Chemotherapy Drugs

Question 1

What are the side effects associated with chemotherapy drugs?

Answer 1

Bone marrow suppression

Impaired wound healing

Loss of hair

Damage to GI epithelium

Damage to reproductive system

Bleeding/bruising

Stunted growth in children

Question 2

What are the different classes of cancer drugs and how do they work?

Answer 2

Cytotoxic -by blocking DNA synthesis and preventing cell division

Hormones -by suppressing opposing hormone secretion or inhibiting their actions

Monoclonal antibodies -by targeting specific cancer cells

Protein kinase inhibitors -by blocking cell signalling pathways in rapidly dividing cells

Question 3

What is the mechanism of action of alkylating agents?

Answer 3

Target the cell in S phase and form covalent bonds with the DNA (cross linking) which prevents uncoiling and therefore inhibits replication

Question 4

What are the different classes of alkylating agents?

Answer 4

Nitrogen mustards

Nitrosoureas

Platinum compounds

Question 5

Name three nitrogen mustards

Answer 5

Cyclophosphamide

Melphalan

Chlorambucil

Bendamustine

Estramustine

Question 6

What is a complication associated with cyclophosphamide?

Answer 6

Activated in the liver to form phosphoramide mustard and acrolein

Acrolein can cause haemorrhagic cystitis

This can be prevented by administering large volumes of fluid

Question 7

What are the three different aims of cancer therapy?

Answer 7

Curing the patient by eliminating all cancer

Prolonging life by shrinking the tumour and relieving the symptoms

Palliative therapy to reduce pain and improve quality of life

Question 8

Give two examples of nitrosoureas and how they are administered

Answer 8

Carmustine -administered IV

Lomustine -administered orally

Question 9

Which drugs are platinum compounds and how do they work?

Answer 9

Cisplatin

Carboplatin

Oxaliplatin

Work by binding to purine bases (G, A, U) on RNA

Question 10

Which cancers are most commonly treated with cisplatin?

Answer 10

Testicular and ovarian cancers

Question 11

What are the side effects associated with cisplatin?

Answer 11

Severe nausea and vomiting

Risk of tinnitus, peripheral neuropathy, hyperuricaemia (gout) and anaphylaxis

Very nephrotoxic so requires hydration

Question 12

Which type of cancer is most commonly treated with Oxaliplatin?

Answer 12

Colorectal cancer

Question 13

Name three other alkylating agents and what they are most commonly used to treat

Answer 13

Busulfan -leukaemia

Procarbazine -Hodgkin’s disease

Trabectedin -soft tissue sarcoma /advanced ovarian cancer

Question 14

How do antimetabolites work?

Answer 14

As folate antagonists -folate is essential for DNA synthesis

Question 15

Give three examples of antimetabolites

Answer 15

Methotrexate

Fluorouracil

Capecitabine

Cytarbine

Gemcitabine

Mercaptopurine

Tioguanine

Pentostatin

Fludarabine

Question 16

Name three cytotoxic antibiotics

Answer 16

Duxorubicin

Bleomycin

Dactinomycin

Mitomycin

Question 17

Why is doxorubicin limited to 450mg/m2?

Answer 17

Because it can cause cardiac dysrhythmias or heart failure in high doses

Question 18

How do vinca alkaloids work?

Answer 18

By preventing the polymerisation of tubulin, which prevents spindle formation

Question 19

Name three vinca alkaloids

Answer 19

Vincristine

Vinblastine

Vindesine

Question 20

What are the different classes of plant derivatives and what plants are they derived from?

Answer 20

Vinca alkaloids -Madagascar periwinkle

Taxanes -Yew tree bark

Etoposide -Mandrake root

Question 21

Which cancers are usually treated with taxanes?

Answer 21

Advanced breast cancer

Question 22

Which cancers are usually treated with etoposide?

Answer 22

Testicular cancer

Lymphomas

Question 23

What are the different classes of hormones used to treat cancer?

Answer 23

Oestrogens

Progestogens

GnRH analogues

Somastostatin analogues

Question 24

How do glucocorticoids work in treating cancer?

Answer 24

By inhibiting lymphocyte proliferation

Counter-act some side-effects of other anti-cancer drugs

Question 25

Name two glucocorticoids used in cancer treatment

Answer 25

Prednisolone

Dexamethasone

Question 26

How do hormones work in treating cancer?

Answer 26

By inhibiting R antagonists

By inhibiting hormones with opposing actions

By blocking the synthesis of endogenous hormones

Question 27

At what point are hormones usually used in the treatment of cancer?

Answer 27

Most commonly at palliative stage

Question 28

How do monoclonal antibodies work in treating cancer?

Answer 28

By reacting with specific target proteins expressed on cancer cells, which activates the immune system to initiate lysis of cancer cells

Question 29

How does the monoclonal antibody rituximab work in treating cancer?

Answer 29

By binding to CD20 proteins which are expressed on certain lymphoma cells, causing the lysis of B-lymphocytes

Question 30

How do protein kinase inhibitors work in treating cancer?

Answer 30

By blocking tyrosine kinases involved in GF signalling pathways

Question 31

Why are cytotoxic drugs usually given in combination?

Answer 31

To increase the cytotoxicity without increasing the general toxicity as different drugs have different side effects

To decrease the chance of developing resistance to individual drugs

Question 32

Why are cytotoxic drugs usually given in large doses every 2-3 weeks?

Answer 32

To allow the bone marrow to regenerate

To decrease the chance of developing resistance to drugs

More effective than several small doses

Question 33

What are the two different types of stem cell transplant?

Answer 33

Autologous -stem cells are harvested from the patient and infused back after chemotherapy

Allogenic -stem cells from a matched donor