Chemotherapy/ Personalised Medicine Flashcards
What therapy is typically used for breast cancer?
Hormone therapy
What is thyroid cancer sensitive to?
Radioactive Iodine
What is photodynamic therapy?
Using light to active anti-cancer drugs when they are applied topically in regards to skin cancer
Why is chemotherapy given?
To cure cancer To increase the success of other treatments e.g. surgery for ovarian patients Reduce risk of recurrence Treat metastatic disease Palliative setting to relieve symptoms
Give an example of when chemotherapy is used for maintenance?
In breast cancer
Use of Tamoxifen
Can be taken for 5 years after surgery
Relatively non-toxic
Name some curable cancers
Teratoma Seminoma Highgrade non-hodgkin's lymphoma Wilm's tumour Myeloma
Name some cancers with a clear survival benefit
colorectal cancer Small cell lung cancer Oesphageal cancer Ovarian cancer Breast cancer Cervical cancer Low-grad lymphoma Non-small cell lung cancer
Name some cancer with a modest survival benefit
Pancreatic cancer Gastric cancer Hepatoma Sarcoma Bladder cancer Primary brain cancer Nasopharyngeal cancer
Name some cancers with no survival gain from chemotherapy
Melanoma
Renal Cancer
Cholangiocarcinoma
What does melanoma respond to?
Immunotherapies
What was the first chemotherapy drugs derived from?
Mustard gas
How do antimetabolites work?
They look similar to DNA bases, the body recognises them as a subtle change to DNA modification of the DNA bases so can be taken up and since something is missing, it blocks transcription
How many patients typically receive an inadequate chemotherapy dose?
~30%
How many patients receive a chemotherapy dose which is too high?
~10%
What calculation is used to determine the dose of drug given to a patient?
Body surface area calculation
Common side effects of chemotherapy
myelosuppression (decreased production of blood cells)
Immunosuppression
Anaemia
Mucositis (inflammation of the lining of the GI tract)
Alopecia (hair loss)
Fatigue
Why does chemotherapy cause these side effects?
It targets highly proliferating cells
What are the routes for administration of chemotherapy?
IV
Oral
Topical
How is tamoxifen administered?
Orally
What kind of cancers can use topical administration?
Non-melanoma skin cancer
How long for IV administered chemotherapy take to work?
A few hours
After chemotherapy, when is the white cell count lowest?
7-14 days post chemo
When is the recovery time for chemo?
18-28 days post chemo
When are chemo regimens scheduled?
every 21-28 days
How long will chemotherapy treatment last?
4-12 months
At what point in the cell cycle to cells respond best to treatment?
S and M phases
Why is the location of the tumour important for the success of chemotherapy?
The chemotherapy needs a blood supply to work and therefore the further away the tumour is, the less effective it’ll be
Give examples of chemotherapy supportive drugs
Anti-emetics
Steroids
Mineral supplementation
Diuretics
What is the average number of drugs a cancer patient is receiving?
14
What chemotherapy works best for ovarian cancer?
Platinum drugs
What does the choice of chemotherapy depend on?
Disease site Stage/ grade of cancer Metastatic disease? Individual patient issues e.g. their general health Curative or palliative intent Differences in metabolism/ drug targets
What metabolising tamoxifen?
CYP2D6
What monoclonal antibody targets EGFR?
Cetuximab
What targets Raf?
Vemurafenib
When should patients not receive cetuximab?
If they have a Kras mutation
An example drug which targets BCR:Abl
Imatinib
An example drug which targets ErbB2
Lapatanib
An example drug which targets VEGFR
Sorafenib
Name an example PARP inhibitor
Olaparib
When is Olaparib used?
In ovarian and breast cancer patients with BRCA1/2 mutations
What types of cancer is Rituximab used in?
Non-hodgkins lymphoma
B cell lymphoma
What types of cancer is herceptin used in?
ErbB2 positive breast cancer
When cancers is cetuximab used in?
CRC, head and neck
What does bevacizumab target?
VEGF
What cancers is bevacizumab used in?
CRC and ovarian cancer
How responsive is immunotherapy?
~50% response rate
How much does immunotherapy cost?
Up to £10,000/ month