Biologic Response Modifiers B Flashcards


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1

Inhibitory signals (T-cell inhibition)

CTLA-4, PD-1, LAG-3

2

Activating signals (T-cell stimulation)

CD28

3

HER2 drugs

(for breast and GI cancers)

pertuzumab, trastuzumab

4

HER2 side effects

decreased EF (reversible)

5

EGFR drugs

(for lung and GI cancers)

cetuximab, necitumumab, panitumumab

6

EGFR side effects

rash (predictive biomarker), electrolyte depletion which can lead to cardiopulmonary collapse

7

VEGF drugs

(GI, lung, brain, RCC and gyne tumors)

bevacizumab, ramucirumab, ziv-aflibercept

8

VEGF side effects

wound healing, GI perforation or fistulae, hemorrhage, increased risk of clots, severe HTN, renal injury- proteinuria, nephrotic syndrome

9

Anti-CD20 drugs

(for heme malignancies)

rituximab, ibritumomab, obinutuzumab, ofatumumab

10

Anti-CD20 effects

infective reactivation (hepatitis B, HSV, EBV), tumor lysis syndrome

11

Bispecific T-cell engagers (BITES) drugs

blinatumomab, amivantamab, tebentafusp-tebn

(2 drug targets)

12

What drug is a CD52 selective monoclonal antibody

Alemtuzumab (for chronic lymphocytic leukemia and transplant)

SE-infections

13

What drug is a CD38 selective monoclonal antibody

Daratumumab (for multiple myeloma)

SE- neutropenia, thrombocytopenia

14

What drug is a Glycolipid GD2 selective monoclonal antibody

Dinutuximab (for pediatrics-high risk neuroblastoma)

SE- neurotoxicity

15

What drug is a SLAMF7 selective monoclonal antibody

Elotuzumab (for multiple myeloma)

SE- opportunistic infections

16

-omab is

100% murine (comes from mice)

17

-ximab is

30% mice (chimeric)

18

-zumab is

10% mice (humanized)

19

-umab is

100% human

20

Prevention of hypersensitivity

subcutaneous injection is not advisable for 1st administration, higher likelihood and higher severity of reaction with the initial few treatments then can give slow IV infusion then increase prn, premeds, can switch from IV to subcutaneously after the first few doses

21

Grade 1 (mild) hypersensitivity and infusion-related reaction

do not interrupt infusion, intervention not indicated

22

Grade 2 (moderate) hypersensitivity and infusion-related reaction

interrupt infusion-> responds promptly to symptomatic treatment (antihistamine, NSAIDs, narcotics, IV fluids)-> prophylactic medications indicated for <24 hours

23

Grade 3 (severe) hypersensitivity and infusion-related reaction

interrupt infusion-> prolonged/not rapidly responsive to symptomatic medications and/or brief interruption of infusion-> recurrence of symptoms following initial improvement-> direct admin to hospital if does not respond

24

Grade 4 (life-threatening) hypersensitivity and infusion-related reaction

interrupt infusion-> urgent intervention indicated-> cardiopulmonary-> requires desensitization to continue therapy

25

MOA of rituximab

chimeric antibody directed against the cluster of differentiation CD20 antigen found on the surface of normal and cancerous B-cells

-Fab domain of rituximab binds to CD20 antigen on B lymphocytes

-Fc domain recruits immune effector functions to mediate B-cell lysis

26

If patient is on Rituximab and had chronic hepatitis B infection or past hepatitis B infection what should be done?

prophylaxis with entecavir for at least 12 months after last dose of rituximab

27

To avoid infusion reaction with Rituximab, what can you premedicate with?

APAP and diphenhydramine

28

MOA of EGFR inhibitors

inhibit EGFR which inhibits cell growth, induces apoptosis and inhibits VEGFR production

(is RAS mutation is detected, do NOT give)

29

Hypersensitivity with Cetuximab has an increased risk with

history of tick bites, red meat allergy, presence of IgE antibodies against galactose-a-1, 3-galactose

(prevention: diphenhydramine 50mg IV)

30

What drug class is most likely to form acneiform rash

EGFR inhibitors

31

How to prevent acneiform rash

  • hydrocortisone 1% cream BID for the first 6 weeks
  • doxycycline 100 mg PO BID for the first 6 weeks
  • skin moisturizer and sunscreen indefinitely

32

What happens due to decreased differentiation of skin cells and characterized by papules and pustules coupled with pruritus and pain

Acneiform rash

33

Why does magnesium loss (dose-dependent) occur with EGFR inhibitor

because EGFR in the distal convoluted tubule regulates magnesium reabsorption-- inhibiting EGFR causes magnesium wasting

34

HER2 is a protein involved in

normal cell growth in breast cells

35

MOA of HER2 inhibitors

inhibit the HER2 receptor (leads to cell death in cancer cells overexpressing HER2)

36

HER2 inhibitor drugs

trastuzumab, pertuzumab

37

MOA of VEGF

protein that stimulates that formation of blood vessels, inhibitors circulating VEGFR preventing the activation and promotion of angiogenesis

38

VEGF inhibitors drugs

bevacizumab

39

VEGF inhibitors side effects

bleeding, increased VTE risk, delayed wound healing, risk of GI perforation and fistulae, hypertension, and proteinuria

40

Hold VEGF inhibitors ___ days major surgery, may resume when wounds are healed

28