day 1 oncology Flashcards
Most common types of cancer?
Breast, prostate, lung, colon, lymphoma
Most common cancer deaths?
Lung, colon, breast, prostate, pancreas
What is cancer?
• Disease caused by accumulated mutations in DNA that alter cell function
this gives cancer cells growth advantages over nml cells
Why is cancer bad?
As cancers grow they invade other areas/ organs of the body
becomes a burden which causes organ failure/ death
What is a primary tumor
original mass of cancer cells of solid tumor in a body orgam
benign tumors
are abnormal tumor growth but is not as invasive or fatal as malignant
How is cancer treated?
localized therapy treatment systemic therapies (2)
2 types of localized therapy treatments?
- Surgery
* Radiation
3 types of chemotherapy
– Traditional chemo
monoclonal antibodies
targeted angents
What is immunomodulation
Stem cell transplantation
What are 3 goals if treating with surgery?
– Hope for complete removal of tumor
sometime remove tumor/organ
remove troublesome metastases
cant use in hematologic malignancies
What is radiation therapy
alone or combo therapy with surgery or chemo
exposes the patients to radioactive energy that destroys cancer cells
Chemotherapy involves what?
Involves use of drugs with various MOA that disrupts cancer cell functions
IV or oral
Why is chemotherapy used?
Many types of chemo target mechanisms of cell function that block cancer cell growth and division
most active against rapidly growing tumors that have active growth mechanics
Traditional chemotherapy targets what?
mechanics of cell divisions
DNA, RNA, spindle fiber formation
newer chemotherapy targets what?
Newer target specific proteins that are required for various cancer cell functions
Principles of cancer chemotherapy– Log cell kinetics
– A given treatment kills a constant fraction of cells
subsequent doses reduce the cancer burden proportionally over time
more cells killed= the higher chance for cure
Principles of cancer chemotherapy– Gompertzian model
Growth fraction of a tumor is not constant
growth fraction decreases as tumor gets larger
results in decrease number of cells susceptible to chemo
1st line primary therapy
Used in advanced cancer cases in which other treatments would not be effective
Neoadjuvant chemotherapy
Used prior to the use of local therapies to improve their effect by reducing the size of the tumor
Adjuvant chemotherapy
Used after local therapies to improve their long term effect by eliminating any remaining undetected cancer cells
Dose density is what?
Giving repeated doses of multiple chemotherapy agents over a period of time
regular exposure gives a wave like approach to killing cancer cells over time
Definition of cure
a sustained cancer free period
Defition of control
reduce cancer burden
prevent extension of cancer
extend survival
cure unlikely
Definition of palliation?
reduce symptoms of disease
improve QOL
prolong survival
cure not likely
Defition of remission?
when we cant detect cancer we call this REMISSION. if remission last about 5 yrs we call it a cure BUT doesnt mean the cancer cant come back
4 responses to treatment?
complete remission
cure
partial response
treatment failure/progression of disease
How do you determine the response of treatment
Physical exam
tests: xray, CT scan, MRI
blood tests
tumor markers/ proteins in blood
Mutations within cancer cells could?
– Block chemo actions
block uptake of chemo into the cells
facilitate excessive transport of drug back out of the cell
Difference between primary and acquired resistance to chemotherapy
primary= cancer was never susceptable to the chemo acquired= cancer changed and no longer responds
Chemotherapy resistances
mutations
drug interactions could decrease exposure to chemo within the patients body
Calculated dose does not match pts body characteristics (obese pt)
What are the 3 treatment options if primary treatment is unsuccessful?
salvage treatment–> giving second line agent
stem cell transplant
investigational therapies
What are the 2 types of stem cell transplant?
autologous SCT
allogenic SCT
Autologous SCT
high dose chemo followed by reinfusion of patients own stem cells
Allogenic SCT
completely changing the pts immune system—give them stem cells from a healthy donor
2 targets of new chemotherapy
• Tyrosine kinase
growth factor receptors
3 targets of traditional chemotherapy?
• DNA/RNA
mechanics of cell division
DNA polymerase
Alkalating agents are what?
groups of molecules that trasfer an alkalating group to other molecules
disrupt normal DNA structure by altering atomic interactions and prevents use of DNA as a blueprint for cell division
What do alkalating agents target?
sulfydryl, amino, hydroxyl
phosphate group on DNA
What are some examples of alkalating agents?
Lomustine Cyclophosphamide Mechlorethamine Bendamustine Melphalan Temozolomide Thiotepa Dacarbazine Procarbazine
What are the uses of alkalating agents?
Cyclophosphamide: breast CA, lymphoma, leukemia, myeloma
melphalan: myeloma
procarbazine: lymphoma
Mechanisms that reduce susceptibility to alkalayting agents
– Increase repair of damaged DNA
decrease transport of alkalating agent into cell
Common Adverse effects of alkalating agents
– Bone marrow toxicity mucositis N/V sterility tissue damage following extravasation risk of secondary malignancies
MOA of platinum analogs
binding DNA and form intra and interstrand crosslinks
bind to cytoplasmic and nuclear proteins required for cell function
3 examples of platinum analogs
Cisplatin
Carboplatin
Oxaliplatin
uses of platinum analogs
• Cisplatin and carboplatin- lung, esophagus, ovary, head, neck, bladder
oxaliplatin- more commonly used for colorectal
Adverse effects of Cisplatin
renal toxicity,
N/V
anemia
ototoxicity
carboplatin adverse effect
myelosuppression
oxaliplatin adverse effects (3)
neurotoxicity, diarrhea, myelosuppression
What is antimetabolite?
Antimetabolites are molecules that substitute for actual components of metabolic process
- inhibits cell processes that produce components of DNA
- *S phase specific
examples of antimetabolites?
methotrexate 5-FU 6-MP Fludarabine Gemcitabine cytarabine capecitabine
Uses of antimetabolites
• Methotrexate: leukemia, lymphoma, breast CA, RA pemetrexed- lung CA 5-FU- colorectal, breast CA cytarabine- leukemia, lymphoma gem- pancreas, bladder, breast capecitabine- breast cancer
Leucovorin
no anticancer action
reduced form of folic acid
mimics action of tetrahydrofolate
2 key uses of Leucovorin
– Reduce methotrexate toxicity by rescuing normal cells
increase 5-FU activity against colon cancer
Adverse effects of animetabolites
Methotrexate: diarrhea, mucositis, myelosupprssion
pemetrexed- rash, diarrhea, PPE
5-FU- diarrhea, mucositis, myelosupprssion
cytarabine- N/V, pulmonary toxicity
gem- diarrhea, N/V, myelosupprssion
capecitabine- PPE N/V, diarrhea
What is palmar plantar erythrodysesthesia treated with?
dexamethazone
Chemo derived from natural products
– Vinca alkaloids
taxanes
epipodophyllotoxins
camptothecins
MOA of vinca alkaloids
Inhibit tubulin polymerization required for microtubule assembly
blocks cell division during metaphases and causes cell death
Uses of vinca alkaloids
• Vincristine: leukemia, lymphoma, rhabdomyosarcoma
vinblastin- germ cell cancer, leukemia, lymphoma
vinorelbine- lung breast ovary
Adverse effects of vinca alkaloids
• Alopecia • Neurotoxicity constipation myelosuppression vesicant action of extravasation
MOA of taxanes
Act by promoting microtubule formation
prevents spindle fibers from retracting
blocks completion of cell division causing cell death
Uses of taxanes
• Paclitaxel: ovary, lung, prostate, breast
cabazitaxel- prostate
ixabepilone- breast
adverse effects of taxanes
• Myelosuppression
• Hypersensitivity reactions
peripheral neuropathy
fluid retention
