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Module 17-Urinary, Endocrinology, Oncology > Cancer Treatment (Chemotherapy) > Flashcards

Cancer Treatment (Chemotherapy) Flashcards

1
Q

Chemotherapy - aims

A

To prolong survival
To maintain good quality life
To minimise side-effects

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2
Q

Rank Haemopoietic, Mast cell tumours and Sarcomas based on chemosensitivity

A

Drugs work best on rapidly dividing cells:
Haemo
Mast cell tumour
Sarcomas

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3
Q

Two types of chemotherapy treatments

A

Conventional (Max tolerated dose MTD)
Targeted therapies

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4
Q

Outline conventional chemotherapy treatment

A

Works on rapidly dividing cells in a non-specific way
Does not differentiate between tumour and normal cells
Minimises side-effects by allowing normal cells to recover between doses

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5
Q

Why should I use a combination of chemotherapy drugs to treat lymphoma

A

different drugs should have a different mode of action
affect different phases of the cell cycle
and have different methods of resistance

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6
Q

What do I need to ensure when giving a combination of chemo drugs to patient with lymphoma

A

Drug toxicities do not overlap
Drugs do not interfere with each other

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7
Q

Why should I use an established protocol in chemotherapy

A

Ensure each drug is effective against tumour
Avoid overlapping toxicities/ drug interactions
Ensure adequate time for cells to recover

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8
Q

Are side effects from chemotherapy common in animals?

A

Usually minimal because protocols adapted to animals
Occasionally can be severe
Need good knowledge of hazards and careful monitoring to prevent side-effects!
Need to educate clients as to what to look out for!

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9
Q

Most common side effects of chemotherapy

A

Bone marrow suppression,
Alopecia,
GI upsets,

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10
Q

Outline chemotherapy for lymphoma

A

Treat any concurrent disease first
Eg Antibiotics for skin infection,iv saline diuresis for hypercalcaemia
Use specific chemotherapy
Induce clinical remission with high doses
Continue with maintenance (lower doses)
Intensify protocol if response not complete or change protocol to different drugs
Monitor for side-effects

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11
Q

What could I do if there is no evidence chemotherapy is working for patient

A

add a boost eg L-asparaginase or change protocol

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12
Q

What should I do if animal is showing sign of side effects after last dose

A

consider dose reduction, more GI protectants /anti-nausea drugs
OR change drugs /protocol
OR stop treatment

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13
Q

What are the drugs in COP protocol

A

Cyclophosphamide
Vincristine (Oncovin)
Prednisolone

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14
Q

Outline the induction phase in the COP protocol

A

Continuous every other day tablet administration /weekly injections
High doses of drugs for 1st 6-8 weeks to induce remission

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15
Q

Outline maintenance phase after induction in low dose COP protocol

A

Alternate week therapy (week of drugs, week of no drugs, week of drugs etc)
then 1 week in 3, 1 week in 4 etc for up to 2 years if the animal survives that long
Change cyclophosphamide to chlorambucil after 6 months to reduce risk of haemorrhagic cystitis developing.

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16
Q

What could cyclophosphamide cause in the long term

A

Haemorrhagic cystitis

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17
Q

Prevention of haemorrhagic cystitis

A

Give cyclophosphamide tablets in a.m.
Encourage drinking and urination (Prednisolone is helpful!)
Monitor urine for traces of BLOOD by dipstick (cheap) or urinalysis (precise)
Administer a diuretic (furosemide) at time of administration if infrequent use of cyclophosphamide eg CHOP

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18
Q

Treatment for haemorrhagic cystitis

A

Stop cyclophosphamide
Culture urine ± give antibiotics for secondary infection
Substitute chlorambucil /melphalan for cyclophosphamide in protocol.

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19
Q

When is high dose COP protocol suitable

A

Useful for cats where 50mg tablet size can be difficult to dose accurately or for animals/owners that want fewer visits

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20
Q

What is the CHOP protocol

A

Cyclophosphamide
Hydroxydaunorubicin = doxorubicin (Adriamycin)
Vincristine (Oncovin)
Prednisolone
Induction phase over 10 weeks is essentially 2 cycles of 4 drugs, given as weekly pulses

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21
Q

What chemo drug is cardiotoxic

A

Hydroxydaunorubicin = doxorubicin (Adriamycin)

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22
Q

Prevention of cardiotoxicity in chemotherapy

A

Assess cardiac function prior to 1st dose and continue to monitor after 4-6 doses
Baseline echocardiography measurements of
- Fractional shortening (Contractility)
- Ejection fraction
Do not exceed cumulative dose 180mg/m2
Consider less cardiotoxic equivalent drugs

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23
Q

What chemo drug could cause hypersensitivity

A

Occurs occasionally with Doxorubicin, L-asparaginase

24
Q

What side effects are caused by hypersensitivity

A

Vomiting, restlessness, pruritus, wheals, oedema
Dyspnoea, mouth breathing (cat)

25
Q

Prevention of side effects caused by hypersensitivity

A

Use Antihistamine premedication
Ensure correct route of administration (sc or im for L-asp)
Administer very slowly for doxorubicin

26
Q

Treatment for hypersensivity

A

STOP drug admin
IV fluids
Antihistamines
Dexamethasone
Adrenaline
Avoid using the drug again

27
Q

Things to monitor when using CHOP protocol

A

Haematology (neutropenia)
- Baseline before treatment
- Weekly
Urine (haemorrhagic cystitis)
- Baseline
- After each cyclophosphamide admin/prior to next
Echocardiography (heart contractility)
- Baseline
- At 4th Doxorubicin treatment

28
Q

Level of neutrophils to stop/reduce giving chemo

A

Lower than 2.5

29
Q

What is Acute tumour lysis syndrome

A

Large tumour burden - rapid cell kill in 1st week
Rapid release of ions, i-cellular products
HyperK+, hyper PO4-, hypoCa2+
Metabolic acidosis, uric acid production
Acute renal failure
Improves after 1st week

30
Q

Name of protein causing chemodrug resistance

A

Multidrug resistance protein 1 (MDR1) –also called P-glycoprotein (p170) encoded by (MDR1) gene

31
Q

Drugs affected by P-glycoprotein (p170)

A

Vinca alkaloids
Anthracyclines (Dox, Mitox),
Actinomycin D

32
Q

Drugs not affected by P-glycoprotein (p170)

A

Alkylating agents (melphalan, lomustine)
Carboplatin

33
Q

Relapse therapy for Lymphoma

A

Start induction phase again – go back to beginning
Use novel drug (single agents)
Use novel potent drug combinations

34
Q

Mean survival after diagnosis of lymphoma with no treatment

A

1-2 months

35
Q

Mean survival after diagnosis of lymphoma with steroids

A

2-3 months

36
Q

Mean survival after diagnosis of lymphoma with COP protocol

A

6-9 months

37
Q

Mean survival after diagnosis of lymphoma with CHOP protocol

A

10-12 months

38
Q

Acute lymphoblastic (ALL) chemotherapy treatment

A

Similar to high grade LSA
Lymphoma protocols if sufficient neutrophils
Prognosis poor

39
Q

Chronic lymphocytic (CLL) chemotherapy treatment

A

Similar to low grade LSA (mature lymphocytes, slowly dividing)
No treatment needed in some cases (mild)
OR Chlorambucil, Prednisolone

40
Q

Solid tumours are sensitive to chemotherapy (T/F)

A

False!

41
Q

Treatment for solid tumours

A

Use surgery (or radiotherapy) to remove the tissue bulk and stimulate division of any residual tumour cells
Use adjuvant chemotherapy for residual primary tumour (microscopic)
Use adjuvant chemotherapy to delay growth of subclinical metastases

42
Q

Haemangiosarcoma

A

highly malignant cancer arising from cells that normally create blood vessels. It most commonly affects the spleen, liver, right atrium of the heart, and skin

43
Q

Treatment for haemangiosarcoma

A

Chemotherapy with single agent Doxorubicin q3 weeks for 4-6 doses to delay metastasis

44
Q

Survival time for haemangiosarcoma with just surgery

A

1-3 months

45
Q

Survival time for haemangiosarcoma with surgery and chemo

A

5-7 months

46
Q

What protocol for haemangiosarcoma?

A

VAC protocol used by some centres (Vincristine, Adriamycin, Cyclophosphamide)
Metronomic cyclophosphamide +NSAID therapy also tried (antiangiogenic and immunomodulatory)

47
Q

What is Metronomic chemotherapy (MC)

A

Cytotoxic drugs given at LOW doses on a more continuous DAILY administration protocol rather than as high doses in pulses

48
Q

Advantages of metronomic chemotherapy

A

Prevents repair and repopulation of endothelial cells in breaks needed with MTD therapy – anti-angiogenic
May also reduce Tregs –immunomodulatory
May target dormant cells and cancer stem cells - prevents tumour repopulation
Low doses mean fewer side-effects – well tolerated
Usually combined with other anti-angiogenic drugs eg COX inhibitors - NSAIDs – piroxicam, celecoxib

49
Q

Osteosarcomas often metastasis to which organ?

A

Lungs

50
Q

Treatment for osteosarcomas

A

Amputation for primary tumour (possibly limb salvage or radiotherapy for pain relief)
Chemotherapy with single agent Carboplatin for 4-6 doses to delay metastasis

51
Q

Median survival time of bone tumor with no treatment

A

1 month

52
Q

Median survival time of bone tumor with amputation alone

A

3-4 months

53
Q

Prognosis of osteosarcomas

A

Rapid euthanasia if no pain relief possible.
Rapid metastatic spread if no chemotherapy.

54
Q

Median survival time of bone tumor with amputation and chemo

A

> 10 months

55
Q

Summarise Tyrosine kinase inhibitors (TKIs)

A

Tyrosine kinase inhibitors (TKIs) are a class of medications used in cancer treatment that work by targeting specific enzymes called tyrosine kinases. These enzymes are often overactive in cancer cells, leading to uncontrolled cell growth and proliferation. By inhibiting these enzymes, TKIs help to slow down or stop the growth of cancer cells.

Module 17-Urinary, Endocrinology, Oncology (28 decks)

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