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Heme/Onc > Chemo Principles/Process > Flashcards

Chemo Principles/Process Flashcards

1
Q

What factors affect response to chemotherapy?

A 
Tumor heterogeneity
Tumor size/site
Drug dose and schedule/Dose intensity
Drug resistance
Pt characteristics
Pharmacogenomics
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2
Q

What is dose intensity?

A

Dose delivered to the patient over a specified period of time

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3
Q

What is a major determinant of response?

A

Dose intensity

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4
Q

What is dose density?

A

Shortening of usual interval between doses

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5
Q

What is the rationale for combination chemotherapy?

A

Tumor cell heterogeneity
Acquired resistance to single agents
Increase response rate (synergy)

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6
Q

What are the advantages of combination chemotherapy?

A

Multiple MOA

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7
Q

What are the disadvantages of combination chemotherapy?

A

Complicated admin schedules
Toxicities
Cost

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8
Q

What is the rationale for 1-3 week intervals between chemotherapy courses?

A

Tumor response

Allows for recovery from AE, particularly myelosuppression

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9
Q

What is the purpose for tumor response in 1-3 week intervals?

A

Lock-step cell cycle for cells to become more homogenous

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10
Q

How do cancers develop drug resistance?

A

Inability to distribute to the tumor: CNS tumors
Inactivation of chemotherapy by glutatione metabolism
Ability to repair DNA damage (from alkylators, bleomycin)
Altered target enzyme activity or amount
Enhanced tumor cell efflux

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11
Q

What are examples of liposomal compounds?

A

Cytarabine

Doxorubicin

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12
Q

What drugs can be administered intrathecal?

A

Cytarabine

MTX

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13
Q

What are the immune system innovations?

A

Supuleucel-T
Blinatumomab
Tisagenlecleucel

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14
Q

What is the MOA of spuleucel-T

A

Primes the body’s own immune system

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15
Q

What is sipuleucel-T derived from?

A

Dendritic cells removed from the patient, altered in lab, and reinfused into the patient

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16
Q

What is the MOA of blinatumomab?

A

Bispecific T-cell engager (BiTE) - helps connect T-cell to cancer cell

17
Q

What is the origin of Blinatumomab?

A

Not patient’s own cells

18
Q

What is the MOA of Tisagenlecleucel?

A

Chimeric antigen receptor (CAR)-T cell therapy?

19
Q

What is Tisagenlecleucel derived from?

A

T cells removed from patient, altered in the lab, and reinfused into the patient

20
Q

What happens during G0 of the cell cycle?

A

Resting phase

21
Q

What happens during G1 of the cell cycle?

A

Enzymes necessary for DNA production are produced

22
Q

What happens during S of the cell cycle?

A

DNA synthesis

23
Q

What happens during G2 of the cell cycle?

A

Specialized protein and RNA synthesis

24
Q

What is considered a complete response to therapy?

A

Disappearance of all cancer w/o evidence of new disease for at least 1 month

25
Q

What is considered a partial response to therapy?

A

A decrease in the size of a tumor, or in the extent of cancer in the body, in response to treatment

26
Q

What is progressive disease?

A

Cancer that is growing, spreading, or getting worse

27
Q

What is stable disease?

A

No growth or disappearance by above criteria

28
Q

What is considered progression-free survival?

A

A measure used in clinical trials to show length of time that cancer is not getting worse while participant is on a treatment

29
Q

What are common mistakes in chemotherapy orders?

A

Abbreviations
Brand/drug name mixups
Dosing
Missing patient information

30
Q

How do we tell patients and caregivers to handle oral chemotherapy?

A

Understanding on how/when to take therapy
Use of gloves/hand washing
Using separate adherence devices from other drugs
Specific plan for when to contact provider

31
Q

What is the PRONTO method for reviewing chemotherapy orders?

A 
Person
Regimen
Organ function
Numbers
Toxicities
Order entry
32
Q

What parts of the person do we want to verify?

A

Verify right patient, with second identifier
Age, performance status
Cancer type, stage, goal

33
Q

What parts of the regimen are on the prescription?

A

Study protocol
Journal article
Which cycle patient is on

34
Q

What parts of organ function do we want to verify?

A

Do drug doses have to be adjusted
Renal/liver function
Blood cell counts
Electrolytes

35
Q

How is ANC calculated?

A

% neutrophils in the differential WBC count
% neutrophils = segs + bands
ANC = % neutrophils x total WBC count

36
Q

When is the calvert equation used?

A

Carboplatin dosing only

37
Q

What is the calvert equation?

A

Dose (mg) = target AUC x (CrCl + 25)
Target AUC indicated by physician (normal range 4-8)
CrCl (calculated)

38
Q

How do we treat toxicities in therapy?

A

Preventative measures

Supportive medications

39
Q

What are the supportive medications for toxicities?

A

Fluids
Antiemetics
Premedications to avoid hypersensitivity
Tumor lysis prevention

Heme/Onc (20 decks)

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