Chapter 8 - Malignant Disease

Question 1

Chemotherapy can be given out of two general intents. What are these?

Answer 1

1) curative approach

2) palliative approach - e.g degenerate disease with no cure, aiming to prolong disease progression and lessen symptoms

Question 2

What is neoadjuvant chemotherapy?

Answer 2

Initial treatment with chemo aimed to shrink the primary tumor, rendering local therapy less destructive and/or more effective

Question 3

What is adjuvant chemotherapy?

Answer 3

usually refers to surgery followed by chemo (or radiotherapy) to help decrease the risk of the cancer recurring (coming back).

Question 4

What are the most common side effects of cytotoxic drugs?

Answer 4

Extravasation of IV drugs - leakage of cytotoxics into the extravascular compartment may cause severe local tissue necrosis

Oral mucositis (sore mouth)

Tumour lysis syndrome (TLS) - occurs when a large number of tumour cells are killed rapidly, releasing intracellular ions and contents - leads to hyperuricaemia, hyperkalaemia, hyperphosphataemia, hypocalcaemia and acute renal function.

Hyperuricaemia

Bone marrow suppression

Aloepecia

Thromboembolism - cancer is a risk factor itself but chemotherapy may increase risk

Nausea/vomiting

Question 5

Which cytotoxics are most commonly associated with oral mucositis as a side effect?

Answer 5

flurouracil, methotrexate and the anthracyclines

Question 6

Which types of cancers would you expect to see TLS/ hyperuricaemia occur most with?

Answer 6

Lymphomas and leukaemias - vast number of tumour cells present

Question 7

Which drug is used for prophylaxis of TLS/ hyperuricaemia?

Answer 7

Allopurinol

Question 8

All cytotoxics cause bone marrow suppression as a side effect, except 2. What are these two cytotoxics?

Answer 8

Vincristine and bleomycin

Question 9

A patient with a WCC of less than ………………… and is undergoing chemotherapy is considered to be neutropenic.

Answer 9

1.06 x 10^9

Question 10

Which cytotoxics are associated with mild emotengenic symptoms?

Answer 10

Flurouracil, etopside and methotrexate (100mg/m^2)

Question 11

Which cytotoxics produce high risk emetogenic symptoms?

Answer 11

Cisplatin, dacarbazine and high dose cyclophosphamide

Question 12

For patients undergoing low risk emotegenic chemotherapy, which antiemetics are favoured?

Answer 12

Dexamethasone
Or
Lorazepam

Question 13

For patients undergoing highly emotengenic chemotherapy, which antiemetics are used?

Answer 13

5HT3-Antagonists (e.g ondansetron) in combo with
Dexamethasone
Aprepitant

Question 14

Which side-effects are specifically associated with anthracycline use?

Answer 14

Cadiotoxicity

Question 15

What drugs are classed under anthracyclines?

Answer 15

Danorubicin
Doxorubicin
Epirubicin
Idarubicin

Mitoxantrone - anthracycline derivative

Question 16

Topoisomerase 1 is an enzyme essential for DNA replication. What are the topoisomerase 1 inhibitors?

Answer 16

Irenotecan

Topotecan

Question 17

What affects the choice of adjuvant therapy when deciding chemotherapy for breast cancer?

Answer 17

• safety and efficacy of drug
• oestrogen receptor status
• human epidermal growth factor 2 status (HER2)

Question 18

For pre-menopausal women with oestrogen receptor positive breast cancer, which chemotherapy agent is usually preferred and why?

Answer 18

Tamoxifen

Tamoxifen acts primarily as an antioestrogen, preventing oestrogen binding to the oestrogen receptor - therefore preventing tumour proliferation.

Tamoxifen can be used in both pre and post menopausal women

Other agents such as aromatase inhibitors (e.g letrozole) are used in post-menopausal women instead of pre-menopausal women as they encourage ovarian stimulation of oestrogen, even though they reduce oestrogen production from other tissues and organs in the body.

Question 19

What is generally first line therapy for the treatment of breast cancer in post-menopausal women?

Answer 19

Aromatase inhibitors e.g letrozole, anastrazole

Question 20

For women who have HER2 positive breast cancer, which chemotherapy agent is used for first line treatment?

Answer 20

Trastuzumab