Chemotherapy Flashcards
Properties of cancer that causes increased cell proliferation
Self-sufficiency in growth signals Evades apoptosis Insensitivity to anti-growth signals Tissue invasion and metastasis Sustained angiogenesis Limitless replicative potential
Types of cancer therapy
Neoadjuvant
Adjuvant
Palliative
Neoadjuvant chemotherapy
Chemotherapy before definitive treatment to shrink the tumour and optimise outcomes
Adjuvant chemotherapy
Chemotherapy given after treatment to reduce the risk of disease recurrence
Palliative chemotherapy
Chemotherapy to relieve symptoms and improve quality of life but not cure the cancer
Treatments for cancer
Surgery
Chemotherapy
Radiotherapy
Immunotherapy - monoclonal antibodies or checkpoint inhibitors
5 - fluorouracil (5-FU)
Thymidylate synthase inhibitor
- colorectal cancer
- breast cancer
- gastric/ oesophageal cancer
Platinum agents
Such as cisplatin
Forms adducts with DNA
- colorectal cancer
- lung cancer
- gastric cancer
Vinka alkaloids
Inhibits the function of microtubules therefore permanently in metaphase and cannot undergo anaphase
Pathophysiology of drug resistance
- Decreased entry or increased exit of agent - membrane modification, efflux pumps or transporter loss
- Inactivation of agent within the cell - degradation
- Enhanced repair of the DNA damage
Prescribing cytotoxic drugs
- Narrow therapeutic window
- Dose specific to patient based on BMI, renal/liver function/ performance status
- combination of drugs
Neurological side effects of chemotherapy
Peripheral neuropathy
Fatigue
Chemo brain - fuzzy
Alopecia
Cardiac side effects of chemotherapy
Neutropenic sepsis
Cardiomyopathy
Myelosupression
GI side effects of chemotherapy
Vomiting
Mucositis
Diarrhoea
Constipation
Bladder side effects of chemotherapy
Haemorrhagic cystitis - carbamazepine
Skin side effects of chemotherapy
PPE - Pruritic Papular Eruption
Rash
Nail loss
Renal side effects of chemotherapy
AKI
Electrolyte disturbance
Liver side effects of chemotherapy
Deranged LFTs
Pulmonary side effects of chemotherapy
Pneumonitis
Pulmonary emboli
Reproductive side effects of chemotherapy
Infertility
Decreased libido
Premature menopause
Types of immunotherapy
Passive - ex vivo activated cells that was once inside the body, inserted to compensate for deficient immune functions such as peptide vaccines
Active - stimulate effector functions in vivo, requires pt’s immune system to respond
Types of monoclonal antibody
HER2 inhibitor - Trastuzumab - breast cancer
VEGR inhibitor (vascular epithelial growth receptor) - Bevacizumab - ovarian an bowel cancer
EGFR inhibitor (epithelial growth factor receptor) - cetuximab - bowel cancer
Side effects of targetted therapies
Skin toxicity - acneform rash, dry skin Hair growth disorders Pruritis Nail changes Delayed wound healing
Fatigue
Myelosuppression
Arterial thromboembolic event
Diarrhoea
Nausea
GI perforation
Hypertension
Proteinuria
Cardiac ischaemia
Treatment of grades of rash
Grade I - keep skin well hydrated and avoid alcohol-based products
Grade II - topical antibiotics
Grade III - hold treatment, oral + topical antibiotics and corticosteroids
Grade IV - stop treatment
