Chapter 8 - Malignant Disease Flashcards
Chemotherapy can be given out of two general intents. What are these?
1) curative approach
2) palliative approach - e.g degenerate disease with no cure, aiming to prolong disease progression and lessen symptoms
What is neoadjuvant chemotherapy?
Initial treatment with chemo aimed to shrink the primary tumor, rendering local therapy less destructive and/or more effective
What is adjuvant chemotherapy?
usually refers to surgery followed by chemo (or radiotherapy) to help decrease the risk of the cancer recurring (coming back).
What are the most common side effects of cytotoxic drugs?
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
Which cytotoxics are most commonly associated with oral mucositis as a side effect?
flurouracil, methotrexate and the anthracyclines
Which types of cancers would you expect to see TLS/ hyperuricaemia occur most with?
Lymphomas and leukaemias - vast number of tumour cells present
Which drug is used for prophylaxis of TLS/ hyperuricaemia?
Allopurinol
All cytotoxics cause bone marrow suppression as a side effect, except 2. What are these two cytotoxics?
Vincristine and bleomycin
A patient with a WCC of less than ………………… and is undergoing chemotherapy is considered to be neutropenic.
1.06 x 10^9
Which cytotoxics are associated with mild emotengenic symptoms?
Flurouracil, etopside and methotrexate (100mg/m^2)
Which cytotoxics produce high risk emetogenic symptoms?
Cisplatin, dacarbazine and high dose cyclophosphamide
For patients undergoing low risk emotegenic chemotherapy, which antiemetics are favoured?
Dexamethasone
Or
Lorazepam
For patients undergoing highly emotengenic chemotherapy, which antiemetics are used?
5HT3-Antagonists (e.g ondansetron) in combo with
Dexamethasone
Aprepitant
Which side-effects are specifically associated with anthracycline use?
Cadiotoxicity
What drugs are classed under anthracyclines?
Danorubicin
Doxorubicin
Epirubicin
Idarubicin
Mitoxantrone - anthracycline derivative
Topoisomerase 1 is an enzyme essential for DNA replication. What are the topoisomerase 1 inhibitors?
Irenotecan
Topotecan
What affects the choice of adjuvant therapy when deciding chemotherapy for breast cancer?
- safety and efficacy of drug
- oestrogen receptor status
- human epidermal growth factor 2 status (HER2)
For pre-menopausal women with oestrogen receptor positive breast cancer, which chemotherapy agent is usually preferred and why?
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.
What is generally first line therapy for the treatment of breast cancer in post-menopausal women?
Aromatase inhibitors e.g letrozole, anastrazole
For women who have HER2 positive breast cancer, which chemotherapy agent is used for first line treatment?
Trastuzumab
