Chemotherapy Flashcards

1
Q

What is the fractional cell kill hypothesis?

A

Chemo kills tumour cells as well as bone marrow cells
Both have the oppurtunity to repair themselves
Bone marrow recovers faster than tumour cells
So you need to give bone marrow enough time to grow back but not the tumour cells
This means you don’t wipe out bone marrow but you get a gradual reduction in tumour cells

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2
Q

What tumours are highly sensitive to chemotherapy?

A

Lymphoma
Germ cell tumours
Neuroblastoma

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3
Q

What tumours have a moderate sensitivity to chemotherapy?

A

Breast
Colorectal
Bladder

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4
Q

What tumours have a low sensitivity to chemotherapy?

A

Prostate
Renal cell
Brain tumours

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5
Q

What is the optimal treatment for cancer? And how can chemo be involved here?

A

Surgery cures most cancers

Chemo mops up leftover tumour cells (only takes one for it to grow back)

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6
Q

How do alkylating agents work?

A

Inhibit transcription of DNA to RNA, therefore stopping protein synthesis
Substitute alkyl groups for hydrogen atoms on DNA
- this forms cross links, so that DNA can’t unravel to replicate
Affects cancer cells the most because they divide very rapidly

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7
Q

How do Platinum compounds work?

A

Adds sub groups which are bulky and interrupt with replication
Pushes cancer cells towards apoptosis

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8
Q

How do anti-metabolites work?

A

Similar to precursors of DNA synthesis

Interfere with purine and pyrimidine production

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9
Q

How do spindle poisons work?

A

Inhibit depolymerization of spindle microtubules at metaphase
Stops cancer cell division

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10
Q

How can cancer cells develop resistance to chemo?

A
  • decreased entry or increased exit of the agent
  • inactivation of agent inside the cell
  • enhanced repair of DNA lesions produced especially by alkylation
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11
Q

What do you have to consider when prescribing chemo?

A

Performance score

  • 0-5 (fine to dead)
  • patients with a higher score are less likely to be able to tolerate chemo

So there’s no point giving chemo to someone who’s going to die anyway as you’ll decrease their quality of life

However if they’re more likely to benefit from it in the long term then it is worth it

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12
Q

What are some side effects of chemo? (See notes for more)

A
Alopecia 
Mucositis 
Nausea and vomiting 
Diarrheoa 
Sterility
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13
Q

How can chemo lead to acute renal failure?

A

Hyperuricaemia is caused by tumour lysis

This leads to precipitation of urate crystals in renal tubules

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14
Q

What causes variability between patients responses to chemo?

A

Abnormal in absorption, distribution, elimination and protein binding

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15
Q

What drugs increase chemo action?

A
Vincristine 
Warfarin 
Methotrexate 
St. John's Wort 
Grapefruit juice
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16
Q

How do cancer cells multiply?

A

Exponentially