cancer therapy

Question 1

what are examples of alkylating agents?

Answer 1

cyclophosphamide
chlorambucil
busulfan

Question 2

what is the mechanism of action of cyclophosphamide?

Answer 2

alkylating agent - causes cross-linking in DNA

Question 3

what are adverse effects of cyclophosphamide?

Answer 3

haemorrhagic cystitis- give mesna
hair loss
meylosuppression
TCC- transitional cell carcinoma

Question 4

what are examples of cytotoxic antibiotics?

Answer 4

bleomycin
anthracyclines eg doxorubicin
actinomycin D/dactinomycin

Question 5

what is the mechanism of action of bleomycin?

Answer 5

degrades pre-formed DNA

Question 6

what are the adverse effects of bleomycin?

Answer 6

lung fibrosis

Question 7

what is the mechanism of action of anthracyclines eg doxorubicin?

Answer 7

stabilises DNA- topoisomerase II complex inhibits DNA + RNA synthesis

Question 8

what are adverse effects of anthracyclines eg doxorubicin?

Answer 8

cardiomyopathy

Question 9

what is mechanism of action of dactinomycin?

Answer 9

antineoplastic antibiotic

Question 10

what are adverse effects of dactinomycin?

Answer 10

myelosuppression
GI toxicity

Question 11

what are antimetabolites?

Answer 11

methotrexate
5-FU fluorouracil
6-mercaptopurine
cytarabine

Question 12

what is the mechanism of action of methotrexate?

Answer 12

inhibits dihydrofolate reductase + thymidylate synthesis

Question 13

what are adverse effects of methotrexate?

Answer 13

myelosuppression
mucositis
liver fibrosis
lung fibrosis

Question 14

what is the mechanism of action of 5-FU?

Answer 14

pyrimidine analogue inducing cell cycle arrest + apoptosis by blocking thymidylate synthase (works during S phase)

Question 15

what are adverse effects of 5-FU?

Answer 15

myelosuppression
mucositis
dermatitis

Question 16

what is the mechanism of action of 6-mercaptopurine?

Answer 16

purine analogue that is activated by HGPRTase
decreasing purine synthesis

Question 17

what are adverse effects of 6-mercaptopurine?

Answer 17

myelosuppression

Question 18

what is the mechanism of action of cytarabine?

Answer 18

pyrimidine antagonist
interferes with DNA synthesis at S phase of cell cycle + inhibits DNA polymerase

Question 19

what are adverse effects of cytarabine?

Answer 19

myelosuppression
ataxia

Question 20

which cytotoxic agents act on microtubules?

Answer 20

vincristine
vinblastine
docetaxel

Question 21

what is the mechanism of action of vincristine/vinblastine?

Answer 21

inhibits formation of microtubules

Question 22

what is the mechanism of action of docetaxel?

Answer 22

prevents microtubule depolymerisation + disassembly
decreasing free tubulin

Question 23

what are adverse effects of vincristine?

Answer 23

peripheral neuropathy- reversible (urinary hesitancy can result from bladder atony)
paralytic ileus

Question 24

what are adverse effects of vinblastine?

Answer 24

myelosuppression

Question 25

what are topoisomerase inhibitors?

Answer 25

irinotecan

Question 26

what is the mechanism of action of irinotecan?

Answer 26

inhibits topoisomerase I which prevents relaxation of supercoiled DNA

Question 27

what are adverse effects of irinotecan?

Answer 27

myelosuppression

Question 28

what is the mechanism of action of cisplatin?

Answer 28

causes cross-linking in DNA

Question 29

what are adverse effects of cisplatin?

Answer 29

ototoxicity peripheral neuropathy hypomagnesaemia n+v nephrotoxic

Question 30

what is the mechanism of action of hydroxyurea (hydroxycarbamide)?

Answer 30

inhibits ribonucleotide reductase which decreases DNA synthesis

Question 31

what are adverse effects of hydroxyurea?

Answer 31

myelosuppression

Question 32

what are examples of taxanes?

Answer 32

paclitaxel

Question 33

what are adverse effects of paclitaxel?

Answer 33

hypersensitivity

Question 34

what are immune modulators?

Answer 34

thalidomide lenalidomide

Question 35

what are tyrosine kinase inhibitors?

Answer 35

erlotinib- lung ca imatinib- CML

Question 36

what are endocrine modulators?

Answer 36

tamoxifen anastrazole

Question 37

what is trastuzumab and which cancer is it given in?

Answer 37

anti-Her2 breast ca

Question 38

what is bevacizumab and which cancer is it given in?

Answer 38

anti-VEGF RCC, CRC, lung

Question 39

what is cetuximab and which cancer is it given in?

Answer 39

anti-EGFR CRC

Question 40

what is rituximab and which cancer is it given in?

Answer 40

anti-CD20 NHL

Question 41

what are common side effects of chemotherapies?

Answer 41

n+v- prophylactic granisetron + dex alopecia neutropenia- 10-14d after chemo extravasation of chemo agent - presents w pain, burning + bruising at infusion site - stop infusion, give steroids, apply cold pack - liaise early w plastics

Question 42

what is radial radiotherapy?

Answer 42

treatment w curative intent 40-70gy (gray- radiation dose) given in 15-30 daily fractions

Question 43

what is palliative radiotherapy?

Answer 43

for symptom relief- bone pain, haemoptysis, cough, dyspnoea, bleeding 8-30Gy 1-10 fractions

Question 44

what are early reactions to radiotherapy?

Answer 44

tiredness skin reactions- erythema -> ulceration mucositis n+v- occur w stomach, liver or brain rx diarrhoea- w pelvic or abdo rx cystitis myelosuppression

Question 45

what are late reactions to radiotherapy? (months or years)

Answer 45

brachial plexopathy- follows axillary radiotherapy- numb, weak, painful arm lymphoedema pneumonitis - dry cough +/- dyspnoea, rx w pred xerostomia- oral dryness benign strictures fistulae reduced fertility panhypopituitarism

Question 46

what is neoadjuvant chemotherapy?

Answer 46

receives chemo prior to primary treatment shrink tumour to reduce need for major surgery control early micrometastases

Question 47

what is adjuvant chemotherapy?

Answer 47

chemo given after primary treatment to reduce chance of relapse eg breast and GI ca

Question 48

what is palliative chemo?

Answer 48

provide relief from symptoms prolong survival