Chemotherapy - Introduction

Question 1

What cures cancer?

Answer 1

1. Surgery - most of the time
2. Radiotherapy - cervix, Head and Neck, Some lymphomas
3. Chemotherapy - Germ cell tumours Leukemias, some lymphomas, childhood tumours
4. Combined modality therapy: Breast cancer, colon cancer

Question 2

Why do cancer patients die?

Answer 2

1. Complication of tumour
2. complication treatment - toxicity
3. Infection, cachexia
4. Metastasis (main cause of most deaths)

Question 3

What are the 5 main types of systemic treatments for cancer?

Answer 3

1. Chemotherapy - used to treat metastatic cancer
2. Hormonal therapy - Breast prostate
3. Targeted therapies (antibodies) - Lymphoma and breast cancer e.g. Rituximab, Transtuzumab (herceptin)
4. Immunotherapy - interferon, interleukin, vaccines
5. Agents controlling: cell cycle, signal transduction/ angiogenesis - e.g. Imantinib BCR/ABL and c-Kit Kinase inhibitor for CML

Question 4

What are the main side effects of chemotherapy

Answer 4

Toxic to other proliferating tissues: BM, GI tract, Hair follicles

Non specific toxicities: N and V

Low therapeutic ratio therefore have to use near maximum tolerated dose

Question 5

What are the different chemotherapy drug classes?

Answer 5

DNA reactive drugs:

1. Alkylating agents: Monofunction - Dacarbazine, Bifunction - Cyclophosphamide
2. Platinium drugs: Cisplatin/ Carboplatin

Anti-metabolites (Inhibitors of DNA synthesis):

3. Anti-folates: Methotrexate,
4. Nucleotide analogues: Pyrimidine analogues - 5 Fluorouracil, Purine analogues - 6 mercaptopurine

Tubulin binders (inhibitors of cell division):

5. Vinca Alkaloids: Vincristine
6. Taxanes: Paclitaxel

Topoisomerase inhibitors (inhibitors of DNA processing):

7. Topoisomerase II: Anthracyclins (intercalating agents): Antibiotics - Doxorubicin, Non intercalating - Etoposide
8. Topoisomerase inhibitors: I - Topotecan