Chemotherapy From A Clinical Perspective Flashcards
What kills patients with cancer
Local complication of tumour
Systemic complications of cancer
Direct complications of the treatments
Metastasis
Why is stage 4 difficult to treat
Require systemic treatment e,g drug administered into blood
Targeted treatment would be unaffected
What are the 4 types of treatments that can be given to a patients with cancer
Surgery
Radiotherapy
Supportive therapy
Systemic therapy
Many receive multi-modality treatments
What is supportive therapy
Addressing immediate symptoms e.g pain, emesis and phsycological issues
When is surgery beneficial
When the tumour is localised or at an early stage
When can radiotherapy be used
Can be used instead of surgery for localised cancers
Shrinks area of cancer to reduce burden
What are the 4 types of systemic cancer therapies
Chemotherapy
Hormone therapy
Immunotherapy
Targeted agents
Desiree chemotherapy
Targets DNA replication
Are anti-proliferative agents
Non-selective = normal tissue toxicity
What makes an effective chemotherapy drug
Reaches tumour cells
Sufficient [active component] enters cells
Tumour cells sensitive to drug
Normal tissue can recover/tolerate
What do you need to consider before combining treatments
Principles of tumour biology
Cellular kinetics
Pharmacology
Drug resistance
Describe combination treatment
Several different drugs each independently active against a disease
What is the result of combination therapy
Chance of emergence of drug resistance clone decreases
Rate of cell kill increases
Name a way that drugs in a combination treatment interact
Affect different phases of the cell cycle
Why should a patients fitness and co-morbidity be considered prior to combination treatment
Affect how well the body will tolerate the chemotherapy and the side effects
Allows to customise the dose for maximum efficacy and lowest toxicity
Why should organ functions be measured before any combined treatment
Kidney and liver metabolise drugs
-> low function = can’t metabolise or excrete the chemotherapy effectively
What are the 2 outcomes that we are trying to achieve in cancer treatment
Curative and non-curative intent
When is high dose/ radical chemotherapy used
Germ cell tumours e.g lymphomas and leukaemias
Completely get rid of the cancer in patients
What is neo-adjuvant chemotherapy
Course of chemo given before surgery/radiotherapy with the intent to cure the cancer
Used when a large tumour is localised and needs to be shrunk before surgery
When is palliative chemotherapy given
In the presence of advanced metastatic disease
Can’t cure it but can prolong survival
What does the growth of tumour depend on
Actively growing fraction of the tumour
What are the 3 classes of anti-tumour drugs that effect the mitotic cycle
- Cell cycle active - phase specific
- Cell cycle active - phase non-specific
- Non-cell cycle active
What is the mechanism of action for bifunctional alkylating agents
Transfer an alkyl group to the N7 of guanine residue
= cross links with DNA
= no DNA synthesis + cell cycle arrest
What phase of the cell cycle are bifunctional alkylating agents active in
All phases
Name 2 alkylating agents
Cyclophosphamide
Melphalan
