Basics Of Systemic Treatment Flashcards
How does traditional chemotherapy work ?
Systemic drug used to kill cancer cells by causing lethal cytotoxicity or apoptosis.
Where can chemotherapy be used ?
Primary chemotherapy - induction of remission
Neo-adjuvant - treat/shrink cancer before surgery
Adjuvant - after surgery to kill any remaining cells
Maintenance lower doses to prolong remission
Palliative - improve cancer symptoms
What are some benefits of targeted therapy over chemotherapy ?
More specific
Better tolerated
Can be given for longer periods
What is an example of a small molecule agent ( targeted therapy ) ?
Tyrosine kinase inhibitor - imatinib
How are biologic therapies used in cancer management ?
Usually monoclonal antibodies against cell surface or circulating antigens
In what cancers are hormonal agents useful ?
Breast
Prostate
When can hormonal agents be used in breast cancer and what is given ?
When the cancer is oestrogen positive
Selective oestrogen receptor modulators or aromatase inhibitors
What hormonal therapy can be given for prostate cancer ?
Androgen deprivation therapy - GnRH agonists or antagonists
When does Alopecia occur in cancer management ?
Usually 7-10 days after chemotherapy
What causes nausea and vomiting in cancer management ?
Traditional chemotherapy
What are some management options for nausea and vomiting due to chemotherapy ?
Ondansetron
Olanzapine
Dexamethasone
When does neutropenia occur in cancer management ?
Traditional systemic agents
When is neutropenia an emergency after chemotherapy ?
Associated with a fever - neutropenic sepsis
What can cause oral mucositis ?
Traditional chemo
Radiotherapy
What is oral mucositis ?
Acute inflammation or ulceration of the oral or oropharyngeal mucosal membranes which can interfere with eating, swallowing or speech due to pain or discomfort.
Which medications are associated with peripheral neuropathy ?
Traditional chemo - platinum therapies and microtubule inhibitors
How can chemo induced peripheral neuropathy be managed ?
Consider dose adjustment
Gabapentin or duloxetine
What are some cancer treatments associated with secondary cancers ?
Chemotherapy - alkylating agents, platinum agents, topoisomerase inhibitors
Targeted therapies - SSC of the skin
How do alkylating agents work ?
Cell cycle non specific drugs which contain alkyl groups that form reactive molecular species that interact with and cross link with DNA. This halts DNA replication.
What is an example of an alkylating agent ?
( and its indications )
Cyclophosphamide
ALL, CLL, Hodgkin’s and non-Hodgkin’s, myeloma, breast, ovary, Wilma tumour
What are some side effects of cyclophosphamide ?
Alopecia
Nausea and vomiting
Diarrhoea
Myelosuppression
Haemorrhagic cystitis
What are some examples of microtubule inhibitors ?
Vincristine
Docetaxel and paclitaxel
What are some indications for vincristine ?
Hodgkin and other lymphomas
Wilson tumour
Rhabdomyosarcoma
Neuroblastoma
What are some side effects of vincristine ?
Neurotoxicity
Peripheral neuropathy
Myelosuppression
What are the indications of docetaxel ?
Breast
Non small cell lung cancer
Ovarian cancer
Bladder
Head and neck cancer
what are some side effects of docetaxel ?
Hypersensitivity
Neutropenia
Peripheral neuropathy
What are some examples of platinum agents ?
( +Indications )
Cisplatin, Carboplatin and oxaliplatin
Testicular
Ovarian
Bladder
What are some side effects of platinum agents ?
Peripheral neuropathy
Ototoxicity
Nephrotoxicity
Nausea and vomiting
Myelosuppression
What is an example of selective oestrogen receptor modulators ( + indications ) ?
Tamoxifen
Oestrogen responsive breast cancer
What are some side effects of tamoxifen ?
Hot flushes
Vaginal bleeding
DVT
Endometrial hyperplasia and malignancy
What are some aromatase inhibitors ?
Anastrozole and letrozole
What are the indications for aromatase inhibitors ?
Oestrogen positive breast cancer in postmenopausal women
What are some side effects of aromatase inhibitors ?
Hot flashes
Reduced bone mineral density
Arthralgia
What is an example of a monoclonal antibody in cancer management ?
Herceptin
When can herceptin be used in breast cancer management ?
HER-2 positive
What are some side effects of herceptin ?
Cardiotoxicity
Reduction in left ventricular ejection fraction
What is an indication of imatinib ?
Chronic myeloid leukaemia
What are some side effects of imatinib ?
Myelosuppression
Hepatotoxicity
Fluid retention
Which cancers can be treated with hydroxyurea ?
Head and neck
CML
Melanoma
Ovarian
Myeloproliferative
What cancers can bleomycin be used for ?
Testicular
Lymphomas
What are some side effects of bleomycin ?
Pulmonary toxicity - Pneumonitis and fibrosis
What can Rituximab be used for ?
Non-Hodgkin’s
B cell lymphoma
What is radiation ?
Released when an unstable higher energy atom configuration changes into a more stable lower energy configuration.
Uses X ray waves
What happens at the level of tissue in the process of killing a cancer using radiation ?
Repair - cancer cells can’t repair between the fractions of radiation
Repopulation - radiation damages the tumour cells ability to repopulate
Re-assortment - the radiation will catch cells in different phases of the cell cycle ( different fractions will catch cells in more vulnerable phases of the cycle )
Re-oxygenation - indirect damage
In palliative setting when is radiation used ?
Bone mets
Lung mets
Brain mets
Spinal cord compression
SVC obstruction
What are some side effects of radiation therapy ?
Fatigue
Sun - burnt appearance
Dry skin
Hair loss
Mucositis
Cough
Pneumonitis
Dysphagia
Nausea and vomiting
diarrhoea
Headache
Marrow suppression
What are some WHO principles of screening ?
Important health problem
There should be a treatment
Facilities should be available
Latent stage of disease
Test or exam for the disease
Test should be acceptable to public
Agreed policy for who to treat
What is the purpose of staging ?
Assessment of local disease
Assessment of distant disease
This determines operability and choice of treatment
