Chapter 11: Nutritional Effects of Cancer Therapies Flashcards
What are the six different types Biotherapies used either alone or with chemotherapy?
Monoclonal Antibodies Protein-Targeted Therapies Angiogensis Inhibitors Cytokines Cancer Vaccine Therapies Radiopharmaceuticals
What are monoclonal Antibodies?
therapies that signal external cellular pathway targets
What are protein-targeted therapies?
Therapies that signal internal cellular pathway targets
What are angiogenesis inhibitors?
Therapies that target tumor vasculature and angiogenesis
What are cytokines?
therapies that stimulate a broad-based immune response as opposted to generating a targeted response to a specific tumor antigen
What are Cancer Vaccine Therapies?
Therapies that signal an individual’s own immune system against tumor antigens
What are Radiopharmaceuticals?
Monoclonal antibody therapies that deliver radioactive molecules to specific cancer cells
What are the two classifications of Chemotherapy?
Cell cycle non-specific agents - damage cells in all phases of cell cycle (alkylating agents, antitumor antibiotics, hormone therapies, and nitrosoureas)
Cell cycle-specific agents - exert their effect within a specific phase of the cell cycle (antimetabolites and campotothecins (sythesis phase), plant alkaloids and taxanes (mitosis phase) and others)
How are Antineoplastic Agents administered?
Oral IV Intrathecal/Intraventicular (IT) Intrapleural (IP) Intra-arterial (IA) Subcutaneous (SC) Intramuscular (IM) Topically
Given in Cycles
What are the three factors to note with Antineoplastic Agents?
Frequency of cycles (daily, weekly, every 14 days, every 21 days, monthly, continuously)
Length of cycles (Injection, bolus, or continuous)
Number of cycles (determined by research/trials)
Goal of Chemoprevention
use of meds, vit/min, or other agents to reduce the risk of, or delay the development of cancer
example: hormone therapy to reduce risk of breast CA in woman determined to be a high risk
Goal of Adjuvant Therapy
use of additional cancer treatment given after primary therapy to reduce risk of recurrence and decrease incidence of metastatic disease
example: chemo after lobectomy for lung CA; chemo, hormone therapy, and monoclonal antibody therapy after lumpectomy for breast CA
Goal of Definitive Therapy
use of radiation therapy prescribed as primary treatment modality, with or without chemo.
example: xrt as primary for prostate CA
Goal of Neoadjuvant Therapy
use of one or more treatment modalities given before the primary therapy to reduce size of primary tumor to improve the effectiveness of surgery/decrease incidence of mets
example: chemo and external beam XRT before an esophagectomy for esophageal CA
Goal of Palliation
use of cancer treatment modalities when cure/control of disease can’t be achieved to relief of side effects/symptoms cause by cancer and other serious illness to improve QOL
example: external beam XRT to palliate painful bony lesions related to met prostate CA
Goal of Prophylaxis Therapy
use of radiation therapy for relief of symptoms such as pain, bleeding, neurological compromise, or airway obstruction to improve QOL or treat life-threatening problems
example: whole brain irradiation given for asymptomatic individuals diagnosed with CA that have high risk of occurrence of mets (like sc lung CA)
Define Tumor Burden or Tumor Load
the size of the tumor or amount in the body. As increases in size, growth rate can slow, thus reducing the effectiveness of the treatment
Define Tumor Growth Rate
what proportion of cancer cells within the tumor are growing/dividing to form new ca cells. rapidly growing are usually more responsive to treatment
Principles of Chemotherapy
chemical agents or drugs to systemically kill cancer cells. Has a cytotoxic effect to all cells, side effects/toxicities are often the result of damage to rapidly dividing cells. Normal cells are able to better repair themselves, making most toxicities reversible.
What body cells are susceptible to the effects of chemotherapy?
Bone Marrow, hair follicles, gonads (testes/ovaries) and gastrointestinal mucosa
Five phases of cell cycle
G0 - Resting - cells are temporarily out of the cycle and have stopped dividing
G1 - Post-Mitotic - cells begin t the 1st phase of reproduction by synthesizing protein and RNA necessary for cell division
S - Synthesis - DNA is synthesized
G2 - Pre-Mitotic - cells prepare to divide
M - Mitosis - cell growth and protein production stops. Cellular energy is focused on the orderly division of two daughter cells
What is Biotherapy?
treatment to boost or restore the ability of the immune system to fight cancer, infection, and other diseases by inducing, enhancing, or suppressing an individual’s own immune response
Also called immunotherapy or Biological Response modifier (BMR) therapy
What are possible side effects/nutritional implications of Monoclonal antibodies?
Infusion-related symptoms - fever/chills/fatigue/headache
Gastrointestinal - N/V/D - usually mild*** Primary Nutrition Concern
Cardiotoxicity - dyspnea, peripheral edema
myelosuppression - increased risk if with chemo
pulmonary toxicity - cough, PIs, PEs
skin issues - rash, facial erythema, hand-food syndrome
What are the five molecular targets for monoclonal antibodies? Name an example of each.
CD20: B-lymphocyte agtigen CD20 – Rituxan
EGFR: epidermal growth factor receptor – Erbitux
HER-2/neu: human epidermal growth factor receptor 2 – Herceptin
RANKL: receptor activator of nuclear factor kappa-B ligand – Xgeva
VEGF: vascular endothelial growth factor – Prolia
What are the three different types/mechanism of action of Small Molecule Inhibitors (Protein targeted therapies)? Name an example for each.
Tyrosine Kinase Inhibitors (TKIs) – Gleevec
mTOR Inhibitor – Affinitor
Proteasome Inhibitor – Velcade
What are possible side effects/nutritional implications of Protein-targeted therapies?
Skin issues - rash, facial erythema, hand-food syndrome
Cardiotoxicity - QT prolongation, HTN, Bleeding, MI
Gastrointestinal - N/V/D, decreased appetite
What are two different targets for angiogenesis inhibitors? Name an example of each.
VEGF – Avastin
Immunomodulatory Drugs – Revlimid
What are possible side effects/nutritional implications of angiogenesis inhibitors?
HTN
Arterial Thromboembolic events (MI, stroke)
Proteinuria
Hemorrhage - including GI bleed
GI perforation – can present at N/V/C/abd pain, fever and occur within first 60 days of treatment
Hypothyroidism
What are two different targets for Cytokines? Name an example of each.
Interleukein-2 or IL-2 – Aldesleukin
Interferon-a – Roferon or Intron A
What are possible side effects/nutritional implications of cytokines?
Flu-like Symptoms
Consitutional - fatigue/anorexia
myelosuppression
gastrointestinal - N/V/D
renal and cardiotoxicity - renal insufficiency, capillary leak syndrome
What are the three therapies used for Radiation therapy?
External Beam Radiation Therapy - ionizing radiation delivered from outside the body to treat a specific field
Brachytherapy (internal) - temporary or permanent placement of radioactive material precisely placed inside a body cavity, tissue or surface
Radiopharmaceutical therapy - radioactive substances used to systemically treat cancer
What are possible acute side effects from radiation therapy that is specific to brain treatment fields?
Fatigue Hair Loss N/V Skin Changes Others: Headache, blurry vision
What are possible acute side effects from radiation therapy that is specific to Breast treatment fields?
Fatigue
Hair Loss
Skin Changes
Others: Tenderness, swelling of breast
What are possible acute side effects from radiation therapy that is specific to Chest treatment fields?
Fatigue Hair Loss N/V Skin Changes Throat Changes (Dysphagia, Odynophagia, Esophagitis) Others: Cough, Dyspnea
What are possible acute side effects from radiation therapy that is specific to Head and Neck treatment fields?
Fatigue
Hair Loss
Skin Changes
Throat Changes (Dysphagia, Odynophagia, Esophagitis)
Others: Thick Salvia, Oral infections, stiffness of jaw
What are possible acute side effects from radiation therapy that is specific to Pelvis treatment fields?
Diarrhea Fatigue Hair Loss Sexuality/Fertility Changes Skin Changes Urinary/Bladder Changes
What are possible acute side effects from radiation therapy that is specific to Rectum treatment fields?
Diarrhea Fatigue Hair Loss Sexuality/Fertility Changes Skin Changes Urinary/Bladder Changes
What are possible acute side effects from radiation therapy that is specific to Stomach and Abdomen treatment fields?
Diarrhea Fatigue Hair Loss N/V Sexuality/Fertility Changes Skin Changes Urinary/Bladder Changes
What are possible late side effects from radiation therapy that is specific to Brain treatment fields?
Headaches
Memory/Attention changes
Dementia
What are possible late side effects from radiation therapy that is specific to Bone treatment fields?
Damage to Osteoblasts, Osteopenia
What are possible late side effects from radiation therapy that is specific to Cardiovascular treatment fields?
Angina upon Exertion
Cardiac Enlargement
CHF
What are possible late side effects from radiation therapy that is specific to Esophagus treatment fields?
Esophageal stenosis/fibrosis or necrosis
What are possible late side effects from radiation therapy that is specific to GI treatment fields?
Diarrhea
Malabsorption
chronic enteritis/colitis
strictures/ulceration/obstruction/fistula
What are possible late side effects from radiation therapy that is specific to Head and Neck treatment fields?
Trismus
alterations of taste/smell
permanent xerostomia (dry mouth)
What are possible late side effects from radiation therapy that is specific to Lymphatics treatment fields?
secondary lymphedema
What are possible late side effects from radiation therapy that is specific to Pulmonary treatment fields?
dyspnea
cough
pneumonitis
What are possible late side effects from radiation therapy that is specific to Sexual Organs treatment fields?
infertility
What are possible late side effects from radiation therapy that is specific to Skin treatment fields?
telangiectasias
pigmentation changes
atrophy
fibrosis
What are possible late side effects from radiation therapy that is specific to Urinary treatment fields?
hematuria
cystitis
Types of Brachytherapy
Interstitial - placed into the tumor (Breast, Gyn, HN, Lung, Prostate, Rectal)
Interacavitary or Contact - placed into a surgical/body cavity to be near a tumor (Gyn, HN)
With what chemotherapy should cold foods be avoided?
Oxaliplatin (Eloxatin)
