Cancer Chemotherapy

Question 1

Types of cytotoxic drugs

Answer 1

Anti metabolites
Alkylating agents
Cytotoxic antibiotics aka intercalating agents
Mitotic inhibitors aka spindle poisons

Question 2

Name two anti metabolites

Answer 2

Methotrexate

5 FU

Question 3

Name some Alkylating agents

Answer 3

Platinum compounds eg cisplatin and carboplatin

Cyclophosphamide

Question 4

Name some cytotoxic antibiotics aka intercalating agents

Answer 4

Anthracyclines eg doxo and dauno rubicin

Bleomycin

Question 5

Mitotic inhibitors are plant derivatives affecting micro tubules
Name 2 examples and whether they inhibit polymerisation or depolymerisation

Answer 5

Taxanes allow formation then inhibit depolymerisation

Vinca alkaloids prevent polymerisation

Question 6

MoA of anthracycline antibiotics (part of intercalating agents)

Answer 6

Inhibit topoisomerase II (a DNA gyrase that prevents DNA tangling)
Also intercalate DNA

Question 7

MoA Bleomycin

Answer 7

Chelates w iron ions producing free radicals (DNA scisson)

Also binds to DNA directly

Question 8

Alkylating agents only form bonds within cells. Why?

Answer 8

High Cl- concentration outside cells prevents dissociation of the “buffer” chloride attached to the active carbon.
Inside cells, Cl- levels are lower so the Cl- dissociates and the C+ can bind to nucleophilic groups on DNA bases

Question 9

5 FU MoA

Answer 9

Interferes with thymidylate synthase (part of pyramidine synthesis)

Question 10

Why is the Log kill ratio important?

Answer 10

Pulses of chemo every 2-3 weeks gives bone marrow cells time to recover while tumour cell numbers still decrease overall

Question 11

Drug resistance in chemotherapy is a problem, what clinical strategies attempt to offset this?

Answer 11

High dose
Short term
Intermittent repeated therapy
W optimal drug combinations

Question 12

Give 3 mechanisms of chemotherapy drug resistance

Answer 12

MDRP expression increased (acquired drug resistance)
Inactivation of agents within cells
Enhanced repair of DNA lesions

Question 13

Name some common chemotherapy ADRs

Answer 13

ALOPECIA, Mucositis
(pulmonary fibrosis, cardio toxicity, renal failure)
NAUSEA/VOMITING, diarrhoea
Myelosuppression

Question 14

Chemotherapy ADRs due to effect on tumour

Answer 14

Acute Renal Failure (tumour lysis-> hyperuricaemia etc)

GI perforation (at site of tumour eg GIT lymphoma)

DIC (treating AML)

Question 15

Why is Nausea and Vomiting such an important ADR?

Answer 15

In built deterrent to patient compliance

Question 16

What is the most frequent dose limiting ADR in chemotherapy?

Answer 16

Haematological toxicity

Most frequent chemotherapy cause of death

Question 17

Name the chemotherapy drug most likely to cause cardio toxicity

Answer 17

Doxo and dauno rubicin (free radical production)

Question 18

Name the chemotherapy drug most likely to cause pulmonary fibrosis

Answer 18

Bleomycin

Question 19

Name the chemotherapy drug most likely to cause hearing loss and other neurotoxic effects

Answer 19

Cisplatin

Question 20

Name the chemotherapy drug most likely to cause glove and stocking type peripheral neuropathy

Answer 20

Mitotic spindle inhibitors

Question 21

Anti cancer drug broad classes

Answer 21

Cytotoxic drugs
Hormones
Monoclonal antibodies
Protein kinase inhibitors