Chemotherapy Flashcards
goals of anticancer regimen
CURE
–if cannot cure…
control growth
offer palliation
growth fraction and tumor growth
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
barriers to success with chemo
–100% kill required
–toxicity
–late detection
–tumor response
–drug resistance
–cell heterogeneity
consequences of late detection
–mets
–less responsive
–patient more debilitated by disease
solid tumors and treatment
–low growth fraction
–respond poorly
–limited blood supply
drug resistance and cancer cells
–CA cells mutate constantly
–natural selection = drug-resistant mutants flourish
heterogeneity and cancer cells
–ongoing mutation
–cells differ greatly (diff. responses to drugs)
–as tumor ages, heterogeneity increases
strategies for success with chemo
–intermittent chemo
–combo therapy
–optimal dosing
–regional therapy
goal of intermittent chemo
100% cancer cell death with limited normal cell injury
advantages of combo therapy
–reduces:
drug resistance
normal cell injury
–increases:
cancer cells kill
optimal dosing schedules
–maximize results
–cell-cycle specific agents
–keep active drug present in body
regional drug therapy
–access to tumors
–high drug concentrations
–decrease systemic toxicity
examples of regional drug therapy
–intraarterial
–intrathecal
–intraperitoneal
–intravesical
usual toxicities
–N/V for several days after chemo
–1-2 weeks after first round:
decreased WBCs, RBCs, platelets
diarrhea
alopecia
fatigue
three major complications of cancer treatment
–neutropenia = infection
–erythrocytopenia = anemia
–thrombocytopenia = bleeding
other toxicities
–bone marrow
–digestive tract injury
–stomatitis
–reproductive toxicity
–hyperuricemia
–extravasation
–carcinogenesis
–organ damage
magic mouthwash
–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
cytotoxic agents
–alkylating agents
–antimetabolites
–antitumor antibiotics
–mitotic inhibitors
anti-cancer agents
–cytotoxic agents
–hormonal agents
–biologicals
–targeted drugs
role of cytotoxic agents
cell death
role of hormonal agents
block effects of hormones on tumor
role of biologics
alter the body’s response to cancer
drugs to help deal with toxicity
–ondansetron
–dexamethasone
–magic mouthwash
MOA of cytotoxic agents
–disrupt DNA synthesis
–disrupt mitosis
example of antimetabolite
methotrexate
specifics about antimetabolites
–cell cycle specific
–resemble natural metabolites
–resistance
adverse effects of antimetabolites
usual toxicities PLUS:
–nephrotoxicity
–hepatotoxicity
–fetal death and abnormalities
example of antitumor antibiotic
doxorubin (Adriamycin)
specifics of antitumor antibiotics
–cell cycle nonspecific
–origin = streptomyces
adverse effects of antitumor antibiotics
usual toxicities PLUS:
–cardiotoxicity
–acute and delayed reaction
example of mitotic inhibitors
vincristine (Vincasar)
mitotic inhibitor specifics
–cell cycle specific
–source = periwinkle
adverse effects of mitotic inhibitors
–no bone marrow suppression in some drugs
–peripheral neuropathy
–vesicant
example of dopamine antagonist
promethazine (Phenergan)
uses of promethazine
chemo, post-op, general N/V
MOA of promethazine
blocks dopamine receptors in the CTZ
adverse effects of promethazine
–respiratory depression
–drowsiness, sedation
–black box warnings = respiratory depression < 2 years old; gangrenous extravasation
MOA of biologics
uses body’s immune system to kill cancer cells
what are biologics approved for use for?
–leukemias/lymphomas
–breast
–bladder
–brain
–colon
–lung
–pancreatic
side effects of biologics
–pain, swelling, soreness
–flu-like symptoms
–weight gain
–diarrhea
–risk of infection
route for biologics
–IV
–oral
–topical
–intravesical
