Chemotherapy

Question 1

How do alkylating agents work?
e.g topoisomerase inhibitors?

Answer 1

Prevent the uncoiling of DNA so that DNA cannot replicate.

Question 2

MOA of vinca alkaloids:

Answer 2

Cell cycle arrest by preventing microtubule formation.

Question 3

MOA of taxanes?

Answer 3

Spindle cell inhibition.

Question 4

Skim how antimiotic antibiotics work:

Answer 4

• Intercalation - inhibiting synthesis.
• Membrane binding, increased permeability and destruction.
• Free radical formation, disrupts the DNA chain and prevents mitosis alkylation (thus blocking DNA replication).

Question 5

Name three common antimiotic antibiotics from the lecture?

Answer 5

Doxorubicin
Epirubicin
Bleomycin (non-anthracycline).

Question 6

Paclitaxel, docetaxel are what class of chemotherapy agent?

Answer 6

Taxanes

Question 7

Vincristine, vinblastine are what class of chemotherapy agent?

Answer 7

Vinca alkaloids

Question 8

Etoposide, ifosphamide are what class of chemotherapy agent?

Answer 8

Classical alkylating drugs

Question 9

Cisplatin, carboplatin, oxaliplatin are what class of chemotherapy agent?

Answer 9

Non-classical alkylating drugs

Question 10

Methotrexate, 5-FU, Capecitabine are what class of chemotherapy agent?

Answer 10

Antimetabolites

Question 11

How do antimetabolites like methotrexate work?

Answer 11

Prevents DNA synthesis

Question 12

Vinca alkaloids are used in what type of cancer?

Answer 12

Lung cancer most commonly
also secondary metastatic breast cancer

Question 13

Radiotherapy is commonly used in conjunction with what type of chemotherapy?

Answer 13

Platinum based chemo

Question 14

What is meant by neoadjuvant?

Answer 14

Neoadjuvant chemotherapy is given before the main treatment, usually surgery, in order to reduce the size of the tumour and make it easier to remove. It is often used in cases where the tumour is large or has spread to nearby tissues but has not yet metastasized to other parts of the body.

Question 15

What is meant by adjuvant?

Answer 15

Adjuvant chemotherapy is given after the main treatment, usually surgery, in order to destroy any remaining cancer cells that may be present in the body and reduce the risk of the cancer recurring. It is often used when the cancer has a high risk of recurrence or has spread to nearby tissues or lymph nodes.

Question 16

What side effect may be seen with anthracyclines if the maximum cumulative dose is exceeded?

Answer 16

Cardiotoxicity

Question 17

What side effect may be seen with bleomycin if the maximum cumulative dose is exceeded?

Answer 17

Pneumonitis and ILD

Question 18

What drugs need close renal function monitoring?

Answer 18

Platinums
Capectiabine
Ifosfamide
Methotrexate

Question 19

What drugs need close liver function monitoring?

Answer 19

Etoposide
Taxanes
Anthracyclines

Question 20

Common general side effects of chemotherapy:

Answer 20

• Neutropenic Sepsis
• Nausea and Vomiting
• Hair loss
• Bone marrow suppression
• Mucositis
• Diarrhoea
• Fatigue

Question 21

How is neutropenia approached with patients on chemo?

Answer 21

Safety netting. Most patients will be neutropenic but not require treatment.
- Patient education on taking their temperature everyday.

Question 22

Pulmonary fibrosis is caused by what chemotherapy drug?

Answer 22

Bleomycin

Question 23

Cardiotoxicity is caused by what chemotherapy drugs?

Answer 23

Anthracyclines e.g. Doxorubicin, Epirubicin
Alkylating agents e.g Etoposide, ifosphamide.

Question 24

Resp side effect from gemcitabine?

Answer 24

Pneumonitis
- note bleomycin also can cause a pneumonitis.

Question 25

5-FU is what type of chemo drug and what are it's side effects?

Answer 25

5-FU - Coronary vasospasm, hand and foot syndrome aka palmar, plantar erythema. 5-FU is an antimetabolite like methotrexate.

Question 26

Peripheral neuropathy is a side effect of what chemotherapy agents?

Answer 26

Taxanes

Question 27

Give two examples of taxanes:

Answer 27

Paclitaxel, docetaxel.

Question 28

What testing is needed before starting a 5-FU chemotherapy based treatment?

Answer 28

Test for DPD deficiency - can otherwise lead to severe mucositis, diarrhoea, dehydration and a stay on ICU (can be life-threatening).

Question 29

Terms describing response to chemotherapy:

Answer 29

- Complete response - disappearance of all measurable disease - Partial response - 30% decrease from baseline. - Minimal response - decrease in measurable lesions; no new lesions observed - less than 30% but still a decrease. - Stable disease - neither partial response or progressive decease criteria have been met. - This is the goal, along with symptomatic benefit. - Progressive disease - 20% increase in one or more lesions. - Confirms no response to the chemotherapy.

Question 30

What criteria is used to assess response to chemo treatment?

Answer 30

RESIST Criteria (about the different responses)

Question 31

What chemo drugs cause peripheral neuropathy?

Answer 31

Vinca alkaloids Taxanes Cisplatin

Question 32

Side effects of cisplatin?

Answer 32

Hearing loss Metallic taste in mouth Peripheral neuropathy

Question 33

Platinum based chemo side effects:

Answer 33

Peripheral neuropathy and sensorineural hearing loss (due too to toxicity) Cisplatin can cause nephrotoxicity as well as ototoxicity

Question 34

What chemo drug gives a metallic taste in the mouth?

Answer 34

Cisplatin

Question 35

Ifosphamide side effects

Answer 35

Haemorrhagic cystitis Encephalopathy- give methylene blue

Question 36

Methotrexate give what for the OSCE!!!!!

Answer 36

Folic acid

Question 37

Cisplatin side effects:

Answer 37

Need to add full list!

Question 38

Methotrexate side effects

Answer 38

Nephrotoxic Myelosuppression ILD

Question 39

Cyclophosphamide side effects

Answer 39

Nephrotoxic Bladder toxicity SIADH

Question 40

Bleomycin needs what investigation in the OSCE

Answer 40

Baseline chest x-ray for pulmonary fibrosis.

Question 41

Haemorrhagic cystitis chemotherapy?

Answer 41

Cyclophosphamide

Question 42

5fu can cause heart attacks

Answer 42

5fu can cause heart attacks

Question 43

When to give methylene blue?

Answer 43

Encephalopathy caused by ifosphamide

Question 44

Which chemotherapy agent is associated with hypomagnesia?

Answer 44

Cisplatin is associated with hypomagnesaemia