Chemotherapy Flashcards
What is the aim of curative treatment?
Aggressive treatment with the aim of curing the cancer
e.g. if in early stage, good cure rate cancers
What is neoadjuvant treatment?
Treatment given before surgery to decrease the size of the tumour (shrink)
What is the aim of palliative treatment?
Treatment given to prolong life and reduce symptoms
This can be for YEARS, just will never be cured
What is adjuvant treatment?
Treatment given after surgery to ‘mop up’ any remaining cancer cells
What is the aim of concomitant treatment?
Drugs given to make cells more sensitive to therapies such as radiotherapy e.g. Tenzolamide
What is subsequent line therapy?
Start with one therapy until toxicity/side effects/ progress means a need in charge of treatment
What factors need to be taken into consideration when determining chemotherapy used?
- If need to be mono-therapy or combination treatment
- Route of delivery- systemic ( IV, IM, SC, Oral) or Regional (Intrathecal- inject into spine, intra-arterial, intra-vesical). Oral is becoming more and more common
- Patient- specific dosing, can use:
- Body surface area
- Mg/kg
- Area under the curve- renal function
- Flat dose
Patient
- Performance status- 0-5 ( where 5 is dead)- if 4, not well enough to treat for example
- Age- young people more likely to be able to cope
- Previous treatment- is there eligible funding for another treatment? Also have they had anthracyclines- if so need to work out total exposure
- Co-morbidities- on steroids for DM- may need to monitor glucose more
- Polypharmacy- Need to check what other medications they are taking- interactions
Why is it important to know whether a patient has taken anthracyclines before?
Because anthracyclines (e.g. idarubicin, Doxarubucin) have a cumulative lifetime dose that can not be exceeded sue to risk of heart failure
- Must measure total % exposure
How can impact of treatment be monitored?
- A lump or tumour involving lymph nodes can be felt and measured externally by physical examination
- Some internal cancer tumours will show up on an x-ray or CT scan and can be measured with a ruler
- Blood tests, including those that measure organ function can be performed.
- A tumour marker test can be done for certain cancers
What is cytotoxic chemotherapy?
These are cytotoxic drugs, of which most of anti-cancer drugs are- most traditional
- They are anti-proliferative so inhibit cell division (at all stages of the cell cycle) to decrease replication of cancerous cells
However, they can act on all body cells as are not specific to the cancer cells and therefore cause lots of side effects e.g. even hair follicle cells are tareted so cause loss of hair
+ They are fairly cheap and are still effecticve
What is combination therapy and its benefits?
When multiple drugs are started at the same time and then removed if not needed instead of being added gradually
+ Target multiple pathways
+ Minimal overlap of toxicity- reduce toxicity of one class
+ Less danger of resistance to the drug
+ increased efficacy of treatment
What is the rationale behind hormone therapy, with an example?
Hormones can feed tumour growth
E.g. tests can be done to see if oestrogen is helping breast/ovarian cancer tumours grow. If it is, the cancer is oestrogen-positive ( or hormone-receptor positive).
Drugs can be given to block the oestrogen-receptor e.g. Tamoxifen
How do monoclonal antibodies work to treat cancer, with an example?
e.g. Bevacizumab (Avastin)
- MAB drugs recognise and find specific proteins on cancer cells- can stop endothelial growth factors- this stops growth of the vascular system to the cancerous cells and will cut off nutrients and O2 supply causing them to die
What are the advantages and disadvantages of using oral therapies in cancer treatments?
+ Grown massively in last 20 years
+ Can be taken at home- convenient, less hospital time, increased patient satisfaction
+ less invasive
+ increased role for pharmacists
- Poor adherence- we don’t know what they’re doing at home
- Absorption- can be impacted by diet
- Polypharmacy- patients may not disclose medications, supplements they are taking that may cause interactions
- Still very strong side effects
How do tyrosine kinase inhibitors work to treat cancer?
e.g. Imatinib
Good oral treatment for those with the Philadelphia chromosome (translocation of chromosomes 9 and 22)
Tyrosine Kinases are chemical messengers (enzymes) used by cells to control how they grow and divide. When the growth factor attaches to the outside of the cell it switches the tyrosine kinase ‘on’. This signals the cell to divide. When these are blocked the cell can no longer grow and divide.
