Breast Cancer Case - Overview of Chemotherapy Flashcards
What is chemotherapy?
The use of cytotoxic drugs in the treatment of cancer.
Systemic treatment.
What are the goals of chemotherapy?
Provides cure, control, or palliation
When was chemotherapy first developed, and by who?
Developed by Paul Erhlich, the “father of chemotherapy” in the early 1900s
How was chemotherapy first discovered?
A result of the advances Paul Elrich made in the discovery of chemicals to treat infections.
During WWI and WWII it was discovered that through the use of mustard gas, alkylating agents, cause marrow and lymphoid suppression
When was chemotherapy first used as a treatment, and what was it used to treat?
Resulted in the treatment of Hodkin’s and other lymphoma.
Began in the 1950’s as a treatment modality, common practice in the 1970’s
how does chemotherapy work?
Interferes with the steps of the cell cycle specifically involved in synthesis of DNA and replication of tumour cells.
How are chemotherapeutic agents classified?
Can be cell cycle phase specific or cell cycle phase nonspecific.
Chemotherapeutic agents are classified according to their action/interference with the cell cycle.
What is application of chemotherapy based on?
Application is based on concepts of cellular kinetics: cell cycle, cell-cycle time, growth fraction, and tumor burden
What are the five stages of reproduction provess that occurs in both normal and malignant cells?
G0 phase S phase G2 phase M phase G1 phase
What is cell-cycle time?
Time required for cell to move from one mitosis to another mitosis.
What is the major determinant in cell-cycle time?
Major determinant is the G1 phase
Varies with specific cells
What is the effect of a shorter cell-cycle?
Shorter cell-cycle time leads to higher cell kill with exposure to cell specific agents.
What is the growth fraction of a tumor?
Percent of cells actively dividing at one time
What is the effect of growth fraction of tumours?
Higher growth fraction leads to higher cell kill with cycle specific agents.
What kind of chemotherapy agents should be used for tumours with a higher fraction of cells in G0 (resting phase)?
Tumours with >fraction of cells in G0 are more sensitive to cell-cycle non-specific agents
What is tumour burden?
Number of cells present in the tumour
What is the effect of tumour burden?
Cancers with small tumour burden are more sensitive to antineoplastic therapy
As the tumour burden increases, the growth rate decreases, and active cell dicvision decreases.
What is the effect of a high tumour cell burden?
The higher the tumor cell burden, the greater chance of heterogeneity of tumour cells and the emergence of drug-resistant clones
Tumour burden increases -> growth rate decreases -> and active cell division dicreases
What are four various approaches for chemotherapy?
Single agent
Combination
Regional
High dose
How are chemotherapy agents delivered? (What routes)
Oral Subcutaneous Intramuscular Topical Intraarterial Intracavity Intraperitoneal Intrathecal Intravenous
What are alkylating agents (what classification, and examples of specific meds)?
CEll cycle nonspecific (platins, non-platins)
Ex. cyclophosphamide
Cisplatin
What are antimetabolites? (classification and examples of specific meds)?
Cell cycle specific (s-phase)
Ex. 5-fluorouracil, capecitabine
What are antitumour antibiotics? (classification and examples of specific meds)
Cell cycle specific (s-phase)
Ex. doxorubicin, bleomycin
What are vinca alkaloids? (classification and examples of specific meds)
Cell cycle phase specific (m phase)
Ex. vincristine, vinblastine
What are taxanes? (classification and examples of specific meds)
M-phase specific
Ex. paclitaxel, docetaxel
What are podophyllotoxins? (classification and examples of specific meds)
M-phase specific
Ex. etoposide, teniposide
What are camptothecins?(classification and examples of specific meds)
S-phase specific
ex. Irinotecan, topotecan
What are the effects of steroids in cancer patients? What are some examples of steroids used in cancer treatment?
Reduces ICP, spinal cord compression
Ex. prednisone, deximethasone
Are hormones cell cycle specific?
Non-cell cycle phase speciic
What is an example of a hormone used to treat cancer?
Tamoxifen
Which factors determine the chemotherapy regime prescribed?
Pt eligibility Cancer cell type Rate of drug absorption Tumour location Tumour load Tumour resistance Staging and grading
Which three things determine the selection of drug combinations?
The proven effectiveness of each drug when used alone against that cancer
A difference in each drug’s method of attacking the cancer (so that maximum cancer-kill can be achieved in each cycle while minimizing the chance of developing resistance to any one drug)
A difference in the side effects of each drug (minimally overlapping toxicity), so that your healthy tissue will not be badly damaged by the cancer drugs
What are common hematopoetic adverse effects of chemotherapy?
Neutropenia
Thrombocytopenia
Anemia
(This triad is called pancytopenia)
What are common GI adverse effects of chemotherapy?
Anorexia and vomiting
Mucositis
Stomatitis
What are common skin adverse effects of chemotherapy?
Dermatitis
Alopecia
Nail cahnges
What are some genitourinary adverse effects of chemotherapy?
Cystitis
ARF
What are some cardiovascular adverse effects of chemotherapy?
Extravasation
Phlebitis
Cardiac toxicity
What are some neurologic adverse effects of chemotherapy?
Ototoxicity
Peripheral neuropathies
What are some pulmonary adverse effects of chemotherapy?
Pulmonary Edema
Pneumonitis
What are some reproductive adverse effects of chemotherapy?
Infertility
Changes in libido
What are some mood alterations that are side effects of chemotherapy?
Anxiety
Depression
What are some metabolic alterations caused by chemotherapy?
Hypo/hypercalcemia
Hypo/hyperglycemia
What are some latent effects of chemotherapy?
Changes in memory
Secondary malignancies
What are some other adverse effects of chemotherapy not specified to a body system?
Hypersensitivity
Fatigue (CRF)
