Chemotherapy Flashcards
Can chemotherapy drugs be carcinogenic?
Yep.
What’s one way cancer can reoccur?
If cells are sitting in the G0 phase but later pop-back out of it after treatment.
What kinds of difficult cancers might we use alkylating-like drugs for?
Genitourinary, head and neck, lung, ovarian,
What do alkylating-like drugs end in?
-platin
What do alkylating drugs alkylate?
The 7’ nitrogen of GUANINE in DNA.
What’s an old alkylating drug with bad historical juju?
Nitrogen mustard.
What metal are alkylating-like drugs derived from?
Platinum.
T or F: secondary cancers are characteristically hard to treat.
TRUE.
Why might methotrexate freak Emma or Anne out?
It’s a chemotherapy drug (folate inhibitor) also used for autoimmune therapy (esp. rheumatoid).
What should you not confuse the cancer chemotherapeutic 5-fluorouracil for?
5-flucytosine, the antifungal given with amphotericin.
Why might I be sympathetic with a particular antitumour antibiotic?
Anthracyclines (damn right, you CALL you them that).
If it’s an antitumour antibiotic and it’s not anthracycline then it ends with…
…mycin. Usually with some letter. E.g. actinomycin-D.
Which main drug heading has a lifetime dose limit and why?
Topo inhibitors, because of dose dependent permanent heart damage.
Drugs under which main heading are dose-limited by peripheral nerve damage?
Mitotic inhibitors - plant aklaloids.
Bonus: e.g. mitotic spindle inhibitors and the -taxels.
Name the two antitumour antibiotic groups - what are their endings?
Poor Christians spend time in camps trying to inhibit their sins. Some were even taken there by force.
It’s a viscious cycle. They just wanna top someone. Why rob them of that?
Anthracyclines (topo I) - rubicins
Camptothecins
Which main drug headings are non-specific in their attack of the cell cycle?
Antitumour antibiotics and alkylating drugs.
Which phase do antimetabolites attack?
The S phase.
Which phase to MMMitotic inhibitors work in?
The M phase.
Say five broad side effects of chemo.
alopaecia myelosuppression impaired wound healing emesis sterility
bonus: recurrence??
Detectable tumours have around how many resistant cells?
10000
Apart from natural selection, why might a cancer be unresponsive to chemotherapy?
Lack of growth.
What is one reason monotherapy is ineffective?
Chances of resistance and recurrence is high high high. You need to attack the tumour with different drugs of non-overlapping toxicity profiles.
Briefly, what’s the log cell kill principle?
Chemo will never kill all cells, it kills a CONSTANT FRACTION OF CELLS. Dose + time between doses therefore affects the timeline of tumour destruction. If it can be outgrown, there’s no point.
EGFR is positive in how many epithelial cancers?
30%
What mab is used for EGFR?
Jack Donaghy’s SET of tuxedos is EPIC.
Cetuximab
Cetuximab is an anti-EGFR antibody. What is the characteristic side effect?
Massive dose dependent rash.
What is the name of the HER2 antibody?
Trust Karen to go and get breast cancer.
Trastizumab
What’s the name of the VEGF antibody?
Bev Bailey had the personality of a vegetable. I hope I never see her at the zoo and have to strike up a conversation with her.
Bevacizumab.
Which growth factor receptor in melanomas has a specific carcinogenic SNP that drugs target?
BRAF1
What are two physiological PK issues in cancer chemotherapy?
Poor vascularity
BBB (CNS)
comorbid hepatic problems
What are three metabolic problems in cancer chemotherapy?
Comorbid hepatic problems (clearance or prodrug conversion)
Inherent renal damage (for renally cleared drugs) - poor clearance
High degree of interpatient variation in drug metabolism
Cancer cells can evade immune detection by expressing _________, which immune cells detect with their expressed _________.
Cancer expresses PD-1.
Immune cells express PD-L1 and PD-L2.
Nivolumab is an anti-____ antibody.
PD-1
What Mab is anti-PD-1?
Nivolumab
What’s that ingenious idea called?
EnGeneic (EDV particles with tumour-specific antibodies).
What have been packed into EDVs
microRNA, chemotherapeutics
