Chemotherapy

Question 1

goals of anticancer regimen

Answer 1

CURE
–if cannot cure…
control growth
offer palliation

Question 2

growth fraction and tumor growth

Answer 2

as tumor increases in size, rate of proliferation decreases (low growth fraction)
–large tumors –> necrotic core
–decreased nutrient supply at core
–more cells in resting phase
–more difficult to treat

Question 3

barriers to success with chemo

Answer 3

–100% kill required
–toxicity
–late detection
–tumor response
–drug resistance
–cell heterogeneity

Question 4

consequences of late detection

Answer 4

–mets
–less responsive
–patient more debilitated by disease

Question 5

solid tumors and treatment

Answer 5

–low growth fraction
–respond poorly
–limited blood supply

Question 6

drug resistance and cancer cells

Answer 6

–CA cells mutate constantly
–natural selection = drug-resistant mutants flourish

Question 7

heterogeneity and cancer cells

Answer 7

–ongoing mutation
–cells differ greatly (diff. responses to drugs)
–as tumor ages, heterogeneity increases

Question 8

strategies for success with chemo

Answer 8

–intermittent chemo
–combo therapy
–optimal dosing
–regional therapy

Question 9

goal of intermittent chemo

Answer 9

100% cancer cell death with limited normal cell injury

Question 10

advantages of combo therapy

Answer 10

–reduces:
drug resistance
normal cell injury

–increases:
cancer cells kill

Question 11

optimal dosing schedules

Answer 11

–maximize results
–cell-cycle specific agents
–keep active drug present in body

Question 12

regional drug therapy

Answer 12

–access to tumors
–high drug concentrations
–decrease systemic toxicity

Question 13

examples of regional drug therapy

Answer 13

–intraarterial
–intrathecal
–intraperitoneal
–intravesical

Question 14

usual toxicities

Answer 14

–N/V for several days after chemo
–1-2 weeks after first round:
decreased WBCs, RBCs, platelets
diarrhea
alopecia
fatigue

Question 15

three major complications of cancer treatment

Answer 15

–neutropenia = infection
–erythrocytopenia = anemia
–thrombocytopenia = bleeding

Question 16

other toxicities

Answer 16

–bone marrow
–digestive tract injury
–stomatitis
–reproductive toxicity
–hyperuricemia
–extravasation
–carcinogenesis
–organ damage

Question 17

magic mouthwash

Answer 17

–stomatitis
–equal parts of:
viscous lidocaine
mylanta
diphenhydramine
nystatin
prednisolone
distilled water
–swish, gargle, and spit 5-10 mL every 6 hours prn
–may be swallowed if esophageal involvement
–not curative

Question 18

cytotoxic agents

Answer 18

–alkylating agents
–antimetabolites
–antitumor antibiotics
–mitotic inhibitors

Question 19

anti-cancer agents

Answer 19

–cytotoxic agents
–hormonal agents
–biologicals
–targeted drugs

Question 20

role of cytotoxic agents

Answer 20

cell death

Question 21

role of hormonal agents

Answer 21

block effects of hormones on tumor

Question 22

role of biologics

Answer 22

alter the body’s response to cancer

Question 23

drugs to help deal with toxicity

Answer 23

–ondansetron
–dexamethasone
–magic mouthwash

Question 24

MOA of cytotoxic agents

Answer 24

–disrupt DNA synthesis
–disrupt mitosis

Question 25

example of antimetabolite

Answer 25

methotrexate

Question 26

specifics about antimetabolites

Answer 26

–cell cycle specific
–resemble natural metabolites
–resistance

Question 27

adverse effects of antimetabolites

Answer 27

usual toxicities PLUS:
–nephrotoxicity
–hepatotoxicity
–fetal death and abnormalities

Question 28

example of antitumor antibiotic

Answer 28

doxorubin (Adriamycin)

Question 29

specifics of antitumor antibiotics

Answer 29

–cell cycle nonspecific
–origin = streptomyces

Question 30

adverse effects of antitumor antibiotics

Answer 30

usual toxicities PLUS:
–cardiotoxicity
–acute and delayed reaction

Question 31

example of mitotic inhibitors

Answer 31

vincristine (Vincasar)

Question 32

mitotic inhibitor specifics

Answer 32

–cell cycle specific
–source = periwinkle

Question 33

adverse effects of mitotic inhibitors

Answer 33

–no bone marrow suppression in some drugs
–peripheral neuropathy
–vesicant

Question 34

example of dopamine antagonist

Answer 34

promethazine (Phenergan)

Question 35

uses of promethazine

Answer 35

chemo, post-op, general N/V

Question 36

MOA of promethazine

Answer 36

blocks dopamine receptors in the CTZ

Question 37

adverse effects of promethazine

Answer 37

–respiratory depression
–drowsiness, sedation
–black box warnings = respiratory depression < 2 years old; gangrenous extravasation

Question 38

MOA of biologics

Answer 38

uses body’s immune system to kill cancer cells

Question 39

what are biologics approved for use for?

Answer 39

–leukemias/lymphomas
–breast
–bladder
–brain
–colon
–lung
–pancreatic

Question 40

side effects of biologics

Answer 40

–pain, swelling, soreness
–flu-like symptoms
–weight gain
–diarrhea
–risk of infection

Question 41

route for biologics

Answer 41

–IV
–oral
–topical
–intravesical