Oncologic Regimen Design

Question 1

Regimen Design Factors

Answer 1

1. Tolerability
2. Toxicity Limitations
3. Theoretic Rationale
4. Circumvention of Resistance
5. Initial Aggression

Question 2

Tolerability

Answer 2

• Limits significantly myelosuppressive chemo regimens to Q2-3 weeks
• Designed with agents that have non-overlapping toxicities

Question 3

Toxicity Limitations

Answer 3

• Some agents cannot be delivered in combination with other agents
• EX: Trastuzumab and anthracyclines

Question 4

Theoretic Rationale

Answer 4

• Some classes of agents are believed to limit efficacy of other agents
• Don’t give in combination
• EX: Chemotherapy and anti-hormone therapy in breast cancer

Question 5

Circumvention of Resistance

Answer 5

• May focus on continuously altering type of chemotherapy throughout regimen
• Especially seen in acute leukemia

Question 6

Initial Aggression

Answer 6

• Some regimens may be more aggressive at the start

- Leukemia to maximize leukemic cell death early on to prevent resistance

Question 7

Breast Cancer Regimens

Answer 7

• Anthracyclines
• Cyclophosphamide
• Taxanes +/- HER-2 agents
• Hormonal Therapy

Question 8

Prostate Cancer Regimens

Answer 8

Castration therapy + Antiandrogen agents +/- taxane chemotherapy

Question 9

Ovarian Cancer Regimen

Answer 9

• Platinum + Taxane based chemotherapy

- Possibility for intra-peritoneal administration

Question 10

Myeloma Regimen

Answer 10

• Immunomodulators
• Proteosome Inhibitors
• Dexamethasone until CR
• +/- transplant and or maintenance Rx

Question 11

Leukemia Regimen

Answer 11

• Antimetabolites
• Corticosteroids
• Vinca alkyloids
• Alkylating agents
• Anti-asparagine
• TK-inhibitors

Question 12

Lymphomas Regimen

Answer 12

• Anthracyclines
• Bleomycin
• Alkylating agents
• Vinca alkyloids
• Corticosteroids

Question 13

Lung Cancer Regimens

Answer 13

• Small Cell: Platinum + etoposide or irinotecan or vinorelbine or taxane
• Non-small cell: Platinum + etoposide or gemcitabine or taxane +/ PD-LI inhibitors +/- EGFR inhibitors +/- TK inhibitors

Question 14

Colon Cancer Regimens

Answer 14

• Antimetabolites (5-FU)
• Leucovorin
• Platinum
• Campothecans
• VEGF and EGFR inhibitors
• PD-1 inhibitors

Question 15

Melanoma Regimen

Answer 15

• CTLA-4 inhibitors

- PD-1 inhibitors

Question 16

Breast Cancer Treatment Duration

Answer 16

• Chemo: 6-8 months
• HER-2: 1 year
• Hormonal Rx: 5+ years

Question 17

Ovarian Cancer Treatment Duration

Answer 17

-Chemo: 6-8 months

Question 18

Prostate Cancer Treatment Duration

Answer 18

• LHRH for remainder of life

- Anti-androgen until relapse and then change

Question 19

Leukemia Treatment Duration

Answer 19

• ALL: 2.5-3 years

- AML: 4-6 months

Question 20

Lymphoma Treatment Duration

Answer 20

-6 months

Question 21

Chemotherapy Basics

Answer 21

• Immune system recovers in ~6 months after completion
• Some ADRs may not resolve
• Dose to max tolerability for many agents, need to know dosing/schedule to prevent ADEs
• N/V is the most bothersome toxicity by chemotherapy patients
• Cancer therapy will have less effect and be more toxic following relapse
• Cancer agents, especially new ones, are the most expensive pharmacotherapy