Chemotherapy Flashcards
What are the objectives of chemotherapy?
- cure
- decrease tumor size, reduce symptoms (palliative)
- adjuvant
- neoadjuvant
What is adjuvant chemotherapy?
Chemotherapy is given after definitive therapy (surgery, radiation)
Why is adjuvant therapy given?
To eliminate remaining disease
What is neoadjuvant chemotherapy?
Chemotherapy given before definitive therapy (surgery, radiation)
Why is neoadjuvant therapy given?
Decrease the tumor burden before definitive therapy
How is response to chemotherapy defined?
- complete response (CR): 100% clearance
- partial response (PR): >50% reduction
- stable disease: tumor size neither grows nor shrinks <25% change in size
- progression or no response: > 25% increase in tumor size or appearance of new lesions
How is response rate (RR) defined?
Response rate (RR) = complete response (CR) + partial response (PR)
Classification of chemotherapeutic agents?
- alkylating agents
- antitumor antibiotics
- anti metabolites
- mitotic inhibitors
- topoisomerase inhibitors
- enzymes
- protein tyrosine kinase inhibitors
- hormones
- biological response modifiers
MOA of alkylating agents?
Inhibit dna replication by causing cross-linking and abnormal base pairing of dna strands
Alkylating agents are Classified as?
Phase non-specific agents
Examples of alkylating agents:
Cyclophosphamide
Ifosfamide
Carmustine
Lomustine
Cisplatin
Busulfan
Chlorambucil
MOA of antitumor antibodies?
Inhibits dna synthesis by sliding between base pairs
Antitumor antibodies are classified as?
Phase non-specific agents
Examples of antitumor antibodies:
Doxorubicin
Bleomycin
MOA of antimetabolites?
Inhibit dna synthesis by acting as false substitutions in the production of nucleic acids
Antimetabolites are classified as?
S-phase specific agents
Examples of antimetabolites?
Methotrexate
6-mercaptopurine
5-fluorouracil
Cytarabine
Azacitidine
Capecitabine
MOA of mitotic inhibitors?
Inhibit cell division by preventing microtubule formation
Mitotic inhibitors are also known as?
Taxanes
Mitotic inhibitors are classified as?
M-phase specific
Examples of mitotic inhibitors?
Vincristine
Vinblastine
Paclitaxel
MOA of topoisomerase inhibitors?
Inhibit topoisomerase enzyme necessary for dna replication and rna transcription
Topoisomerase inhibitors are classified as?
G2-specific agents
Examples of topoisomerase inhibitors?
Topotecan
Irinotecan
Etoposide
Example of enzyme based chemotherapeutic agents?
Asparaginase
Asparaginase is classified as?
G1-specific agent
Example of protein tyrosine kinase inhibitors?
Imatinib mesylate
MOA of imatinib mesylate?
Selective tyrosine kinase inhibitor that causes apoptosis
Examples of hormonal chemotherapeutic agents?
Adrenocorticoids (dexamethasone, prednisone)
Estrogens (estradiol, dirthylstbestrol)
Antiestrogen (tamoxifen)
Aromatase inhibitor (anastrazole)
Androgens (testosterone)
Antiandrogens (flutamide)
Examples of adrenocorticoids?
Dexamethasone
Prednisone
Examples of estrogen
Estradiol
Diethylstilbestrol
Antiestrogen?
Tamoxifen
Aromatase inhibitor?
Anastrazole
Androgen?
Testosterone
Antiandrogen?
Flutamide
MOA of biological response modifiers?
Alter of enhance the patient’s immune system to fight cancer
Examples of biological response modifiers?
Cytokines
Monoclonal antibodies
Function of monoclonal antibodies in cancer treatment?
- identify cancer-specific antigens and help target cytotoxic therapy to the tumor cells
- inhibit angiogenesis (inhibiting blood supply) to the tumor by inhibiting vascular endothelial growth factor (VEGF)
Examples of monoclonal antibodies that help target cytotoxic therapy to tumor cells?
Suffix -ab
Example of monoclonal antibody that inhibits VEGF?
Bevacizumab
G1-phase specific agents?
Asparaginase
Prednisone
Cortisone
S-phase specific agents?
Antimetabolites
G2-phase specific?
Topoisomerase inhibitors
Topotecan, irinotecan, etoposide
Phase non-specific agents?
Alkylating agents
Antitumor antibiotics
M-phase specific agents?
Mitotic inhibitors (taxanes)
Which chemotherapeutic agents cause alopecia?
Doxorubicin
Cyclophosphamide
Paclitaxel
Doctor ruby’s head was a cycle when she packed her taxes
Which chemotherapeutic agents cause gi toxicity (diarrhea)?
Irinotecan
Fluorouracil
Which chemotherapeutic agent causes gi toxicity (constipation)?
Vincristine
Solution for tumor lysis syndrome?
IV hydration
Alkalinizing urine by decreasing uric acid
Cause of hypercalcemia in cancer patients?
Release of parathyroid hormone related protein from tumor cells
Solution for hypercalcemia?
Hydration with normal saline
Which chemotherapeutic agent causes chills and fever?
Bleomycin
Cytarabine
Monoclonal antibodies
IL-2
Which chemotherapeutic agents cause pulmonary toxicity?
Bleomycin
Busulfan
Cardiac toxicity?
Doxorubicin
Daunorubicin
Cardioprotective agent against doxorubicin?
Dexrazoxane
Hypersensitivity reaction?
Asparaginase
Cisplatin
Etoposide
Paclitaxel
Hemorrhagic cystitis?
Cyclophosphamide
Ifosfasmide
Cause of hemorrhagic cystitis? Solution?
Acrolein (toxic metabolite)
Mesna (binds to it)
Renal toxicity?
Cisplatin
Methotrexate
Ifosfamide
Hepatotoxicity?
Mercaptopurine
Asparaginase
Methotrexate
Cytarabine
Secondary malignancies?
Cyclophosphamide
Etoposide
Infertility?
Cyclophosphamide
Chlorambucil
Adverse effects of cyclophosphamide?
Alopecia
Hemorrhagic cystitis
Secondary malignancies
Infertility
Adv effect of cisplatin?
Ototoxicity
Nephrotoxicity
Nausea and vomiting
Adv effect of cytarabine?
Chemical conjunctivitis
Which agents cause cardio toxicity?
Doxorubicin
Daunorubicin
Pulmonary toxicity?
Bleomycin
Busulfan
Hemorrhagic cystitis?
Cyclophosphamide
Ifosfamide
Diarrhea?
Irinotecan