Chemo Principles/Process

Question 1

What factors affect response to chemotherapy?

Answer 1

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

Question 2

What is dose intensity?

Answer 2

Dose delivered to the patient over a specified period of time

Question 3

What is a major determinant of response?

Answer 3

Dose intensity

Question 4

What is dose density?

Answer 4

Shortening of usual interval between doses

Question 5

What is the rationale for combination chemotherapy?

Answer 5

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

Question 6

What are the advantages of combination chemotherapy?

Answer 6

Multiple MOA

Question 7

What are the disadvantages of combination chemotherapy?

Answer 7

Complicated admin schedules
Toxicities
Cost

Question 8

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

Answer 8

Tumor response

Allows for recovery from AE, particularly myelosuppression

Question 9

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

Answer 9

Lock-step cell cycle for cells to become more homogenous

Question 10

How do cancers develop drug resistance?

Answer 10

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

Question 11

What are examples of liposomal compounds?

Answer 11

Cytarabine

Doxorubicin

Question 12

What drugs can be administered intrathecal?

Answer 12

Cytarabine

MTX

Question 13

What are the immune system innovations?

Answer 13

Supuleucel-T
Blinatumomab
Tisagenlecleucel

Question 14

What is the MOA of spuleucel-T

Answer 14

Primes the body’s own immune system

Question 15

What is sipuleucel-T derived from?

Answer 15

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

Question 16

What is the MOA of blinatumomab?

Answer 16

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

Question 17

What is the origin of Blinatumomab?

Answer 17

Not patient’s own cells

Question 18

What is the MOA of Tisagenlecleucel?

Answer 18

Chimeric antigen receptor (CAR)-T cell therapy?

Question 19

What is Tisagenlecleucel derived from?

Answer 19

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

Question 20

What happens during G0 of the cell cycle?

Answer 20

Resting phase

Question 21

What happens during G1 of the cell cycle?

Answer 21

Enzymes necessary for DNA production are produced

Question 22

What happens during S of the cell cycle?

Answer 22

DNA synthesis

Question 23

What happens during G2 of the cell cycle?

Answer 23

Specialized protein and RNA synthesis

Question 24

What is considered a complete response to therapy?

Answer 24

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

Question 25

What is considered a partial response to therapy?

Answer 25

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

Question 26

What is progressive disease?

Answer 26

Cancer that is growing, spreading, or getting worse

Question 27

What is stable disease?

Answer 27

No growth or disappearance by above criteria

Question 28

What is considered progression-free survival?

Answer 28

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

Question 29

What are common mistakes in chemotherapy orders?

Answer 29

Abbreviations Brand/drug name mixups Dosing Missing patient information

Question 30

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

Answer 30

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

Question 31

What is the PRONTO method for reviewing chemotherapy orders?

Answer 31

``` Person Regimen Organ function Numbers Toxicities Order entry ```

Question 32

What parts of the person do we want to verify?

Answer 32

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

Question 33

What parts of the regimen are on the prescription?

Answer 33

Study protocol Journal article Which cycle patient is on

Question 34

What parts of organ function do we want to verify?

Answer 34

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

Question 35

How is ANC calculated?

Answer 35

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

Question 36

When is the calvert equation used?

Answer 36

Carboplatin dosing only

Question 37

What is the calvert equation?

Answer 37

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

Question 38

How do we treat toxicities in therapy?

Answer 38

Preventative measures | Supportive medications

Question 39

What are the supportive medications for toxicities?

Answer 39

Fluids Antiemetics Premedications to avoid hypersensitivity Tumor lysis prevention