Cancer treatment Flashcards
what is used to detect remission in hodgkins
PET scan
what are the 2 types of cytotoxic drugs
cell cycle specific
non-cell cycle specific
what are cell-cycle agents good for
proliferating tumours
how do cell-cycle agents work
PREVENTS MITOSIS AND CELL REPLICATION
antimetabolites - impair nucleotide syntheses/incorporation
mitotic spindle fibre inhibitors
examples of antimetabolites and what they act on
methotrexate - inhibits dihydrofolate reductase
mercaptopurine/cytosine arabinoside/fludarabine - artificial bases incorporated into DNA
hydroxyurea - impaired deoxynucleotide synthesis
examples of mitotic spindle inhibitors
vinca alkaloids
taxotere
examples of non-cell cycle agents
alkylating agents (chlorambucil, melphalan) platinum derivatives (cis-platinum, carboplatin) cytotoxic antibiotics (anthracyclines: daunorubicin, doxorubicin)
how do alkylating agents work
bind covalently to bases of DNA - induces apoptosis
general side effects of cytotoxic drugs
bone marrow suppression (anaemia, bleeding, infection) gut mucosa damage hair loss fatigue nausea vomiting
side effect of vinca alkaloids
neuropathy
infertility and secondary malignancy (long term)
side effect of anthracyclines
cardiotoxicity cardiomyopathy (long term)
side effect of cis-platinum
nephrotoxicity
why might chemotherapy fail
slow tumour growth drug resistant mechanisms: decreased accumulation increased drug metabolism increased DNA repair altered gene expression
why is CLL more difficult to treat
mutation of P53 gene
P53 allows cells to recognise when they have been damaged by chemo and induces apoptosis
supportive therapy during cytotoxic therapy
broad spectrum antibiotics
red cell/platelet transfusions
growth factor
prophylactic antibiotics and antifungals (itraconazole or posaconazole)
examples of targeted therapy
monoclonal antibodies
biologic agents
molecularly targeted treatments
how do monoclonal antibodies work
only affect cells which possess target protein
antibody attaches to cell initiating complement cascade and NK cells
when are monoclonal antibodies used
alongside chemotherapy
example of monoclonal antibodies
rituximab
what is rituximab used for
high grade NHL
improves survival and prolongs remission in CLL
why might monoclonal antibodies not work
relies on immune system (NK cells and complement) to be functioning
what is brentuximab vedotin
monoclonal antibody and chemotherapy combines
used in hodgkins and some T cell NHL
examples of biological treatments
protosome inhibitors
IMIDs
what are biologics used in
multiple myeloma
how do protosome inhibitors work
causes build up toxic proteins in cells initiating apoaptosis
what are IMIDs
derivatives of thalidomide
orevent tumours from evading the immune system
when are IMIDs used
remission of low grade NHL and CLL
examples of molecular treatments
tyrosine kinase inhibitors
ibrutinib - targets malignant B cells
when are tyrosine kinase inhibitors used
acute and chronic myeloid leukaemia
examples of tyrosine kinase inhibitors
imatinib
nilotinib
dasatinib
ponatinib
side effects of tyrosine kinase inhibitors
diarrhoea
fluid in lungs
neutropenia
side effects of B cell drugs (ibrutinib)
diarrhoea rash fatigue liver abnormality fever
what are checkpoint inhibitors
nivolumab
prevents immune evasion
when is nivolumab used
malignant melanoma
lymphoma relapses
what is immune therapy
bone marrow transplant - T cells from donor cause immune attack on cancer
adverse effect of bone marrow tansplant
also attacks normal host cells
what is adoptive immunotherapy
makes patients own immune cells recognise the cancer as foreign
CART therapy
when is adoptive immunotherapy used
ALL
NHL
