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Ob/gyn > Chp 44- principles of cancer therapy > Flashcards

Chp 44- principles of cancer therapy Flashcards

1
Q

Define growth fraction

A

proportion of cells in a tumor that are actively involved in cell division

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2
Q

What happens to growth fraction as tumor size increases?

A

decreases as they enlarge because vascular supply and oxygen levels are decreased

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3
Q

Which drugs are phase nonspecific?

A

alkylating agents (cyclophosphamide, ifosfamide, melphalan), antitumor antibiotics, alkylating like agents (cisplatin, carboplatin)

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4
Q

Which drugs are G0 specific?

A

nitrosureas

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5
Q

Which drugs are G1 specific?

A

asparaginase, actinomycin D

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6
Q

Which drugs are S specific?

A

antimetabolites (mtx, 5FU), antifolates, antipyrimidines, antipurines

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7
Q

Which drugs are G2 specific?

A

bleomycin

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8
Q

When should drugs be used in combination?

A
  1. they are effective when used singly 2. have different MOA 3. at least additive
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9
Q

What is adjuvant therapy?

A

set course of combination chemo that is given in a high dose to patients who have no evidence of residual cancer after radiotherapy or surgery. Goal is to kill residual cells and cure.

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10
Q

What is neoadjuvant therapy?

A

aims to eradicate micrometastasis or reduce inoperable disease to prepare patients for surgery and/or radiotherapy

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11
Q

What is induction therapy?

A

combination high dose to cause remission

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12
Q

What is maintenance therapy?

A

long term low dose regimen to maintain remission

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13
Q

MOA of SERMS

A

competitive inhibitors of estrogen binding to ER in cytoplasm. SERM-ER complex binds to chromosomes but does not activate metabolism.

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14
Q

Uses of SERMs

A

prevent cancer recurrence, Important in breast cancers

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15
Q

AE of SERMS

A

increase risk of endometrial cancer and uterine sarcomas

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16
Q

What are aromatise inhibitors?

A

anastrozole, letrozole, used to suppress intratumor and plasma estrogen levels

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17
Q

Uses of AI

A

postmenopausal women with advanced breast cancer. Often used as adjuvant therapy or sequentially with tamoxifene

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18
Q

AE of AI

A

bone loss secondary to induced hypoestrogenic state

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19
Q

What are progestational agents and when are they used?

A

usely in tx of early stage endometrial cancer when surgery is no feasible, unsafe, or not desired. Useful in some pt with recurrent disease. MCly used agents are medroxyprogesterone and megestrol

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20
Q

How does ionizing radiation kill cells?

A

Via first order kinetic. produce free hydrogen ions and hydroxyl radicals which forms H2O2 with sufficient oxygen–> disrupts the structure of DNA

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21
Q

The basis of fractioned dosages comes from the 4 Rs of radiobiology?

A

repair or sublethal injury, repopulation, reoxygenation, redistribution in cell cyle

22
Q

How is radiation measured?

A

rad (radiation absorbed dose). 1 gray=100 rad

23
Q

What is teletherapy?

A

use of high energy beams. Spares skin and delivers less toxic radiation to bone. Used to shrink tumors before localized radiation.

24
Q

What is brachytherapy?

A

Depends on inverse square law- dose of radiation at a given point is inversely proportional to the square of the distance from the radiation source. Uses incapsulated sources of radiation implanted directly into tissues (interstitial) or cavities (intracavitary).

25
Q

What radioactive sources are used in intracavitary devices?

A

Low dose: cesium 137, high dose- iridium 192 or cobalt 60

26
Q

What radioactive sources are used in interstitial impants?

A

iridium 192, iodine 125

27
Q

Acute complications with radiation therapy

A

enteritis, acute cystitis, vulvitis, proctosigmoiditis, dedquamation, BM depression

28
Q

Chronic complications with radiation therapy

A

small blood vessel obliteration, fibrosis, fistulas, rectal/sigmoid stenosis, hemorrhagic cystitis

29
Q

Paclitaxel dlt, and AE

A

DLT: neutropenia, peripheral neuropathy. AE: alopecia, myalgias/arthralgias, GI tox, hypersensitivity rxn

30
Q

Carboplatin dlt and ae

A

DLT: thrombocytopenia. AE: nephro, oto, GI toxicity, alopecia, hypersensitivity

31
Q

Cisplatin dlt and ae

A

dlt- nephrotoxocity, ae- neuro and GI toxicity, hypersensitivity

32
Q

bleomycin dlt and ae

A

dlt- pulm fibrosis ae- derm rxns

33
Q

topotecan dlt and ae

A

dlt-neutropenia, ae- alopecia, gi tox

34
Q

doxorubicin dlt and ae

A

myelosuppression ae- palmar-plantar erythrodysesthesia, gi tox ( stomatitis, n/v), cardiac

35
Q

gemcitabine (antimetabolite) dlt and ae

A

dlt- neutropenia ae- hepato and nephro toxicity, HUS

36
Q

etoposide dlt and ae

A

neutropenia ae- alopecia, gi tox, acute mi, acute leukemia

37
Q

ifosfamide dlt and ae

A

dlt- hem cystitis, ae- nephro, gi tox, alopecia, mild leukopenia

38
Q

mtx dlt and ae

A

dlt- myelosuppression of all cell lines ae-hepato, nephro, and derm toxicity

39
Q

dactinomycin dlt and ae

A

myelosuppresion of all cell lines ae- gi tox, alopecia, extravasation necrosis

40
Q

cyclophosphamide dlt and ae

A

myelosuppression ae- hem cystitis, alopecia, siadh

41
Q

vincristine dlt and ae

A

myelosuppression ae- alopecia, gi tox, myalgias, peripheral neuropathy

42
Q

Which drugs are used for ovarian cancer?

A

paclitaxel, carboplatin, topotecan, doxorubicin, gemcitabine

43
Q

Which drugs are used for endometrial cancer?

A

dactinomycin. Adv-paclitaxel, carbopaltin

44
Q

Which drugs are used for granulosa cell tumors?

A

paclitaxel, carboplatin

45
Q

Which drugs are used for cervical cancer?

A

cisplatin

46
Q

Which drugs are used for germ cell cancer?

A

cisplatin, bleomycin, etoposide

47
Q

Which drugs are used for GTN?

A

etoposide, mtx, actD, cyclophos, vincristine

48
Q

Which drugs are used for uterine sarcoma?

A

ifosfamide

49
Q

Which drugs are used for molar pregnancy?

A

mtx

50
Q

Trastuzumab moa

A

DNA derived monoclonal antibody to h EGF 2 protein (HER2)

51
Q

Bevacizumab moa

A

VEGF

Ob/gyn (7 decks)

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