Anti-Tumor Agents

Question 1

What is meant by primary induction chemotherapy?

Answer 1

• Where drug treatment is primary treatment strategy

* You do not intend to use surgery or radiation

Question 2

Where can primary induction chemotherapy be curative in adults?

Answer 2

• Hodgkins lymphoma
  
  • nonHodgkins lymphoma
  • Germ cell cancers

Question 3

Where can primary induction chemoktherapy be curative in children?

Answer 3

• Acute lymphoblastic lymphoma (ALL)
  
  • Wilms tumor
  • Embryonal rhabdosarcoma

Question 4

If primary induction chemotherapy doesn’t have a good shot at curing, why else might you use it?

Answer 4

• Advanced cases :( not much of a hope with radiation and surgery, so lengthen life without destroying it in the meantime

Question 5

What is meant by neoadjuvant chemotherapy?

Answer 5

• Targeted chemotherapy used in patients where targeted surgery and/or radiation is possible…just might not be all that effective

Question 6

When can you use neoadjuvant chemotherapy in the course of the disease?

Answer 6

• Right before surgery, this can help you save vital normal organs

Question 7

What’s the bonus of using neoadjuvant chemotherapy right before surgery?

Answer 7

• You can nip the micrometastasis right in the bud!

Question 8

What are the overall goals of neoadjuvant chemotherapy?

Answer 8

• Increase effectiveness of surgery/radiation

* Maximize destruction of tumor tissue while minimizing damage to normal tissue

Question 9

What cancers are treated with neoadjuvant therapy (usually in combination with radiation or surgery?)

Answer 9

• Anal
• Bladder
• Breast
• Esophageal
• Head and neck
• Gastric
• Rectal
• Osteogenic and soft tissue sarcomas

Question 10

What are the three kinds of chemotherapy we talked about in class?

Answer 10

Adjuvant therapy, neoadjuvant therapy, primary induction therapy (these are all chemotherapies mind you and they are combined with other procedures in different ways)

Question 11

What kind of chemotherapy (not the drug, but what class of treatment) would you often use for Anal cancer?

Answer 11

Neoadjuvant therapy, combined with surgery/radiation

Question 12

What kind of chemotherapy (not the drug, but what class of treatment) would you often use for Rectal cancer?

Answer 12

Neoadjuvant therapy, combined with surgery/radiation

Question 13

What kind of chemotherapy (not the drug, but what class of treatment) would you often use for osteogenic and soft tissue sarcomas?

Answer 13

Neoadjuvant therapy, combined with surgery/radiation

Question 14

What kind of chemotherapy (not the drug, but what class of treatment) would you often use for Breast cancer?

Answer 14

Neoadjuvant therapy, combined with surgery/radiation

Question 15

What kind of chemotherapy (not the drug, but what class of treatment) would you often use for esophageal cancer?

Answer 15

Neoadjuvant therapy, combined with surgery/radiation

Question 16

What is meant by adjuvant chemotherapy?

Answer 16

Chemotherapy after local treatment (surgery/radiation) to prevent recurrance or removal of primary tumor allowing metastatic seeds to now take over

Question 17

What is the goal of adjuvant chemotherapy?

Answer 17

• Reduce incidence of localized and systemic recurrence by killing metastatic cancer cells
• You’ve gotten rid of the mother ship, now you need a mopping-up action

Question 18

What are the common cancers treated by adjuvant therapy (and by definition some other localized treatment)?

Answer 18

• Breast
  
  • Colorectal
  • Gastric
  • Non small cell lung cancers
  • Melanoma

Question 19

Why is it traditionally difficult to measure the response of a patient to the drug?

Answer 19

• You’ve removed the primary tumor, you can’t measure a response as easily as seeing if the tumor shrunk

Question 20

Conventional Chemotherapeutics have what kind of therapeutic window?

Answer 20

• A minor one. A narrow one. You need to be dang careful with them and have good monitoring in place

Question 21

What are some parameters you need to pay attention to that affect the pharmacokinetics of chemotherapeutics?

Answer 21

• Renal/hepatic function
• Age
• Prior surgery history
○ You need to care about these things because their bodies may handle the drug differently, and you can get to toxicity FAST

Question 22

Do you generally use one chemotherapeutic drug in the treatment of a given patient?

Answer 22

• NOPE. You generally combine several drugs
  
  • There is greater chance of toxicity, both for host tissue and for the cancer. But your success rate goes up when you hit it from different angles

Question 23

What is the main reason you use combinations of drugs in chemotherapy?

Answer 23

• The resistant cells are out there. They will win if you let them
  
  • Tumors are fairly heterogeneous…which is interesting (cells have different susceptibilities)