Cancer Pharmacology Flashcards
Adjuvant therapy
Eradicate residual cancer AFTER primary surgery
Neoadjuvant therapy
Shrink large, locally advanced disease to enable surgical resection
Induction therapy
The first treatment given for a disease
-aims to achieve a rapid reduction in tumor burden or disease activity
Consolidation therapy
Post-remission therapy to eradicate any remaining disease
Maintenance therapy
Administered to prevent cancer from recurring
Palliative therapy
Increase survival and improve quality of life by symptom control for advanced, incurable cancer
Cycle
A period of chemotherapy treatment followed by a period of rest (holiday)
What does the length of time between cycles depend on?
- May give therapy more frequently to enhance tumor effects BUT increases toxicity
- Balance with dose-limiting toxicities
- Also determined by pharmacokinetics of drugs
Alkylating agents
- MOA: Via crosslinking guanine in DNA double-helix strands
- DNA damage
- Ex: Cyclophosphamide
Antitumor Antibodies
- MOA: Via DNA intercalation
- DNA damage
- Ex: Anthracyclines (Doxorubicin - lymphoma, leukemia, breast, ovarian & Daunorubicin - leukemia), Bleomycin - lymphoma
Topoisomerase inhibitors
- Blocks DNA strand re-ligation during DNA synthesis
- DNA synthesis
- Ex: Irinotecan
Antimetabolites
- MOA: Are incorporated into DNA or RNA and inhibit nucleic acid synthesis
- DNA synthesis
- Ex: Folic acid, pyrimidine, or purine analogs - methotrexate, mercaptopurine, 5-FU
Microtubule inhibitors
- MOA: Inhibit tubulin polymerization or function
- Translation/cell division
- Ex: Paclitaxel
- Breast cancer
Nutrient deprivation
- MOA: Inhibition of protein synthesis
- Translation/cell division
- Ex: Asparaginase
Hormonal agents
- MOA: Receptor antagonist. Attenuating estrogen/androgen production (growth signal)
- Targeted therapies (“go” signals)
- Ex: Tamoxifen, degarelix
Epigenetic agents
-MOA:
* HDAC inhibitor - blocks deacetylation by HDAC and restores expression of tumor suppressor genes
* DNMT inhibitor - blocks methylation of promoters and restores expression of tumor suppressor genes
* Targeted signals (“go” signals)
* Ex: Vorinostat, azacitidine
Angiogenesis inhibitors
- Target VGEF secreted by cancer cells or VEGFR
- Ex: Carfilzomib
CDK4/6 inhibitors
- MOA: Prevents phosphorylation of Rb
- Ex: Ribociclib
PARP inhibitors
- MOA: Prevents double-stranded DNA damage repair in BRCA-deficient cells
- Ex: Olaparib
- Activated by DNA damage
What are the three groups of alkylating antineoplastic agents?
- Nitrogen mustards (cyclophosphamide)
- Nitrosoureas (carmustine)
- Non-classic alkylating agents (cisplatin)
What is the mechanism of action of Anthracyclines?
Topoisomerase inhibitors
Chromomycins
Binds to DNA and inhibit RNA translation
Bleomycin
Induces DNA strand breaks
Camptothecins
- Topoisomerases I inhibitor
- Inhibits strand resealing
- Irinotecan (colorectal, lung) and topotecan (ovarian)
Epipodophyllotoxins
- Etoposide (lymphoma, lung, ovarian)
What is the more detailed MOA of antimetabolites?
- Induce cell death during the S phase of cell growth when incorporated into RNA and DNA or inhibit enzymes needed for nucleic acid production
- NOT selective for cancer cells
Cytarabine (Ara-C)
Leukemias
Fluorouracil (5-FU)
Colorectal cancer
Capecitabine
Colorectal
Gemcitabine
Lung, breast, and ovarian cancers
Trifluridine and tipiracil
Colorectal cancer
What are some microtubule inhibitors?
- Eribulin
- Taxanes (Paclitaxel, cabazitaxel, docetaxel)
- Vinca Alkaloids (vincristine)
Eribulin
Breast cancer
Taxanes (Paclitaxel, Cabazitaxel, Docetaxel)
Breast, lung, ovarian, and prostate cancer
Vinca alkaloids (vincristine)
ALL, lymphoma, and lung cancer
Epigenetics
Changes in gene expression that occur without altering DNA sequence
CpG islands
CpG island are regions with a high frequency of CpG sites
Histone modifications
A covalent post-translational modification to histone proteins which includes methylation and acetylation
DNA methyltransferase (DNMT)
Enzymes that catalyze the transfer of a methyl group to DNA
Histone acetyl transferase (HAT)
Enzymes that acetylate conserved lysine amino acids on histone proteins
Histone deacetylase (HDAC)
Enzymes that remove acetyl groups
What are the several stages in which signal transduction can be inhibited?
- mAb against the growth factor receptor
- mAb against a growth factor
- Targeted drugs that inhibit intracellular kinases and prevent subsequent activation of downstream signals
- Targeting downstream signals
- Targeted therapies can be designed for mutated or WT protein
What are the targeted therapies are available for tumors harboring certain mutations?
- Imatinib
- Dastinib
- Nilotinib
- Ponatinib
- Dabrafenib
- Vemurafenib
- Erlotinib
- Afatinib
- Gefitinib
- Osimertinib
- Lapatinib
- Cetuximab
- Panitumumab
What is the G1 phase checkpoint regulated by?
Cyclin D1 and CDK4/6
-tinib
tyrosine kinase inhibitor
-zomib
proteosome inhibitor
-ciclib
cyclin-dependent kinase inhibitor
-parib
poly ADP-ribose polymerase inhibitor