Chemotherapy in Hematology-Oncology Flashcards
Problems with cancer?
- Surrounding anatomy is compromised
- Hormone synthesis is affected
- Cancer required increased blood flow; necrosis occurs when growth of cancer exceeds growth of vasculature
- Malnutrition
Cancer treatment?
Based on primary site (bone cancer as a result of breast cancer is treated as breast cancer)
Does staging change throughout treatment?
NO
Cure rate of chemotherapy
10-15% of cancers
Cancers which respond favorably and have curative potential with chemo?
- Choriocarcinoma
- ALL
- Hodgkin disease
- Burkitt’s lymphoma
- Wilm’s tumor
- Testicular cancer
Adjuvant?
Used after surgery to kill any remaining cancer cells that may be undetectable
Neoadjuvant?
Chemotherapy given prior to surgery to shrink tumor
Palliative?
Relieves symptoms but is not expected to reduce cancer
Induction?
Chemotherapy given to induce remission
Consolidation?
Also called intensification, goal is to sustain remission
Maintenance?
Low dose chemotherapy to prolong remission
Classes affecting M phase?
- Vinca alkaloids
- Taxanes
- Antimicrotubule inhibitor
Classes affecting S phase?
- Antimetabolites
- Epipodophyllotoxin (Topoisomerase II inhibitors)
Classes affecting G2 phase?
- Antitumor antibiotics
- Epipodophyllotoxin (Topoisomerase II inhibitors)
Meds causing pulmonary fibrosis?
- Bleomycin (CCS)
- Busulfan (CCNS)
Meds causing peripheral neuropathy
- Taxanes
- Platinum analogs (cisplatin)
Secondary cancers that respond well to treatment?
Topoisomerase II inhibitors
- etoposide
- teniposide
- mitoxantrone
Secondary cancers that DO NOT respond well to treatment?
Alkylating agents/platinum analogs
- mechlorethamine
- chlorambucil
- cyclophosphamide
- melphalan
- lomustine
- carmustine
- busulfan
- cisplatin
- carboplatin
Where can chemo drugs be found?
In bodily fluids!
- Disposable gloves
- Everything should be washed separate
Glucocorticoids?
Commonly used in leukemias and lymphomas along with other agents
- prednisone
- dexamethasone
Estrogen and androgen antagonists?
- Tamoxifen blocks estrogen in estrogen dependent breast cancer
- Flutamide blocks androgens in prostate cancer
Gonadoropin releasing hormone analogs?
Used in prostate cancers
- leuprolide
- goserelin
Aromatase inhibitors?
Important for the conversion of androgen to estrogen
- anastrozole
- letrozole
Interferons?
- Naturally occurring endogenous glycoproteins that are antiviral and antineoplastic
- Fatigue and flu-like symptoms are a problem
Tyrosine kinase inhibitors?
- Imatinib (Gleevec) began the revolution
- Once a day ORAL medication
- Effectiveness of Gleevec depends on whether patient is in accelerated phase, chronic phase, or blastic phase (worse prognosis)
- Target BCR-ABL tyrosine kinase inhibitor
Bevacizumab side effects?
- Arterial thromboembolic events (MI/stroke) in 4%
- HTN
- Bowel perforation
EGFR inhibitors?
- Acneiform rash
- The worse the rash, the better the treatment is working!
Increased risk of squamous cell carcinoma of skin?
- vemurafenib
- dabrafenib
Non-hodgkin Lymphoma?
- CHOP and R-CHOP
- Monoclonal antibodies
- Interferon
- Immunomodulators
Hodgkin disease?
- ABVD
- Stanford V
- BEACOPP
- Monoclonal antibodies
ALL?
- Tyrosine kinase inhibitors
- Effective in patients with Philadelphia chromosome
CLL?
Just recognize there are a lot of drugs
AML?
Cytarabine and antracyclines are the most commonly used
CML?
- Gleevec has changed the world of CML treatment
- Tyrosine kinase inhibitors are the mainstay of treatment for CML due to the presence of the BCR-ABL oncogene
- If the leukemia produces the T315I mutation that prevents TKIs from being effective, omacetaxine may be used
Multiple Myeloma?
LOTS OF REGIMENS
Also:
Bisphosphonates
Interferon
Ewing’s Sarcoma?
Alternate between two combinations given every 2-3 weeks for about 14-15 cycles
- VAdriaC
- IE
