Chemotherapy Flashcards
MCC of CA death in women and men
MC CA in women
MC CA in men
MCC of CA death in women and men = lung
MC CA in women = breast
MC CA in men = prostate
Cisplatin
Ototoxic, nephrotoxic
Carboplatin
B myeloid suppression
Cyclophosphamide
Acrolein is the active metabolite. Mesna can help with hemorrhagic cystitis
Methotrexate
– inhibits dihydrofolate reductase inhibits purine synthesis. Renal toxicity. Leucovorin rescue reverses effects of MTX
5FU
– SE: Myeloid suppression. inhibits thymidylate synthetase inhibits purine synthesis. Leucovorin increases 5FU toxicity
Leucovorin
Leucovorin = folinic acid
Oxaliplatin
Oxaliplatin – SE Nephrotoxic, neurotoxic, ototoxic, (less than cisplatin)
Gemcitabine
Inhibits thymidylate synthetase
Vincristine
Vincristine – inhibits microtubule synthesis – peripheral neuropathy
Etopisode
S/E: Bone marrow suppression
Taxanes
Taxanes – Promote microtubule formation! S/E: cause neuropathy
Bevacizumab (Avastin)
Bevacizumab (Avastin) – VEGF inhibitor. Used in lung CA and metastatic colorectal CA
Esophageal CA
Esophageal CA – Carboplatin and paclitaxel
ENT chemo
ENT chemo – Cisplatin and 5FU
Squamous cell CA in Anal margin lesions (below the dentate line)
Squamous cell CA in Anal margin lesions (below the dentate line) – Cisplatin and 5FU
Colorectal adenocarcinoma
- First line = 5FU, leucovorin, and irinotecan (FOLFIRI). Add Bevacizumab (Avastin) if metastatic cancer
- 2nd line: 5FU, leucovorin, oxaliplatin (FOLFOX).
For metastatic cancer
- Cetuximab only if EGFR positive and metastatic
- Bevacizumab if metastatic (VEGF inhibitor)
Anal canal (above dentate line) squamous cell CA
5FU and mitomycin with XRT (Nigro protocol)
Small cell lung CA
Small cell lung CA – cisplatin and etoposide (VP16)
Non-seminoma and Seminoma (germ cell tumors)
Non-seminoma and Seminoma (germ cell tumors) – cisplatin, bleomycin, etoposide
Bladder CA
Bladder CA –MVAC; Methotrexate, vinblastine, Adriamycin, cisplatin
Gallbladder
Gallbladder – Gemcitabine + cisplatin or Gemcitabine + capecitabine
Cholangiocarcinoma – Gemcitabine + cisplatin
Pancreatic CA
FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) or gemcitabine
GIST
Imatinib
Carcinoid (used for unresectable disease)
Carcinoid (used for unresectable disease) – streptozocin and 5FU, octreotide
Insulinoma
5FU and streptozocin, diazoxide
Ovarian CA
Cervical CA
Cisplatin and paclitaxel
Breast CA
TAC Taxanes (docetaxel pacletaxal), doxurubicin, and cyclophosphamide
Nephroblastoma (Wilm’s) – Actinomycin and vincristine
Neuroblastoma - (DECC) doxorubicin, etoposide, cisplatin and cyclophosphamide
Non-small cell lung CA (squamous or adenocarcinoma) - carboplatin, taxol (paclitaxel)
Hodgkin’s - (ABVD – Adriamycin, bleomycin, vinblastine, dacarbazine)
Radiation therapy XRT
M phase (mitosis) – most vulnerable stage of cell cycle for XRT. Targets this
Damage done by formation of oxygen radicals maximal effect with high oxygen level
Main target is DNA – XRT and oxygen radicals damage DNA
Higher energy radiation has skin preserving effect (Maximal ionizing potential not reached until deeper structures)
Fractionate XRT doses allows:
- Repair of normal cells
- Re-oxygenation of tumor
- Redistribution of tumor cells in cell cycle
Very radiosensitive tumors (high mitotic rate) – Seminoma, lymphoma
Very radioresistant – epithelial, sarcoma
Antibodies
