Dexamethasone 0.05 mg/mL oral rinse
Resistance is key for this work out.
Spin class
________ therapy is described as chemotherapy delivered before surgery with the goal of shrinking a tumor or stopping the spread of cancer to make surgery less invasive and more effective.
Neoadjuvant
Describe how immune checkpoint inhibitors work, generally.
Immune checkpoint inhibitors work by blocking proteins (checkpoints) that cancer cells use to turn off the body’s immune response
By blocking these proteins, they enhance T-cell activation and proliferation
Drug known for diarrhea that can occur acutely or delayed
Bonus (100 pts): define acute phase, delayed phase, and provide appropriate management recommendations for both
Bonus: acute phase (< 24 h) - atropine, delayed phase (> 24 h) - loperamide
A patient is receiving 5-FU in the clinic today and asked "How do I take the loperamide again? This is all just so much information."
How would you respond (drug/dose/SIG)?
Loperamide 4mg PO then 2 mg q2-4h after each loose stool
This spring event was originally created to fundraise for the Costume Institute and celebrate the opening of it's annual exhibit.
Met Gala
How we refer to disease that worsens while the patient is on therapy. (> 20% increase over smallest sum observed or appearance of new lesions)
(refractory to treatment)
Targeted therapy will only be effective if ________ is present
Bonus 100: describe how targeted therapy works, generally.
genetic mutation
Bonus: Each targeted agent is inhibiting a protein, which will stop down stream signaling within the cancerous cell, stopping cell proliferation
A patient presents with new onset thyroiditis. What cancer-directed therapy is the patient most likely on?
Immune check point inhibitor
Pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, ipilimumab
A patient on pembrolizumab presents for their next dose with a new AKI (Scr > 3x basline - grade 3). You are asked what we should do, what would you recommend?
Hold pembrolizumab and start prednisone 1 mg/kg/day or equivalent
While a similar color, this type of tea has 137x more antioxidants that regular brewed green tea.
Matcha
(according to Full Leaf Tea Co)
These medications act on intracellular targets to slow proliferation/cause tumor cell death, rather than targeting receptors on the surface of cancer cells.
Small molecule drugs
A patient comes into the ED with profuse diarrhea. They started treatment for colon cancer about six weeks ago, but can't remember the name of the drug. They state "I was told to tell doctors that I am not on chemotherapy. The medication I'm getting helps my immune system fight the cancer."
Name one of the medications she is likely receiving.
Immune checkpoint inhibitors
Pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, ipilimumab
A patient presents describing a deep, dull discomfort that is sometimes achy and feels as though it originates from inside the body. They received chemotherapy two days ago and a "shot" yesterday.
What medication would you recommend for their pain?
cetirizine, loratadine
A patient who is intermediate risk for TLS is started on allopurinol 300mg QD. The patient is in an AKI (CrCl 43) and the resident taking care of this patient wants to know if we should decrease the allopurinol dose.
What would you recommend?
50% reduction (according to Lexi) OR
No adjustment (often keep it at 300mg daily in practice)
This spring event is the oldest continuous sporting event in the U.S.
Kentucky Derby
Bonus (100 pts): describe how each mutation leads to formation of cancerous cells
Mutated tumor suppressor gene and mutated proto-oncogene
mutated tumor suppressor gene: loss of function, loose the suppression
mutated proto oncogene: gain of function, increase in production