Cancer Chemotherapy Flashcards
When giving chemotherapy why is it that even though the same number of bone marrow cells are killed, the net reduction of bone marrow cells is less?
What is the idea of the fractional cell kill hypothesis?
What is the longest phase of the cell cycle?
What is cell cycle variation?
Give two tumours highly sensitive to chemotherapy treatment?
What cancers is chemo not used in due to low sensitivity?
What is the implication of modest sensitivity to chemo?
Why is surgery used as adjuvant therapy with chemotherapy if micrometastasis is present?
Bone marrow cells recover quicker than the cancer cells.
That for a defined chemotherapy concentration applied for specific time period, a proportion of a tumour cell population is killed rather than a constant number of cells.
0-30hours G1
9-43 hours.
Small cell lung cancer Neuroblastoma Wilm’s tumour Lymphoma Germ cell tumours
Renal
Brain
Endometrial
Prostate
PREB
Used radiotherapy, chemo, surgery all together,
Removal of the initial tumour can lead to the micrometastases being more susceptible to the chemo agent due to the fractional cell kill hypothesis.
How do platinum compounds work?
Name 3 alkylating agents.
Why are DACH platinum adducts thought to be more effective than platinum addicts?
Alkylating agents that lead to the formation of platinated inter and intra-strand addicts leading to inhibition of DNA synthesis.
Cyclophosphamide
Oxaliplatin
Cisplatin
More bulky
Spindle poisons.
Distinguish between mechanism of action of vinca alkaloids and taxanes/epothilones.
Give three ways in which cancer cells can show resistance to alkylation.
Vinca alkaloids bind to soluble alpha and beta tubulin preventing polymerisation to form tubules, whereas taxanes and epithilones bind to microtubules stabilising them.
Both these MOA result in M phase arrest.
Decreased entry or increased exit (pump out)
Inactivation in cell (glutathione can mop up active moiety of alkylating agent)
Enhanced repair of DNA lesions produced by alkylation.
Give some factors that are used to predict chemotherapy response.
What is meant by performance score?
How does a Hickman line prevent against infection? What is another IV pump that can be used? Why is it used - give two reasons?\
Performance score
Clinical stage
Prognostic factors or score (biological factors)
Molecular of cytogenetic markers.
Score to calculate cancer patient’s well being to determine whether or not they can tolerate a drug.
Tunelling though skin using skins macrophages to help protect against infection source.
PICC line
Out patient chemotherapy
Reduce pneumothorax risk
Give three consequences of myelosupression?
What can be given to treat neutropenia?
Thrombocytopenia
Neutropenia
Anaemia
G-CSF
Tumour lysis syndrome.
What increases and what decreases?
Why does calcium decrease?
Give some risk factors.
Why does uric acid increase?
Give 2 other ADRs due to effect of treatment on the tumour?
K+, phosphate and uric acid increase
Calcium decreased
Due to calcium phosphate crystals formation
Leukaemias Lymphomas Large tumour burden Low baseline renal function Rapid response to chemo drugs (SCLC)
Nucleic acid release from dying tumour cells.
DIC
Perforation (lymphomas)
Give the patterns of vomiting in chemotherapy.
What drugs is hairloss minimal with?
High with?
What may be used to minimise it?
Acute phase (4-12 hours)
Delayed 2-5 days
Chronic - persists for 14 days.
Platinum compounds.
Doxorubicin, vinca alkaloids and cyclophosphamide
Cold cap.
What are the two types of DNA binding agents in chemotherapy?
What are the two broad actions of intercalating agents?
Doxorubicin MOA. Side effect? Another drug associated with this?
Bleomycin MOA. 5 side effects?
Intercalating agents
Alkylating agents
Bind in between base pairs when they are stacking due to being planar molecules and inhibit causing deletions and insertions inhibiting DNA and RNA synthesis.
DNA and RNA synthesis inhibition though interference with DNA topoisomerase II
Degrades preformed DNA
Cardiomyopathy (hyperpigmentation)
Cyclophosphamide
Pulmonary fibrosis
Hyperkeratosis
Hyperpigmentation
Ulcerated pressure surges
What does treatment phasing need to take into account?
What needs to be taken into account regarding dosing?
Growth fraction
Cell kill of each cycle of the chemotherapy
Marrow and GI tract recovery before next cycle
How tolerable the regimen
SA or SMI
Drug handinling ability - liver function, renal function
Ge
