Cancer Chemotherapy Flashcards
Define neoplasm
- Large tumors
- Benign or malignant
Define cancer
- Malignant forms of neoplastic disease
Define carcinogen**
- Things that may cause cancer
- Environmental, viral, genetic
Epidemiology of caner in the US
- 2nd leading cause of death
- One in every 4 deaths in the US is due to cancer
Approaches to treatment of cancer**
- Surgery
- Radiation
- Chemotherapy: adjuvant vs neoadjuvant (chemo 1st) = chemo used in combination with surgery and/or radiation; palliative/curative
What are the general principles of chemotherapy
- Cytotoxic strategy: drug should limit cell proliferation by killing or attenuating the growth of cancerous cells
- Drug inhibits DNA/RNA synthesis & function: drug will be more effective against cells rapidly undergoing mitosis
- **Collateral damage: damage to deathly cells, ideal chemo drugs limit this
Describe drug effects related to the cell cycle specific phases**
- Drug effects specific phase of cell cycle
- Drug will not be effective if cell is in G0 phase
- Ex: Methotrexate
Define growth fraction**
- Percentage of proliferating cells relative to total neoplastic cell population
- Higher growth fraction = more cells are susceptible to treatment
- Growth fraction decreases as tumor size increases
Describe drug effects related to the cell cycle nonspecific phases**
- Drug effective regardless of cell phase
- Ex: Alkylating agents
Define cell kill hypothesis
- Each round of chemotherapy will kill a certain percentage of cancer cells
- In theory you can never kill all of the cancer cells
What are anticancer drugs classified by
- MOA
- Chemical structure
- Source
Describe alkylating agents (IV)
- Cyclophosphamide & Ifosfamide
- MOA: bind DNA strands to prevent DNA function & replication; cell cycle nonspecific
- Commonly used in Leukemia & Carcinomas
Common side effects of alkylating agents
- Blood disorders (-penias)
- N/V (nausea/vomiting)
- Loss of appetite
- CNS toxicity
- Hemorrhagic cystitis (cyclophosphamide)
Describe platinum coordination complexes (IV)
- End in “-platins”
- Cisplatin, Carboplatin, Oxaliplation
- MOA: alkylating agents form cross links between & within DNA strands with platinum as opposed to alkyl side chains
- Commonly used for Ovarian & Colon cancer
Common side effects of platinum coordination complexes
- Blood disorders “penias”
- N/V/D (Pukey platinums; most common)
- Anaphylactoid reactions
- Peripheral neuropathy (carbo, oxal)
- Neurotoxicity (cisplatin)
- Respiratory toxicity (oxaliplatin)
Describes antimetabolites (IV)
- Interfere with normal metabolites during DNA/RNA synthesis
- Incorporation into genetic material or occupying enzymes that synthesize genetic material
- Cell cycle specific
- Commonly used in Leukemias, breast & GI cancers
Where is leukemia and carcinomas
- Leukemia: in the blood
- Carcinomas: in epithelial cells/tissue
Common side effects of antimetabolites
- Blood disorders “-penias”
- N/V
- Muscle pain, fatigue
- Hair loss
- Rash
- Nephrotoxicity (methotrexate)
Describe anticancer antibiotics (IV)
- End in “-mycins” and “-rubicins”
- Block synthesis of RNA, DNA, or both leading to disruption in cell synthesis
- Commonly used in Leukemia, Lymphoma, GI, & Carcinomas
Symptoms of acute toxicity for anticancer antibiotics
- N/V
- Fever
- Red urine: Daunorubicon & Doxorubicin; this is not hematuria
Symptoms of delayed toxicity for anticancer antibiotics
- Pulmonary fibrosis: Bleomycin
- Skin & mucocutaneous
- Cardiotoxicity: “-rubicins”
- Blood disorders “-penias”
Describe antimicrotuble agents (IV)
- End in “-taxel” and “-istine”
- Cell cycle specific (CCS) medications
- Commonly used for Leukemias, Lymphomas, GI, breast, & ovarian cancers
Common side effects of antimicrotuble agents
- Blood disorders “-penias”
- N/V/D
- Cardiopulmonary toxicity (taxanes)
- Peripheral neuropathies
Describe topoisomerase inhibitors (IV)
- Etoposide, Irinotecan
- MOA: inhibit enzymes needed for DNA replication & leads to break in DNA double helix
- Commonly used for lung, ovarian, colorectal cancers
Common side effects of topoisomerase inhibitors
- Severe diarrhea (I-RAN-To-The-Can)
- Blood disorders “-penias”
- N/V
List injection hormonal agents
- Steroids
- Androgens
- Antiandrogens
- Gonadotropin releasing hormones
- Used in hormone responsive cancers such as prostate
List oral hormonal agents**
- Aromatase inhibitors
- Estrogens
- Antiestrogens
- Progestins
- Used for hormone responsive cancers such as breast
Describe targeted/biologic agents
- Monoclonal antibodies (-mabs): mostly IV therapies; Alemtuzumab, bevacizumab, rituximab, trastuzumab
- Cytokines: Interferon alfa-2b & interleukin-2; IV/SQ therapy
- Tyrosine kinase inhibitors (-nibs): oral options; erlotinib, imatinib, sorafenib
- All 3 work along side the immune system instead of attacking the DNA
Describe monoclonal antibodies (MAb)
- Not only used for cancers
- Can be used for immunologic diseases such as Crohn’s, RA, allergies, & more
- Side effects: infusion related reactions
MOA of tyrosine kinase inhibitors (-nib)
- Target therapy
- Disrupt cell signal transduction of cancer specific proteins
- Less damage to normal cells than traditional chemotherapy
Slide 35/36 is good for an overview
Important to know about combination chemotherapy regimens
- Most of the time several chemo agents are administered at one time
- Thought is to inhibit cell replication by more than one target
- Increases likelihood of success
What is the most common reason for treatment failure
- Resistance
What are the methods to overcome resistance
- Increase dose
- Increase treatment frequency
- Adjust sequence
- Clinical trials/alternative therapies
Describe the prevalence of adverse effects
- Common and predictable
- Most impactful on therapy course
- Normal cells undergoing rapid mitosis: hair follicles, bone marrow, immune cells, & epithelial cells (skin/GI)
What are the common side effects of chemotherapy regimens
- N/V
- Fatigue
- Lab problems
- Hair loss
- Pain
Describe treatment of CINV
- Treating GI side effects improves QOL
- Steroids: dexamethasone or prednisone
- **5-HT3 inhibitors (end in”-setron”)
- Neurokini-1 receptor inhibitors: aprepitant or fosaprepitant
- Alcohol swabs can potentially fix a patients nausea
Describe treatment approaches for cancer related pain & fatigue
- Analgesics: may be beneficial for pain
- Non-pharmacologic approaches: exercise, stretching, massage, TENS, reassurance/support
- Moderate fatigue associated with rehab programs improves capacity to tolerate pain, fatigue, and other cancer related side effects
Describe anemia & neutropenia precautions**
- Anemia common: review hemoglobin, hematocrit, & platelets before treating; expect reduced aerobic capacity, tachycardia
- Neutropenia precautions: review WBCs, absolute neutrophil count (ANC); look for meds ending in “-stim” (filgrastim); implications for individual vs group therapy; potential isolation precautions
Describe lymphedema
- Results from lymph node removal during cancer surgery, radiation therapy, or obstructing tumor
- Higher risk in breast, prostate, lymphoma, melanoma, head, & neck cancer
- Most often occurs in the arms or legs
What is the rehabilitation focus for all cancer patients
- Continue for 6-8 wks after last treatment
- Individualize
- Pre-habilitation (if possible)
- Daily to every other day
- Expect/manage side effects
What are the pediatric considerations for cancer PT rehabilitation
- Stretching
- Gait training
- Exercise
- Strength
- Balance
- Neuro or motor rehab
Describe on cycle rehab**
- When a patient is receiving treatment
- Expect clinical deterioration
- Provide reduced intensity plan
- May need to be treated individually due to immunocompromised
Describe off cycle rehab**
- Patient is not actively receiving treatment
- Rebuild what was lost on-cycle
- Increase muscle force & aerobic capacity
Describe the timeline of therapy in cancer patients
- Cancer diagnosis
- Pre-habilitation
- On cycle rehab
- Supportive therapy
- Off cycle rehab
- Restorative therapy
- End of treatment
- Palliative therapy or continued restorative therapy
