Anti-cancer therapy

Question 1

Roles of cancer pharmacotherapy

Answer 1

1. induction
2. curative
3. neo-adjuvant
4. adjuvant
5. maintenance
6. palliative/salvage
7. comb w radiotherapy as radiation sensitisers

Question 2

Most anticancer drugs are used… except selected indications for local/regional therapy like…

Answer 2

systemically

1. ovarian cancer: intraperitoneal
2. bladder cancer: intravesical
3. hepatocellular carcinoma: hepatic artery infusion +/- embolisation
4. skin cancer/malignant lesions: topical tx

Question 3

Why do patients under chemotherapy suffer from alopecia/ hair loss?

Answer 3

chemotherapy

1. greatest selectivity for proliferating cells
2. disrupts cellular process
3. induces apoptosis

Question 4

Cytotoxic drugs follow ____ hypothesis

Answer 4

log kill hypothesis

- follows first-order kinetics– fixed % of tumour cells killed each cycle

Question 5

2 types of cytotoxic drugs

Answer 5

1. cell cycle specific drugs: only S or M phase of cell cycle during replication
   * effective for high growth fraction
2. phase non specific drugs: throughout cycle
   * effective for both low high growth fraction

Question 6

What do you need to take note in designing chemotherapy combinations?

Answer 6

1. efficacy
2. toxicity
3. optimum scheduling
4. DDI- MOA
5. Avoidance of drug changes- as dose changes may reduce efficacy

Question 7

What are the regimens for

1. Breast cancer ACT
2. Hodgkin’s lymphoma ABVD
3. Non-Hodgkin’s lymphoma CHOP

Answer 7

Breast cancer

1. cyclophosphamide
2. a

Hodgkin's lymphoma
1. 
2. 
3. 
4.

Non-Hodgkin's lymphoma
1. cyclophosphamide
2.
3.
4.

Question 8

What are the common chemotherapy side effects?

Answer 8

Common acute toxicity

1. myelosuppression
2. alopecia
3. mucuous membrane ulceration
4. GI

+ Late organ toxicity (eg cardio/nephrotoxicity etc)

Question 9

5 Classes of anti-cancer drugs

Answer 9

1. Alkylating agents

2. Platinum analogues

Question 10

What are the drugs under the alkylating agent drug class?

* phase non specific

Answer 10

1. Nitrogen mustard -cyclophosphamide, melphalan
2.
3. 
4.
5.

Question 11

What is the mechanism of action of alkylating agents/

Answer 11

1. reactive alkyl group
2. covalent bonds to DNA & cross links DNA
3. disrupt DNA RNA replication transcription
4. ds/ss DNA breaks

Question 12

What causes resistance against alkylating agents?

Answer 12

1. decreased drug entry
2. increased drug inactivation (esp GSH rich cells)
3. enhanced repair of DNA lesions produced by alkylation

Question 13

What are the adverse effects of alkylating agents?

Answer 13

1. acute: n/v , vesicant

2. delayed: ___

Question 14

What are the 3 platinum analogs?

Answer 14

1st gen: cisplatin
2nd gen: carboplatin
3rd gen: oxaliplatin

Question 15

What is the mechanism of action of platinum analogs?

Answer 15

1. DNA adducts
2. intra-strand cross links (less interstrand)
3. DNA-protein cross links

• broad spectrum: combi therapy cures testicular cancers

Question 16

Specific AR of platinum analogs

Answer 16

1. acute: N/V (cisplatin)

2. delayed: peripheral neuropathy (cisplatin, oxaliplatin)

Question 17

Which drugs cannot be used/require dose ajd in renal impairment?

Answer 17

Platinum analogs:

1. cisplatin contraind in kidney disease (creatinine clearance <60ml/min)
2. carboplatin dose adjustment