Chemotherapy Flashcards
Two classification systems used to define fitness for treatment prior to chemotherapy.
RCOG performance status 0 -4. 0 = independent, 1 = active >50% + light tasks, 2 = active >50%, no light tasks, 3 = active <50% day + assist some ADLs, 4 = active <50% day, needs helps with ADLS
WHO 0 = fully active and able 1= restricted strenuous activity 2= selfcare 3= limited self care 4= completely disabled 5 = dead
How is chemotherapy dosed?
By BSA (mg/2) carboplatin by renal function (Calvert formula)
(GFR +25)x AUC = dose
How to assess clinical response to chemotherapy?
clinical examination
measurement tumor markers
radiological imaging
define disease progression with chemotherapy
> 20% increase in sum of target lesions
define stable disease
<20% increase but <30% decrease in sum of lesions. no new lesions
partial response to chemotherapy defined by?
> 30% decrease in sum of target lesions, nil new.
Chemo-agents used for epithelial ovarian cancer?
carboplatin and paclitaxel
Side effects paclitaxel
pate = alopecia puke = N+V pins = peripheral neuropathy pee = AKI
Carboplatin side effects?
suppression bone marrow (plt, neut)
kidneys (AKI)
What trial demonstrated benefit of chemotherapy in stage 1 EOC with high grade features?
ICON 1 trial
Response rate of EOC to chemotherapy?
70% exhibit response to adjuvant.
When would neoadjuvant chemo be used for EOC?
Stage IIC or IV. Reduces surgical morbidity compared to primary debulking (EORTC)
Compare paclitaxel to cisplatin in treatment of EOC.
similar effect. Less nephrology and neurotoxic. Less vomiting. (ICON 2)
Response rate of EOC to palliative chemotherapy?
25-60%.
Etoposide PO used for platinum resistant disease.
What non-epithelial ovarian malignancies are treated with chemotherapy?
sex cord and germ cell tumors. primary surgery considered first for fertility preservation.
What chemotherapy regimens are recommended for granuloma cell tumors?
BEP
= bleomycin, etoposide cisplatin
Chemotherapy regime for germ cell tumors?
BEP ( bleomycin, etoposide, cisplatin)
OR
PVB (cisplatin, vinblastine, bleomycin)
When should chemo radiation be considered for cervical cancer?
Stage I-IV cancer
Results in 30-50% reduction in RR of relapse or death
What type of chemotherapy is given for cervical cancer?
Cisplatin
What does adjuvant chemotherapy for endometrial cancer involve?
progestogen therapy
platinum and paclitaxel based regimes.
no trials have demonstrated improved survival.
When would adjuvant chemo radiation be considered for vulval Ca?
- incomplete/inadequate excision margin
- inguinal or pelvic lymph node involvement
Chemo used with radiotherapy. Can be used as neoadjuvant to reduce need for radical surgery.
What are the chemo regimes used for GTN?
low risk (WHO <7) = MTX/folinic acid
high risk = etoposide (E), Methotrexate (M), actinomycin (A), cyclophosphamide (C), Vincristine (O)
EMA-CO
