Chemotherapy Flashcards
Goals of Chemotherapy
- Cure
- Control (live with, like chronic illness)
- Palliation (prevent suffering)
- Neo-adjuvant treatment (before surgery)
- Adjuvant treatment (after surgery)
- Chemoprevention (hormone)
- Myeloablation (preparation for BMT)
Adjuvant
in addition to
surgery > chemotherapy > radiation
Neo-adjuvant
chemotherapy > surgery > radiation
Concurrent
Surgery > (chemo + radiation)
Fundamental Principles of Chemotherapy
- Cell Killer model
2. Norton-Simon Hypothesis
Cell Killer Model
Skipper 1971
# of cancer cells killed per cycle (1st order kinetics)
Assumes all cells are: actively dividing, constantly treatment sensitive, growing at consistent rate
Limitations: not all actively dividing at same time, cells can grow at different rates
***doesn’t work
Norton-Simon Hypothesis
Gompertzian Tumor growth kinetics 1977 Tumor grow faster when small??? Les time to recover, more likely to destroy -dose-dense regimens -shorter cycles -more side effects (use growth factors)
Chemo Basics
-generally nonspecific (attack all dividing cells)
-Target rapidly dividing cells (cancer & healthy)
-cytotoxic
action during cell cycle
combination therapy = greatest effect
Cytotoxic
cellular poison
Cystostatic
blocks cell replication
cytocidal
apoptosis
Chemotherapeutic agents classification
cell cycle specific, nonspecific
Routes of Administration
Oral IV IM intra-arterial Intrathecal Intraperitoneal Intrapleural
Intrathecal
NEVER VINCRISTINE
Cell Cycle
M, G1, S, G2….
Cell cycle Non-specific Drugs (CCNS)
exert effect within any cell cycle phase
Alkylating, Anti-tumor antibodies, nitrosureas, Hormones
Cell cycle specific drugs (CCS)
Exert effect within specific cell cycle phase
Antimetabolits, mitotic inhibitors (vinca, Taxanes), Topoisomerase I inhibitors, Topoisomerase II inhibitors
Alkylating Agents (CCNS)
- cell cycle nonspecific
- MOA: DNA strand breakage, prevent cell reproduction/replication
- Alkylator classes
Common SE of Alkylating Agents
myeolosuppresion hypersensitivity renal toxicities GI cutaneous toxicities (hand and foot) secondary malignancies
Aklylating Agents CCNS: Platinum compounds
- grouped with alkylating agents bc of mechanism of action
- efficacy highly dependent on renal elimination
- Adequate renal function IMPERATIVE
- establish prior and during treatment (BUN and CREAT)
- less likely to cause secondary malignancies
Antitimor Antibiotics: CCNS
different from those for infectiosn
- MOA: Cell cycle nonspecific, bind with DNA and inhibit synthesis, prevents cell replication
- produced by streptomyes organisms
- Anthracyclines
Antitumor Abx - common SE
Myelosuppression
GI toxicities
Cutaneous toxicities - vesicants (doxorubicin) EMERGENCY
Organ toxicities (cardiotoxic, pulmonary toxic)
Anthracyclines
antitumor antibiotic
has lifetime maximum cumulative dose
too much will affect cardiac function
epipodophyllotoxins
Antitumor antibiotic classification
Topoisomerase II inhibitors
Bleomycin
Antitumor abx CCNS
pulmonary toxicity: fibrosis
fever and chills during and after infusions
lifetime dose limit 400
Doxorubicin
red in color vesicant cardiac toxicity Dexrazoxane (cardioprotectant) given together if possible flare reaction N/V red urine lifetime dose 550mg (reduce if prior irratidation or cotreat with cytoxan)
Nitrosoureas CCNS
cell cycle nonspecific
MOA: break DNA helix, inhibit replication
**crosses BBB (rare), treats brain tumors
highly lipid soluble
treats cancers involving CNS (HL and NHL)
Notrosoureas SE
myelosuppression deyated, severe, and prolonged
GI toxicities: severe N/V, require antiemetics
secondary malignancies such as acute leukemia, bone marrow dysplasia
delayed pulmonary dmage
ex: Carmustine, Lomustine
Carmustine (BCNU)
(Nitrosureas CCNS) myelosuppression - nadir day 14, delayed irritant painful during infusion pulmonary fibrosis
Lomustine
(Nitrosureas CCNS) Myelosuppression, nadir 14-21 given Q6-8 weeks to delay toxicities, time to recover N/V renal and hepatic toxic pulmonary suppression ovarian and sperm suppression
Hormonal Therapy
Anti-estrogen
Anti-Estrogen Aromatase Inhibitor
Lutenizing Hormone-releasing hormone analog
Anti-androgens
Breast tumor tissue tested for:
Estrogen Receptors (ER) Progesteron Receptors (PR) *can use hormonal treatment if responsive