Severe tissue necrosis can occur if this agent infiltrates a surrounding vein:
A. vinorelbine
Case reports of death with this agent have been published after intrathecal (IT) administration:
A. vincristine
This agent is responsible for causing the most significant hair loss of all of the antineoplastic agents:
C. paclitaxel
This agent requires premedication with dexamethasone in order to circumvent hypersensitivity reactions and fluid retention:
D. docetaxel
This agent was originally discovered from the bark of the Pacific Yew tree:
B. paclitaxel
This agent requires the following prescription for supportive care: Loperamide 2 mg capsules. Take 2 caps at first sign of diarrhea, then 1 capsule every 2 hours until diarrhea free x 12 hours. May need to exceed the maximum daily dose of 16 mg:
A. irinotecan
This agent requires patient counseling regarding the associated change in urine color ocurring 1-2 days after administration:
D. all the above
This agent requires lifetime monitoring, with a suggested lifetime dose of 450 mg/m2:
D. doxorubicin
Which one of the following agents is NOT associated with cardiotoxicity?
D. etoposide
This anthracycline has the lowest risk of cardiotoxicity:
A. mitoxantrone
Which one of the following indications AND targets is appropriate for rituximab?
C. NHL; CD-20
This agent requires routine blood pressure and urine protein monitoring:
B. bevacizumab
Which one of the following monoclonal antibodies is entirely made up of a human component (vs. chimeric)?
A. panitumumab
This agent is indicated for breast tumors that overexpress the HER2/neu protein:
D. trastuzumab
This monoclonal antibody targets EGFR1 and has activity in colon cancer:
B. cetuximab
Which of the following agents matches its' appropriate target?
A. erlotinib + tyrosine kinase
Which of the following agents is a topoisomerase inhibitor?
A. doxorubicin
Which of the following agents disrupts purine & thymidylate synthesis and also depletes folates from within cells (healthy & cancer):
C. methotrexate
Which of the following agents stabilizes microtubule assembly?
B. paclitaxel
Which of the following agents binds to the retinoic acid receptor?
B. all-trans-retinoic acid
Which of the following autologous cellular immunotherapy agents was FDA approved in April 2010 for the treatment of hormone refractory prostate cancer?
B. sipuleucel-T
In which one of the following phases of the cell cycle are tumor cells agressively growing?
D. synthesis phase (S phase)
Which one of the folowing mutations is associated with the most common genetic alterations in cancer?
D. p53
A complete response is defined as complete disappearance of all cancer without evidence of new disease for at least _____ (time) after treatment. Fill in the blank.
B. 1 month
If a patient has not relapsed (after completing treatment) from their cancer at 5 years from the time of their diagnosis we consider them "cured" of their cancer. Which of the following explanations is correct?
A. after 5 years, the survival curve has plateaued and the risk of relapse is low for most cancers
You are evaluating the literature of a new novel drug therapy for pancreatic cancer. The following percent (%) of patients who responded are noted within the study: Complete response (CR) = 5%; partial response (PR) = 28%; progressive disease (PD) = 40%; stable disease (SD) = 20%; drop outs = 7%. What is the overall objective response rate for this drug?
C. 33%
Approximately how large does a tumor need to be in order to be detected by physican exam or x-ray?
B. 1,000,000,000 cancer cells
Which one of the following steps in the process of carcinogenesis is potentially reversible?
B. progression
Which one of the following statements is true regarding oncogenes?
A. As a result of an activated oncogene, excess cellular growth, angiogenesis, and metastases may occur
Which of the following determine dose intensity?
D. all the above
Which one of the following statements is correct?
C. Adjuvant therapy is utilized in the setting of early stage cancers (after localized treatment modalities)
Activity of cell-cycle phase specific agents are most optimized when given by which method of administration?
D. A and B
JT's lab values reveal the following: WBC = 1600/mm3 (neutrophils 800/mm3; bands 100/mm3; lymph 200/mm3); other differential not available. Platelet count 80,000/mm3. JT is scheduled to receive cycle #3 of chemotherapy today in the clinic. Should we proceed with chemotherapy administration?
C. Maybe, it depends
i. Calculate the ANC - this value should be above 1500/mm3 before proceeding with chemotherapy. (Some centers may use a slightly different number). The platelet count should also be above 100,000/mm3 before it is considered safe to administer chemotherapy. This patient's ANC is not adequate, neither is the platelet count.
ii. However, the answer here depends on the tumor type! For hematologic malignancies (in whch the disease is in the bone marrow or lymph nodes) the CBC values will be altered, therefore you may proceed with chemotherapy administration. In general, the goal in these types of cancers is to achieve a hematological response (normalization of CBC parameters). For solid tumors, the above ANC & platelet "rules" usually apply.
iii. Always check with your practice as most will have policies/procedures governing chemotherapy administration. These policies will usually indicate ANC and platelet parameters. The WBC (ANC) and plateelt count should always be available to the pharmacy and always be checked before proceeding with chemotherapy preparation and administration.
Which of the following statements is correct?
B. Clinical benefit response is a subjective outcome which may refer to parameters such as pain control, quality of life, or other clinically relevant patient outcome
i. Note the difference between disease free survival and progresion free survival.
One of the most highly emetogenic agents requiring the following antiemetic therapy: Ondansetron (day 1) + aprepitant (days 1-3)+ dexamethasone (days 1-4)
B. cisplatin
This agent has been associated with the development of acute myelogenous leukemia anywhere between 2 to 20 years after exposure.
B. cyclophosphamide
Patients should be carefully counseled about bleeding risks associated with this agent, including reporting any signs and/or symptoms of abnormal bruising:
A. carboplatin
Antimicrobial prophylaxis is required with this agent:
A. fludarabine
This agent requires the following supportive care: Dexamethasone opthalmic drops prior to and 1-2 days after treatment:
B. cytarabine 2000mg/m2 q12h days 1, 3, 5
This agent is an oral prodrug that is converted to fluorouracil:
C. capecitabine
Leucovorin is required with this agent to enhance it's cytotoxic activity:
B. fluorouracil
This agent has a suggested lifetime dose of 450 mg:
C. bleomycin
This agent is indicated for tumors that express EGFR mutations in patients with stage IV non-small cell lung cancer (NSCLC):
C. erlotinib
One of the following doses of methotrexate requires alkalinization of the urine with sodium bicarbonate and leucovorin rescue to prevent the major dose limiting toxicities of myelosuppression and mucositis:
B. methotrexate 2000 mg/m2
Before, during, and after infusion of this agent, patients should be counseled about drinking only hot beverages such as coffee, tea, or hot chocolate:
A. oxaliplatin
This was the fastest drug to gain approval from the FDA, significantly inducing cytogenetic and hematologic responses in patients with chronic myelogenous leukemia (CML):
C. imatinib
This agent is FDA approved for glioblastoma multiforme:
C. temozolomide
This agent requires the following monitoring: CBC with differential, bowel function, and periodic EKG's:
B. nilotinib
In order to reduce the severity of myelosuppression, premedication with cyanocobalamin and folic acid is required with this agent:
B. pemetrexed
This agent is responsible for causing a syndrome resulting in severe fever and respiratory compromise. Close monitoring is required:
C. ATRA
This agent may cause a significant amount of bladder irritation, bladder spasms, abdominal pain, and blood in the urine:
B. ifosphamide
This agent is responsible for causing a syndrome resulting in redness, tenderness, and peeling of the palms and soles (also known as palmar-plantar erythrodysesthesia):
B. sorafenib
Patients who overexpress the HER2/neu protein and relapse after therapy with trastuzumab may be offered this agent as salvage therapy:
B. lapatinib
QTc prolongation (cardiac arrhythmia) is most commonly associated with which one of the following agents?
C. arsenic trioxide
What is the dose limiting toxicity of carboplatin?
D. thrombocytopenia
Which one of the following statements regarding the use of bisphosphonate therapy in metastatic prostate cancer is true?
D. Bisphosphonate therapy is effective in decreasing the skeletal related complications associated with bone metastases
GD is a 76 y man who has been receiving triptorelin and flutamide for 18 months. His PSA level has notably increased over the last month and therefore a change in treatment plan is necessary. Which one of the following is most appropriate for GD at this time?
B. Continue triptorelin, discontinue flutamide
i. Patients who have been initiated on complete androgen blockade - CAB - (LHRH agonist + antiandrogen) and progress on therapy should undergo a trial of androgen withdrawal (i.e. discontinue the flutamide, continue triptorelin). Androgen withdrawal usually results in a reduction in PSA and improvement in clinical symptoms. Responses may last for up to 14 months.
HG is a 55 year old man who presents to his primary care physician for prostate cancer screening. What is the most appropriate screening modality for this patient?
A. PSE + DRE
TM is a 74 year old man with metastatic prostate cancer. Which one of the following signs or symptoms is most likely to be associated with metastatic disease?
C. bone pain
JD is a 75 year old man just diagnosed with metastatic prostate cancer. Metastases are located in lymph nodes and adrenal gland. Which one of the following treatment options is most appropriate for initial therapy?
C. leuprolide or b. leuprolide + flutamide
i. You may have had difficulty choosing between answer a and b - and so does the rest of the urology community! Actually both options are correct (sorry, I can only allow for one correct answer in this program!). First line therapy for newly diagnosed metastatic prostate cancer may consist of an LHRH agonist alone or combined with an antiandrogen. Controversies remain with the use of complete androgen blockade (CAB) - i.e. LHRH agonist + antiandrogen as 1st line therapy. Antiandrogens are also beneficial in preventing tumor flare associated with the LHRH agonists.
Which one of the following best describes the mechanism of action of leuprolide?
D. Downregulation of pituitary receptors and decrease in testosterone production
Medication history for RC: Leuprolide 2/07 - 12/07 Leuprolide + Flutamide 12/07 - 9/08 Leuprolide 9/08 - present RC now presents with significant pain in his back & spine. Bone scan indicates significant bone mets all over. His PSA level has also dramatically increased. Which one of the following treatment options is most appropriate for RC?
A. Discontinue leuprolide, start docetaxel and prednisone and zoledronic acid
i. After reviewing RC's medication history, you can see that he was started on an LHRH agonist as monotherapy, had disease progression and therefore an antiandrogen agent was added (flutamide). Most likely, his disease progressed as his flutamide was discontinued (a trial of antiandrogen withdrawal). Now that he is back on single agent leuprolide with significant disease progression he is no longer responding to hormonal therapy. He has hormone refractory disease (also known as androgen independent disease). At this point, chemotherapy is indicated (as long as his performance status is good!) PLUS a bisphosphonate (bone mets). When chemotherapy is initiated, all other treatments (LHRH agonist) are discontinued
Which one of the following patients could be considered a candidate for finasteride (for chemoprevention of prostate cancer)?
D. 65 year old man with BPH (benign prostatic hypertrophy)
i. Men older than 50 years of age AND BPH may derive benefit of prostate cancer chemoprevention with finasteride and therefore should be offered treatment. See prostate cancer chapter.
The initial mainstay of therapy for metastatic prostate cancer is which one of the following?
C. hormonal therapy
Which one of the following is a widely accepted risk factor associated with prostate cancer?
B. African Americans
i. The major widely accepted risk factors for prostate cancer include age, race-ethnicity, and family history. See Table 134-1 and associated text in required reading chapter.
