Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

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

Question 20.5.6. A 65-year-old woman presented with intermittent constipation and diar-

rhea associated with abdominal cramping. A colonoscopy revealed a

near-obstructing mass, and biopsy revealed a villoglandular polyp. She

underwent an exploratory laparotomy and resection of a 5×5-cm cir-

cumferential necrotic and fungating mass. Pathology revealed a moder-

ately differentiated adenocarcinoma invading into the pericolonic fat with

2 of 30 positive lymph nodes. Margins were negative. CT scan showed

no evidence of metastatic disease. After recovery from her surgery, based

on current evidence, you would recommend:

A. 5FU with leucovorin×6 months

B. Capecitabine×6 months

C. Irinotecan with 5FU (FOLFIRI)×6 months

D. Oxaliplatin with 5FU (FOLFOX)×6 months

E. Oxaliplatin with 5FU (FOLFOX) and bevacizumab×6 months

Question 20.5.7. One week after the first dose of chemotherapy, the patient in Question

20.5.6 developed a fever at 102◦F associated with chills. She also devel-

oped diarrhea, mucositis, confusion, and ataxia. Repeat complete blood

count showed a white blood cell count of 0.5×103 cells/L with an

absolute neutrophil count of 100, hemoglobin of 11.7 g/dL, band platelet

count of 42,000. Which one of the following pharmacogenetic conditions

would best explain her clinical course?

A. The patient is homozygous for the thymidylate synthase (TYMS)

∗3/∗3 polymorphism.

B. The patient is homozygous for UGT1A1∗28 polymorphism.

C. The patient is heterozygous for the IVS14+1G>A DPYD∗2A

mutation.

D. The patient is heterozygous for the ERCC2 Lys751Gln polymor-

phism.

Question 20.5.8. A 62-year-old engineer was diagnosed with metastatic cecal adenocar-

cinoma with lung and liver metastases. He was initially treated with

oxaliplatin plus infusional 5FU (FOLFOX6) and bevacizumab. After four

cycles (2 months), his CT scan showed progressive disease. You discussed

irinotecan 180 mg/m^2 every 2 weeks plus weekly cetuximab based on the

results of the EPIC study. A test for UGT1A1 polymorphism was done,

and results revealed him to be homozygous for UGT1A1∗28/∗28. Which

of the following statements is TRUE?

A. Patients homozygous for the UGT1A1 ∗28 polymorphism glu-

curonidate SN38 more efficiently than those with the wild-type∗ 1

genotype.

B. Patients homozygous for the UGT1A1 ∗28 polymorphism glu-

curonidate SN38 less efficiently than those with the wild-type∗ 1

genotype.

C. Patients homozygous for UGT1A1∗28 polymorphism are at greater

risk for severe neutropenia with irinotecan compared with those with

the wild-type∗1 genotype.

D. A and C are true.

E. B and C are true.