Chemotherapy

Question 1

what are the goals of an anticancer regimen

Answer 1

kill every cancer cell and produce a cure

Question 2

what are the next goals for anticancer treatment if a cure doesnt work

Answer 2

control growth
offer palliation

Question 3

what is growth fraction

Answer 3

the ratio of proliferating cells to resting cells
- inc growth fraction when there are more cells proliferating than resting

Question 4

malignant tumors typically have a ___ growth factor initially

Answer 4

high

Question 5

as a tumor inc in size, the growth factor ___

Answer 5

slows down

Question 6

why do larger tumors have a slower growth factor

Answer 6

they have a necrotic core
dec nutrient supply at core
more cells in resting phase
more difficult to treat

Question 7

what are barriers to successful cancer treatment

Answer 7

100% kill is required
toxicity of the drugs used
late detection of many cancers
drug resistance
cell heterogeneity

Question 8

why is chemo so hard on a pt

Answer 8

most toxic drug group
must use the same does throughout the whole treatment to reach 100% kill
using the right amount of drug to not kill the patient but able to cure the cancer

Question 9

what are consequences of late detection

Answer 9

mets –> spread
less responsive –> low growth fracture
patient more debilitated by disease –> not strong enough for the meds

Question 10

why do solid tumors respond poorly to chemo

Answer 10

low growth factor
limited blood supply

Question 11

why is resistance a problem with chemo drug therapy

Answer 11

cancer cells are constantly mutating
- natural selection, the drug resistants will flourish

Question 12

what is heterogeneity

Answer 12

ongoing mutations that allow cells to differ greatly so
- they can have different responses to drugs
- as tumors age, the heterogeneity increases

Question 13

what are the strategies for chemo success

Answer 13

intermittent combo
combo therapy
optimal dosing
regional therapy

Question 14

what is intermittent chemo goal

Answer 14

100% cancer kills with limited normal cell injury

Question 15

what is intermittent chemo

Answer 15

balancing between letting the normal cells recover and then pumping the pt full of drugs again

Question 16

what is combo therapy

Answer 16

using multiple drugs which help
- reduce drug resistance and normal cell injury
- inc cancer cell kills
- one drug causing problems here while the other drug causes problems there so you dont see a rapid dec in one thing

Question 17

what is optimal dosing

Answer 17

using a dose schedule with cell cycle specific agents to keep active drugs in the body for when the cells finally enter the right stage

Question 18

what is regional dose therapy

Answer 18

allows access to tumors which are difficult to target
- high conc
- dec systemic toxicity
- ex: intraarterial, intrathecal, intraperitoneal, intravesical

Question 19

what are the usual toxicities associated with chemo

Answer 19

NV for several days after chemo
- dec WBC, RBC, platelets
- D
- alopecia
- fatigue

Question 20

what are the major toxicities associated with chemo and bone marrow

Answer 20

neutropenia: infection
erythrocytopenia: anemia
thrombocytopenia: bleeding

Question 21

what is the toxicity associated with the GI tract

Answer 21

stomatits

Question 22

what is magic mouthwash

Answer 22

rx cocktail for stomatitis
- lidocaine, mylanta, diphenhydramine, nystatin, prednisone, distilled water
- swish gargle spit 5-10 ml q 6 hrs
not curative

Question 23

what are reproductive toxicities of chemo

Answer 23

bad for developing fetus
germinal epithelial testes
no for pregnant women, could cause infertility in men

Question 24

what toxicities are associated with the kidneys

Answer 24

hyperuricemia
- excessive levels of uric acid in the blood
- cause cell death/destruction of DNA

Question 25

what are broad toxicity risks

Answer 25

extravasation carcinogenesis organ damage

Question 26

what are the chemo agents

Answer 26

cytotoxic agents - alkylating agents - antimetabolites - antitumor abx - mitotic inhibitors hormonal agents biological agents targeted drugs

Question 27

what do cytotoxic agents cause

Answer 27

cell death

Question 28

what do hormonal agents cause

Answer 28

block effects of hormones on tumor

Question 29

what do biological agents cause

Answer 29

alter the body's response to cancer

Question 30

what is a cell cycle specific phase drug

Answer 30

drug that only works at a specific cell phase

Question 31

what is the problem with phase specific drugs

Answer 31

can't interrupt cells that are in G0

Question 32

what are the implications of phase specific drugs

Answer 32

has to stay in the body a long time in order for the cells to enter into the correct stage

Question 33

what are cell cycle non specific drugs

Answer 33

drugs that work on cells in all phases even G0

Question 34

what is the disadvantage to non specific drug therapy

Answer 34

not as effective as injury to prliferating cells

Question 35

what are cell non specific often used with

Answer 35

combo with cell cycle specific agent

Question 36

what is the moa of cytotoxic agents

Answer 36

disrupt DNA synthesis disrupt mitosis

Question 37

what class is cyclophosphamide

Answer 37

alkylating agents

Question 38

what type of cytotoxic agent is cylophosphamide

Answer 38

cell cycle nonspecific * has some problems with resistance*

Question 39

what are the toxicities of cyclophosphamide

Answer 39

bone marrow suppression, N/V, hair loss vesicant hemorrhagic cystitis sterility discoloration of skin

Question 40

what is the class of methotrexate

Answer 40

antimetabolite - resembles natural metabolites

Question 41

what type of cytotoxic agent is methotrexate

Answer 41

cell cycle specific - usually S phase

Question 42

what is a problem associated with methotrexate

Answer 42

resistance

Question 43

what are the side effects of methotrexate

Answer 43

bone marrow suppression, N/V, hair loss nephro/hepatoxicity fetal death abnormalities

Question 44

what class is doxorubicin

Answer 44

anti tumor abx

Question 45

what type of cytotoxic agent is doxorubicin

Answer 45

cell cycle non specific

Question 46

what is the origin of doxorubicin

Answer 46

streptomyces

Question 47

what are the side effects of doxorubicin

Answer 47

bone marrow suppression, N/V, hair loss cardiotoxicities --> dysrhythmias, heart failure acute and delayed rxn

Question 48

what class is vincristine

Answer 48

vinca alkaloids

Question 49

what type of cytotoxic agent is vincristine

Answer 49

cell cycle specific - M phase

Question 50

what are the toxicities of vincristine

Answer 50

some have no bone marrow suppression peripheral neuropathy vesicant

Question 51

what class is ondansetron

Answer 51

antiemetic, serotonin antagonist

Question 52

what is the moa of ondansetron

Answer 52

block serotonin receptors on vagal nerve in the CTZ - chemo receptor zone

Question 53

what are adverse effects of ondansetron

Answer 53

h/a D dizzy

Question 54

how can ondansetron be improved

Answer 54

improved with use of steroids

Question 55

what class is promethazine

Answer 55

antiemetic, dopamine antagonist

Question 56

what are the uses for promethazine

Answer 56

chemo post op general N/V

Question 57

what is the moa of promethazine

Answer 57

blocks dopamine receptors in the CTZ -both antiemetic and sedative effects

Question 58

what are the adverse effects of promethazine

Answer 58

respiratory depression drowsy, sedation black box: resp depression for those under 2, gangrenous extravasation

Question 59

what is the moa of biologics immunotherapy

Answer 59

uses body's own immune system to kill cancer cells

Question 60

what are the different types of biologic immunotherapies

Answer 60

immune checkpoint inhibitors: allow immune cells to respond strongly t cell transfer therapy: boosts natural abilities of T cell monoclonal antibodies: mark cancer cells so better seen treatment vaccines: boost immune system response immune system modulators:inc immune response to prevent/slow cancer

Question 61

what are biologic immunotherapies used for

Answer 61

leukemia/lymphomas breast bladder brain colon lung pancreatic

Question 62

what are side effects of biologic immunosuppressants

Answer 62

pain, swelling, soreness flu like symptoms wt gain D risk of infection

Question 63

routes of biologic immunosupressants

Answer 63

IV oral topical intravesical