9: Medical Oncology Flashcards
What type of treatments fall under Medical Oncology?
Chemotherapy, targeted therapy, immunotherapy, and hormone therapy
What are the patient-related factors that help determine the type of treatment?
type of cancer
tumor size, location and if it has mets
age/general health
PMH/Social History
previous cancer treatments
genetic testing
cancer pharmacogenomics
Define and state Effect on response for - Tumor Burden or tumor load
Def: the size of the tumor or the amount of the cancer in the body
Effect: as tumor mass increases in size, its growth rate can slow, thus reducing the effectiveness of cancer treatments
Define and state Effect on response for - Tumor Growth Rate
Def: the proportion of cancer cells within the tumor that are growing and dividing to form new cancer cells
Effect: Rapidly growing tumors usually are more responsive to treatment
Define and state Effect on response for - Drug Resistance
Def: The failure of cancer cells to respond to a drug used to kill or weaken them
Effect: Cancer cells may be resistant at the beginning of treatment or may develop resistance after exposure to treatment
Goals of Cancer Therapy Approaches: Prevention
Use of medicines or other agents to reduce the risk of cancer or delay its development
Ex: Hormone therapy to reduce Breast CA in high risk patient or the immunization of adolescents for HPV
Goals of Cancer Therapy Approaches: Preventative Surgery
Use of surgery to reduce the risk of cancer or delay development
Ex: total colectomy in a person who has APC gene or bilat mastectomy if premenopausal woman that has strong family hx
Goals of Cancer Therapy Approaches: Adjuvant Therapy
Use of additional treatment after the primary therapy to reduce the risk of cancer recurrence and to decrease the incidence of met disease
Ex: chemo after a lobectomy for lung CA
Goals of Cancer Therapy Approaches: Definitive therapy
Use of radiation as the primary treatment modality, with or without chemo
Ex: radonc for prostate CA
Goals of Cancer Therapy Approaches: Neoadjuvant Therapy
Use of one or more treatment modalities before the primary therapy to reduce the size of the primary tumor, improve the effectiveness of surgery, and decrease the incidence of met disease
Ex: CCRT before esophagogastrostomy to treat esophageal CA
Goals of Cancer Therapy Approaches: Palliation
Use of cancer treatment modalities, when disease cure and control cannot be achieved, to relieve side effects and symptoms caused by cancer and other serious illnesses, and to improve quality of life
Ex: RT for bony mets
Goals of Cancer Therapy Approaches: Prophylactic Therapy in Radiation Therapy
Use of RT to relieve symptoms, such as pain, bleeding, neurological compromise, or airway obstruction to improve QOL or treat life-threatening problems
Ex: Whole brain RT in asymptomatic patients diagnosed with cancers that have high risk of brain mets (like small cell lung)
Chemotherapy interfere with cell division. What are the different phases it can interfere with?
G0 - Resting phase
G1 - Postmitotic phase
S - synthesis phase
G2 - premitotic phase
M - mitotic phase
What type of chemo agents are cell cycle-nonspecific?
Alkylating Agents
Antitumor antibiotics
hormone therapies
nitrosoureas
What type of agents are cell cycle specific agents for the synthesis phase (2)?
antimetabolites and camptothecins
What type of chemotherapy agent(s) is cell cycle specific agents for the mitosis phase?
plant alkaloids and taxanes
How is chemo administered? What are the 3 factors?
Administered in many ways: oral, intraperitoneal, intravenous, intrathecal, intraventricular, intrapleural, intratopical, subcutaneious or intramuscular, and topical
Factors:
Frequency of cycles (daily, weekly, every 14 or 21 days, monthly, continuously)
Length of cycles (minutes, hours, days)
number of cycles (as determined by research/clinical trials)
What is personalized medicine in cancer treatment?
Also called precision medicine - uses a patient’s genetic information to prevent, diagnose, or treat cancer.
What’s an example of a genetic variation that impacts dosage of 5-FU?
DPD (dihydropyrimindine dehydrogenase) deficiency – an enzymes
Someone with DPD deficiency will have more serious/life threatening reactions to 5-FU side effects
Define Targeted Therapy
Drugs or other substances that are specific to a certain tumor type or they concentrate on a the genetic change instead of the type of cell.
Targeting specific Genes or the proteins found in cancer cells
OR acts on the tissue environment related to cancer cell growth and survival, such as blood cells
Does Targeted Therapy have less side effects?
In theory, but in practice its been noted to have less toxic to normal cells but just very different – more vascular, coagulatory, dermatologic, immunologic, ocular and pulmonary toxicities
Define Immunotherapy
also known as biological therapy or biotherapy - treatment to boost or restore the ability of the immune system to fight cancer, infection, and other diseases by including, enhancing or suppressing an individual’s own immune response
What are the 4 different types of Immunotherapy?
Nonspecific – stimulates a broad-based immune response
Oncolytic Viral Therapy - genetically modified virus to kill cancer cells (T-VEC—first and only one approved by FDA at this time)
Chimeric Antigen Receptor T-Cell Therapy (CAR-T) - obtaining patient’s own T-cells through apheresis, genetically modified in lab by adding the CAR to their surface and given back to the patient — only approved for acute lymphoblastic leukemia in kids and advanced large B-cell lymphoma in adults.
Cancer Vaccines - preventative vaccines to avoid cancer in the future, given to healthy people. Only 2 so far – Hep B Vaccine for liver CA prevention and HPV vaccines for cervical, oral and anal CAs
Define Hormone Therapy
also called endocrine therapy — used to treat hormone-sensitive cancers (breast, ovarian, prostate) by…
stopping/reducing the body’s ability to produce hormones,
interfering with or blocking hormone receptors,
and substituting chemically similar agents for active hormones but that can’t be used by the tumor
