Antitumor Agents

Question 1

Understand differences and purposes of different kinds of chemotherapy- adjuvant, neoadjuvant and primary chemotherapy.

Answer 1

Primary: drugs only. Goals are to palliate tumor-related symptoms,improve quality of life, prolong time to tumor progression, improve length of survival. Alternative to supportive care alone. In some cases, can cure the cancer.Neoadjuvent:Use of chemotherapy in patients who present with localized cancer for which useful local therapies (surgery/ radiation) exist but may not be completely effective. Goals are to increase the effectiveness of the surgery/ radiation. Subsequent removal of residual tumor mass can allow determination of characteristics of residual tumor cells. May also kill micrometastatic disease that is locally present.Adjuvant: Use of chemotherapy in patients after local treatment modalities such as surgery/ radiation treatment. Goal is to reduce the incidence of localized AND systemic recurrence by killing metastatic tumor cells.

Question 2

Understand major differences between “targeted therapies” and conventional cytotoxics.

Answer 2

Conventional agents damage normal cells as well as tumor cells- therapeutic window is largely based on tumor cells being closer to their apoptotic threshold, MTD relevant for conventional agents less so for targeted agents, which are usually less toxic, resistance mechanisms different. Remember: conventional cytotoxics hit specific targets (e.g. Topoisomerase/DNA) just like ““targeted”” agents do- difference is that with the newer ““targeted”” agents we aim to hit a target that is different/faulty in tumor cells but not normal cells.

Question 3

Understand basis for combining anti-tumor agents.

Answer 3

With rare exceptions single drugs at clinically tolerable doses are unable to cure cancer. 3 or more different drugs may be required and more is probably better- e.g. childhood leukemia cure rate increases when active drugs increased from three to seven. However, toxicity is usually increased too.Drugs that are at least partially effective against the same tumor when used alone should be combined.Combining drugs can provide maximal tumor cell kill while remaining within acceptable toxicity ranges, Provide an opportunity to effectively treat cells with different genetic abnormalities in a heterogeneous population, and Slow the subsequent development of drug resistance

Question 4

Know the structure and functions of the skin.

Answer 4

Functions of skin:1.Decoration/Beauty2.Barrier • Physical • Light • Immunologic3.Vitamin D synthesis4.Water Homeostasis5.Thermoregulation6.Insulation/Calorie Reservoir7.Touch/Sensation

Question 5

Recognize regional variation of skin with regard to skin thickness.

Answer 5

Thick skin is hairless and found on the palms and soles. Thin skin is found everywhere else.

Question 6

Acknowledge skin manifestations of systemic disease.

Answer 6

Atopic dermatitis, Ichthyosis, vitiligo, alopecia areata, etc.

Question 7

What is a tumor?

Answer 7

A solid or cystic elevation >2.0 cm in diameterex. follicular cyst