Chemotherapy Flashcards
Broadly describe the moas of old and new cancer therapies
- surgery: remove known tumour masses
- radiation: kill rapidly dividing tumour cells, including those cells in adjacent tissues
- hormonal therapy: inhibit growth and survival of hormone dependent tumour cells. OIften adjunct to surgery or other treatments. Includes sex and non-sex hormones. Examples of cancers include breast, uterine, or prostate. Side effects relate to various hormones affected
- chemo: kull rapidly dividing tyumour cells. Systematically administered usu oral or IV but may also go into cavities eg intrathecal or intraperitoneal, or large blood vessels. Cytotix. Nrrow TI. Works best against dividing cells when tymoyr numbers are small, CYcles to allow recovery of normal cells. OFten given in combinations at maximum individual doses to minimise resistance
- targeted: specifically inhibit processes required for tumour cell growth
- immuno-oncology therapy: activates immune system to attack tumour cells
Describe the aims of cancer treatment
- Curative
- Adjuvant: Can be given as adjuvant therapy (additional)
- post-operativeas consolidation treatment
- Eradicate possible micrometastatic disease (reduce risk of developing distant metastases in the future)
- Eradicate possible local microscopic residualdisease post-op (reduce risk of developing distant metastases in the future)
- pre-operatively (“neoadjuvant treatment”) to eradicate potential micrometastatic disease or downstage primary site of malignancy (facilitate surgery with clear margins)
- Palliation
List and broadly describe the types of chemotherapy agents
Alkylating Agents
- Drugs: Cyclophosphamide, Chlorambucil, Busulphan
- Mechanism: Crosslink DNA
Platinum Compounds
- Drugs: Cisplatin, Carboplatin, Oxaliplatin
- Mechanism: Form DNA adducts
Anthracyclines
- Drugs: Doxorubicin, Epirubicin, Daunorubicin, Idarubicin
- Mechanism: Block DNA intercalation
Antimetabolites
- Drugs: Fluorouracil, Gemcitabine, Cytarabine, Methotrexate, Hydroxyurea
- Mechanism: Act as false substrate
Taxanes
- Drugs: Paclitaxel, Nab-Paclitaxel, Docetaxel
- Mechanism: Block microtubules disassembly
Vinca Alkaloids
- Drugs: Vincristine, Vinblastine, Vinorelbine
- Mechanism: Block microtubule assembly
Topoisomerase Inhibitors
- Drugs: Topotecan, Irinotecan, Etoposide
- Mechanism: Block key enzyme in DNA replication
Describe chemotherapy toxicity
Toxicities
- Most chemotherapy cellular damage is acute, self-limited and reversible
- Treatment is generally supportive
- Chronic/late side effects of chemotherapy may also occur
- Less common
- Side effects which persist after chemotherapy or develop months or years after chemo
- Generally not reversible
- Many side effects of chemotherapy are common to chemo agents (general side effects)
- Some are more class specific related to certain drugs
Side effects can be classified temporally
Describe general side effects: immediate/before, early and late
Anticipatory (nausea and vomiting)
- Learned response after prior episodes of anti-neoplastic nausea and vomiting
Immediate (within 30 minutes of starting treatment)
- Hypersensitivity reaction
- Extravasation
- Pain at insertion site
- Venous pain
- Cold sensation along vein
- Facial and body flushing
- Hypotension
- Abnormal taste or smell
Short-term (3-7 days after therapy begins)
- Nausea and vomiting
- Anorexia
- Mucositis
- Myelosuppression (risk of infection - “immunosuppressed”)
- Recall of radiation skin reactions
- Pain at tumour site
- Flu-like syndromes
- Chemical cystitis
- Haematuria
- Malaise
- Diarrhoea
- Constipation
Long-term
- Alopecia
- Skin reactions
- Fatigue
- Nail ridging
- Thrombophlebitis
- Organ damage (renal, hepatic, lung, cardiac)
- Neuropathy and CNS toxicities
- Sexual and reproductive dysfunction (possible infertility)
- Psychological issues
- Second primary malignancies**
Discuss CINV
- Most feared complication and oneof the most common chemotherapy side effects
- May develop anxiety
- Management important
- Aim to achieve optimal control on 1st cycle of chemotherapy
- Regimes vary based on chemo agent and expected emesis
- Incidence and severity vary according to agent and prior experiences
- 3 processes -
- Acute emesis (first 24 hours and peaking at 5-6 hours)
- Delayed emesis (more than 24 hours post chemo and may last 6-7 days)
- Anticipatory emeists (conditioned response and relates to poor control previously)
- Important to have good control in acute phase to minimise delayed phase CINV
- Depending on the emetogenic potentialof the treatment regime the patient may require a combination of different anti-emetics from different classes (See [[Nausea, vomiting, diarrhoea]])
Describe mucositis
- Erythematous and/or ulcerative lesions of the_mucosal lining of the oral cavity_secondary to antineoplastic agents, radiotherapy, particularly to the head, neck or oesophagus, or high dose chemotherapy followed by blood and marrow transplant (BMT)
- Affected by: chemo agent, chemo dose, patient factors (nutrition, oral hygiene, smoking status)
- Usually peaks about Day 7 post treatment and heals 10-14 days
- Varying severity
- Risk of secondary infection
Describe bone marrow suppression
- Common side effect of chemotherapy
- Leukopenia/neutropenia
- WCC
- Increased risk of infection
- Can be treated (often prophylactic) with G-CSF (Granulocyte colony stimulating factor)
- Thrombocytopenia
- Platelets
- Bleeding/Bruising
- Anaemia
- Haemaglobin
- Tired, cold, exacerbation of angina and/or CHF
Describe neutropenic fever
- Increased risk with increased duration of neutropenia
- Medical emergency
- Risk of overwhemling sepsis
Use therapeutic Guidelines to guide therapy
Early antibiotics (as soon as blood cultures are sent)
- Don’t delay antibiotics for results
- Broad spectrum required initially
- Use culture results to modify antibiotics when possible
- Use local guidelines or Australian Therapeutic Guidelines for antimicrobial treatment
Most patients fever will resolve within 2-3 days, however if it does NOT resolve
- Re-assess possible sources and re-culture
- Avoid changes in antibiotics is patient is clinically stable
- Consider addition of antifungal if risk of fungal infection
Patients generally require 7-14 days of antibiotics
e.g. genta+vanco+piperacillin/tazobactam
Discuss antimicrobial prophyalxis
Patients with immune compromise are at increased risk of infection may need to commence some antimicrobial prophylaxis to reduce the risk of infection.
Each immunosuppressive therapy (and particular combinations) infers a particular risk as does the type of condition being treated and patient specific factors. Chemotherapy protocols include recommendations for prophylaxis
Boadly describe targeted therapes
- Drugs that interfere with specific molecules involved in cancer cell growth
- Designed to target cancer cells without affecting healthy cells
- Often cytostatic (block proliferation of tumour cells) compared with traditional therapies which are cytotoxic (kill)
- May target and inhibit genes responsible for growth, or target and enhance the activity of genes responsible for cell death. May also be used to deliver substances to the cancer cell to kill it
- Less toxicities compared with traditional treatments
