Onc exam 3/final
Trastuzumab
first MAB approved for the tx of HER 2 + metastatic breast cancer
-prevents dimerization
Pertuzumab
approved in combo with docetaxel in combo with pertuzumab for HER2
positive metastatic breast cancer
Panitumumab
specific to the EGFR
approved for metastatic colorectal cancer
-can be used as a single agent or following 5-FU, oxaliplatin-, and
irinotecan-containing chemotherapy regimens
side effects of panitumumab
abdominal pain
N/V
itching, rashi, skin dryness, and nail changes
Trastuzumab side effects
fever
N/V/D
infections
increased cough
HA
fatigue
SOB
rash
low WBC and RBC
muscle pain
,Ramucirumab
fully human MAB developed for the tx of solid tumors
- blocking the binding of VEGF to VEGFR2
Bevacizumab
targets VEGF
used in breast, cervical, colorectal, endometrial, hepatocellular, lung, NSCLC,
ovarian, renal, and some sarcomas
Ipilimumab
approved for melanoma
-activates the immune system, targets CLTA4
Nivolumab
Human IgG4 anti-PD-1 MAB
acts as an immunomodulator by blocking ligand activation of PD-1 receptor on
activated T cells
approved for metastatic melanoma
Pemobrolizumab
approved for metastatic melanoma
-it binds to PD-1 receptor and blocks its interaction with PD-L1 and PD-L2
-used for the treatment of metastatic NSCLC in pts whose tumors express
PD-L1 and have failed other tx
Durvalumab
-blocks the interaction of PD-L1 with the PD-1 and CD80
-approved for locally advanced or metastatic urothelial carinoma, NSCLC, and
head and neck cancer
Atezolizumab
targeted against PD-L1
,Avelumab
targets the protein PD-L1
originally for tx of NSCLC
approved for merkel cell carinoma
improved response rates when used in ovarian cancer
Lung cancer risk factor (5)
tobacco
radon
TB
occupational exposures
family hx
Screening for lung cancer
Low dose CT scanning conducted annually
-if at least 20 pack year smoking hx and at least age 50 yr
Presentation of lung cancer (7)
asymptomatic
local sx: cough, hemoptysis, dyspnea, noarseness, wheezing, chest pain
systemic disease: bone, liver, adrenal
paraneoplastic syndromes: SIADH - decreased Na, increased PTHrP -
increased Ca
HPOA (hypertrophic pulmonary osteroarthropathy)
Cachexia (involuntary weight loss)
fatigue
diagnosis and staging of lung cancer
Hx/PE, CXR, CT of chest/upper abdomen
, bronchoscopy
Brain MRI and bone scan if symptomatic
blood test: routine chemistry, Ca2+, LFTs
PET scan
genomic profiling
PD-L1 status
pahtophysiology of lung cancer
tumors start in epithelial cells (NSCLC) and neuroendocrine cells (SCLC)
local invasion - spread to nodes, then metastasizes to brain, bone, lung, liver,
adrenals, skin
SIADH, pleural effusion, surperior vena cava syndrome, Cushings syndrome
Limited stage SCLC
limited to one hemithorax (one side of the chest) and regional nodes
extensive stage SCLC
spreads rapidly
most pts present with extensive stage
SCLC radition therapy for limited stage
to chest for tumors confined to chest
to head to prevent brain mets (prophylactic)
SCLC radiation therapy for extensive stage
to bone or brain to treat mets
PCI
to chest to treat SVC syndrome, bronchial obstruction. and hemoptysis
(palliative)
SCLC systemic therapy for limited stage
cisplatin + etoposide
cycle Q3-4 weeks
Trastuzumab
first MAB approved for the tx of HER 2 + metastatic breast cancer
-prevents dimerization
Pertuzumab
approved in combo with docetaxel in combo with pertuzumab for HER2
positive metastatic breast cancer
Panitumumab
specific to the EGFR
approved for metastatic colorectal cancer
-can be used as a single agent or following 5-FU, oxaliplatin-, and
irinotecan-containing chemotherapy regimens
side effects of panitumumab
abdominal pain
N/V
itching, rashi, skin dryness, and nail changes
Trastuzumab side effects
fever
N/V/D
infections
increased cough
HA
fatigue
SOB
rash
low WBC and RBC
muscle pain
,Ramucirumab
fully human MAB developed for the tx of solid tumors
- blocking the binding of VEGF to VEGFR2
Bevacizumab
targets VEGF
used in breast, cervical, colorectal, endometrial, hepatocellular, lung, NSCLC,
ovarian, renal, and some sarcomas
Ipilimumab
approved for melanoma
-activates the immune system, targets CLTA4
Nivolumab
Human IgG4 anti-PD-1 MAB
acts as an immunomodulator by blocking ligand activation of PD-1 receptor on
activated T cells
approved for metastatic melanoma
Pemobrolizumab
approved for metastatic melanoma
-it binds to PD-1 receptor and blocks its interaction with PD-L1 and PD-L2
-used for the treatment of metastatic NSCLC in pts whose tumors express
PD-L1 and have failed other tx
Durvalumab
-blocks the interaction of PD-L1 with the PD-1 and CD80
-approved for locally advanced or metastatic urothelial carinoma, NSCLC, and
head and neck cancer
Atezolizumab
targeted against PD-L1
,Avelumab
targets the protein PD-L1
originally for tx of NSCLC
approved for merkel cell carinoma
improved response rates when used in ovarian cancer
Lung cancer risk factor (5)
tobacco
radon
TB
occupational exposures
family hx
Screening for lung cancer
Low dose CT scanning conducted annually
-if at least 20 pack year smoking hx and at least age 50 yr
Presentation of lung cancer (7)
asymptomatic
local sx: cough, hemoptysis, dyspnea, noarseness, wheezing, chest pain
systemic disease: bone, liver, adrenal
paraneoplastic syndromes: SIADH - decreased Na, increased PTHrP -
increased Ca
HPOA (hypertrophic pulmonary osteroarthropathy)
Cachexia (involuntary weight loss)
fatigue
diagnosis and staging of lung cancer
Hx/PE, CXR, CT of chest/upper abdomen
, bronchoscopy
Brain MRI and bone scan if symptomatic
blood test: routine chemistry, Ca2+, LFTs
PET scan
genomic profiling
PD-L1 status
pahtophysiology of lung cancer
tumors start in epithelial cells (NSCLC) and neuroendocrine cells (SCLC)
local invasion - spread to nodes, then metastasizes to brain, bone, lung, liver,
adrenals, skin
SIADH, pleural effusion, surperior vena cava syndrome, Cushings syndrome
Limited stage SCLC
limited to one hemithorax (one side of the chest) and regional nodes
extensive stage SCLC
spreads rapidly
most pts present with extensive stage
SCLC radition therapy for limited stage
to chest for tumors confined to chest
to head to prevent brain mets (prophylactic)
SCLC radiation therapy for extensive stage
to bone or brain to treat mets
PCI
to chest to treat SVC syndrome, bronchial obstruction. and hemoptysis
(palliative)
SCLC systemic therapy for limited stage
cisplatin + etoposide
cycle Q3-4 weeks
