Devita, Hellman, and Rosenberg's Cancer

LWBK1006-11 LWW-Govindan-Review November 24, 2011 11:21

130 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

B 12 intramuscular injections (1000 mcg) should be started 1 week prior to

treatment and repeated every 9 weeks. Folic acid supplementation should

be initiated 1 week prior to treatment and continued daily for at least

21 days after therapy.

Answer 11.6. The answer is C.

Patients receiving FOLFIRI chemotherapy commonly experience both

acute and delayed diarrhea from irinotecan, but this is usually not seen

in combination with mucositis and myelosuppression. Patients who are

homozygous for UGT1A1*28 are at risk for developing more severe

myelosuppression and diarrhea from irinotecan, and would warrant

empiric dose reductions, but this would not typically be seen with severe

mucositis. Patients who have DPD deficiency often present with severe

diarrhea, mucositis, and myelosuppression because of the inability to

metabolize 5-fluorouracil.

Answer 11.7. The answer is B.

Fludarabine causes suppression of the immune system, more specifically

T-cells. After initiation of fludarabine, a quick decline in CD4 positive

cells occurs and often it takes greater than 1 year for recovery. During

this time frame, patients are at risk for many opportunistic infections.

Answer 11.8. The answer is B.

Enhanced sensitivity to p-glycoprotein and drug efflux is thought to be

a major factor in development of anthracycline resistance, but not car-

diotoxicity. Cardiotoxicity is thought to be multifactorial with increased

oxidation–reduction reactions, generation of reactive oxygen species, and

peroxidation of myocardial lipids.

Answer 11.9. The answer is A.

Cabazitaxel was studied in patients who had progressed on docetaxel

chemotherapy. Since it is a poor substrate for the multidrug-resistant p-

glycoprotein efflux pump, it is proposed that cabazitaxel will have efficacy

in chemotherapy-resistant tumors.

Answer 11.10. The answer is C.

Vinca alkaloids alter the tubulin association rate constant and inhibit the

assembly of microtubules thus inducing cell cycle arrest, whereas tax-

ane chemotherapy agents alter the tubulin dissociation rate and inhibit

the disassembly of microtubules. Cabazitaxel exerts it mechanism of

action by stabilizing tubulin and inhibiting microtubule depolymeriza-

tion. Epothilones promote tubulin polymerization and induce mitotic

arrest.

Answer 11.11. The answer is D.

Often the clinical response to therapies like azacitidine is after four to

six cycles of therapy, so it is important to allow enough time to see