Chemotherapy

Question 1

How does the cell cycle relate to the use of chemotherapeutic drugs?

Answer 1

Cancer therapies do not work when the cell is in the dormant stage (G0)

Drugs can be used to enhance the number of cells in the cell cycle

Question 2

Why is chemo given in pulses?

Answer 2

Allows the cell of the bone marrow to regenerate as the cells of the tumour die

Question 3

Discuss antimetabolites

Answer 3

Targets enzymes required for the incorporation of pyrimidines/purines into DNA

E.g. 5-FU, methotrexate

Question 4

Discuss DNA Alkylators

Answer 4

Forms a bond between 2 strands of DNA which stops them from replicating

E.g. Platinum compounds

Question 5

Discuss mitotic inhibitors (spindle poisons)

Answer 5

Toxoids = prevent spindle disassembly

Vinca alkaloids = prevent spindle formation

Question 6

How can cells develop resistance chemotherapeutic drugs?

Answer 6

Efflux pumps on cell surface

Protein within the cytoplasm that bind the chemo agent

DNA repair mechanism

Question 7

What are the clinical indicators for chemo?

Answer 7

Cancer

Malignancies

Predicted response = performance score, clinical stage, prognostic factors, molecular markers

Side effects vs best outcome

Question 8

How can chemotherapy be administered?

Answer 8

IV – most common

Oral

Subcutaneous

Into a body cavity – bladder, pleural effusion

Intralesional – directly into the cancerous area

Intrathecal – into the CSF

Topical

IM – rarely

Question 9

What is a PICC line?

Answer 9

Peripherally inserted central catheter

Question 10

Outline the side effects of chemo

Answer 10

Mucositis – epithelial damage, also happens in the gut causing diarrhoea causing dehydration

Alopecia

Nausea/vomiting/diarrhoea

Skin toxicity – shouldn’t happen, when drugs gets into tissue its dies, requires plastic surgery

Lung toxicity – pulmonary fibrosis

Sterility

Myalgia

Neuropathy

Cardiotoxicity – effects muscles function, arrhythmias

Renal failure

Question 11

How is the dose of chemo decided?

Answer 11

Surface area and/or BMI

Drug handling ability – LFT, renal function

General wellbeing – performance status, comorbidity

Question 12

When monitoring a patient under chemotherapy what is being analysed?

Answer 12

Response of the cancer = imaging, tumour markers

Drug levels = assays

Organ damage = creatinine clearance, echo

Question 13

Define neoadjuvant

Answer 13

Given before surgery or radiotherapy for the primary cancer

Question 14

Define adjuvant

Answer 14

Given after surgery to excise the primary cancer, aiming to reduce relapse risk

Question 15

Define palliative

Answer 15

To treat current or anticipated symptoms without curative intent