Cancer/Chemotherapy (Exam V) Flashcards
Proto-oncogenes vs Tumor Suppressors. Differences?
Proto-oncogenes usually has a function in the cell cycle, when it gets mutated that function gets changed. A single mutation known as gain of function mutation.
Tumor Suppressor Genes (p53 and p16) cause cell to commit suicide if it has an error. If both p53 and p16 are knocked out (two-hit hypothesis), you will most likely develop cancer. Loss of function mutation.
Cancer cell types?
Carcinoma- epithelial origins (basal cell carcinoma, breast carcinoma)
Sarcoma- connective tissues or muscles (osteosarcoma, Kaposi’s sarcoma)
Leukemias/Lymphomas- immune cells (Hodgkin’s lymphoma, AML)
What are three traditional treatments for cancer.
Surgery
Radiation
Chemotherapy
What is Primary Chemotherapy?
What is Neoadjuntive Chemotherapy?
What is Adjunctive Chemotherapy?
Primary: Treatment is chemo, associated with advanced diseased and the goal is to limit spread and improve quality of life. (one treatment)
Neoadjuntive: Chemotherapy induced to reduced tumor size prior to and after surgery. Surgery would be primary treatment and chemo would be secondary. (GI, Breast, Lung CA) (two treatments)
Adjunctive: After surgery reduce incidence and resurgence of tumor. Both surgery and chemotherapy equally important, possible radiation. Goal: Disease free survival and overall survival. (three treatments)
Toxicity of Chemotherapy (7)?
Attacks rapidly dividing cells will result in:
Abortion/Fetal death
Teratogenicity
Carcinogencity
Alopecia
Bone marrow suppression
Immunosuppression
N/V
AT CABIN
What is the largest and most diverse CCNS chemo class?
How do these work?
What are 4 groups of Alkylating Agents?
Alkylating Agents
Either alkylate DNA or interferes by cross linking (platinum compounds)
- Nitrogen Mustards
-Cyclophosphamide- cancer and immunosupressive
-Chlorambucil - least toxic - Nitrosureas- cross BBB
- Alkyl Sulfonate
- Platinum Analogs- cisplatin, carboplatin
MOA of Alkylating Agents (ABCD)?
- Abnormal base pairing
- Break DNA strand (decrease cell proliferation)
- Cross linkage
- Damages RNA and proteins.
What is the MOA of Cisplatin?
Where does Cisplatin concentrate?
Does Cisplatin cross the BBB?
Cisplatin enters the cell and forms highly reactive platinum complexes. Strands cross link resulting in DNA damage and inhibit cell proliferation.
Concentrate in the kidney, intestines, and testes.
Cisplatin does not cross the BBB.
What are the uses of Cisplatin?
How is Cisplatin excreted?
If a patient can’t tolerate Cisplatin, what is an alternative?
Testicular Cancer (85-95% curative)
Ovarian Cancer
Treat tumors in the lungs, esophagus, gastric
Cisplatin is slowly excreted through the urine.
Carboplatin can be an alternative because Cisplatin is very toxic (emesis, nephrotoxicity, peripheral neuropathy, ototoxicity).
What antimetabolite drug is a folate antagonist?
Methotrexate
What is the MOA of Methotrexate?
What are the cytotoxic actions of methotrexate (3)?
Inhibits dihydrofolate reductase (DHFR) and interferes with DNR/RNA synthesis.
Cytotoxic actions:
1. Predominant in the bone marrow (leukemia)
2. Ulceration of intestinal mucosa
3. Crosses placenta and interferes with embryogenesis (fetal malformation and death)
What are the immunosuppressive actions of methotrexate?
What are the anti-inflammatory action of methotrexate?
Immunosuppression: Prevent clonal expansion of B/T lymphocytes
Anti-inflammatory Action: Interferes with release of inflammatory cytokines
Antimetabolites (2).
5-FU
6-MP
Plant Based (2)
Vincristine
Paclitaxel (Taxol)
Antibiotics (3)
Bleomycin
Dactinomycin
Doxorubicin
