LWBK1006-48 LWW-Govindan-Review December 12, 2011 20:53
594 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology ReviewANSWERS
Answer 48.1. The answer is C.
St. John’s Wort has been extensively studied in the treatment of mild-to-
moderate depression and was found to be more effective than placebo and
equally effective as tricyclic antidepressants (TCAs) in the treatment of
mild-to-moderate major depression. However, because of multiple well-
documented drug interactions, its use has been discouraged in patients. St
John’s Wort appears to inhibit the hepatic enzyme cytochrome P-4503A4.
Irinotecan is metabolized via this pathway, and patients receiving irinote-
can (CPT-11) have a greater than 50% reduction in serum levels of the
active metabolite SN-38 after concomitant administration of St. John’s
Wort.Answer 48.2. The answer is A.
St. John’s Wort may decrease levels of tamoxifen through its effects on
hepatic metabolism. St. John’s Wort should, therefore, be discontinued.
Increasing the dose of tamoxifen, changing to an aromatase inhibitor, and
discontinuing green tea are not appropriate in this setting.Answer 48.3. The answer is C.
Acupuncture is a safe and well-tolerated treatment. Several randomized
controlled trials and meta-analysis support its efficacy for the treatment
of acute and chronic pain. In addition, more recently acupuncture has
also been studied in patients with cancer to reduce chemotherapy- and
radiotherapy-induced nausea and vomiting, radiation-induced xerosto-
mia, and for persistent chemotherapy-related fatigue. In a recently pub-
lished randomized controlled trial, acupuncture produced improvement
in xerostomia in patients treated with radiation for head and neck cancer
(J Clin Oncol. 2010;28(15):2565).Answer 48.4. The answer is C.
Some women experience menopause-like symptoms with tamoxifen,
including hot flashes and emotional changes. Phytoestrogens, such as
genistein, are the major constituents of soy and exhibit selective estrogen-
receptor modulator activity. Soy products are popular among women
experiencing perimenopausal symptoms. However, in patients with breast
cancer, genistein might antagonize the effects of tamoxifen, making it
less effective and possibly helping proliferation of the breast cancer
cells.Answer 48.5. The answer is A.
Herbs such as Ginkgo, feverfew, ginger, and garlic have anticoagulant
effects and should be avoided by patients using warfarin, heparin, aspirin,
and related agents.