Drugs to Treat Ovarian and Bladder Cancer Flashcards
OVARIAN CANCER DRUGS:
Carboplatin Cisplatin Cyclophosphamide Doxorubicin Paclitaxel
BLADDER CANCER DRUGS:
Bacillus Calmette-Guerin, BCG Cisplatin Doxorubicin Mitomycin C Thiotepa
Epithelial Ovarian Carcinoma One of the most common?
Gynecologic malignancies; fifth most frequent cause of cancer death in women.
Most important risk factor?
Family history of a 1st degree relative.
Germline mutations in what genes substantially increase risk vs.general population
BRCA1/BRCA2
Prophylactic oophorectomy may be considered after?
The age of 35 if childbearing is complete.
What protein is elevated in Epithelial Ovarian Carcinoma?
CA-125 (cancer antigen-125) protein level is elevated in most ovarian cancer cells.
What Δ in blood is a measure of tumor proliferation/drug effectiveness?
CA-125 (cancer antigen-125) protein level
Chemotherapy involves High volume?
IP cisplatin instillation. Solution instilled and retained for a period, then drained off. Allows higher doses and more frequent administration of drugs.
Epithelial Ovarian Carcinoma Biologics and “targeted” therapies?
Under investigation, but at present none has received approval for routine clinical use.
Epithelial Ovarian Carcinoma Treatment may involve a combination of?
Surgery (bilateral salpingo-oophorectomy or debulking), radiation (external and instilled P32) and chemotherapy.
Bladder Carcinoma is the (blank) most common
- 7th most common cancer in men
- Most (70%) are transitional cell carcinoma
- Most (70%) are superficial upon initial presentation
Bladder Carcinoma most common presenting symptom
Hematuria
Bladder Carcinoma with Non-muscle-invasive cancer treatment?
Trans-urethral resection (TUR) & regular cystoscopy to monitor for recurrence/progression.
Bladder Carcinoma with Non-muscle-invasive cancer drug therapy?
– Intravesicular (IVe) instillation of mitomycin C
– >1 year of IVe Bacillus Calmette-Guérin (BCG)
– Additional IVe drugs for high risk patients
BCG Instillation Used after?
TURBT and in treatment of CIS
BCG Instillation Method & Requirements?
- 50 mL instillation held for 1-2 hr; weekly x 6
- Good response rates for prophylaxis, for CIS, & for eradication of residual disease
- Activity requires an intact immune system
BCG Instillation Mechanism:
– Binds to urothelial cells
– Activates APCs
– Induces production of effector cells (CTLs, NKs, LAKs, BAKs)
– Peak response in 6-24 hr; increasing with successive cycles
– Sustained effect over months
Carboplatin MECHANISM
Forms DNA intrastrand crosslinks and adducts
Cisplatin MECHANISM
Forms DNA intrastrand crosslinks and adducts
Cyclophosphamide MECHANISM
Pro-drug of active alkylating moiety
Doxorubicin MECHANISM
Intercalator, free radical generator, topo II inhibitor
Mitomycin C MECHANISM
Mono- & bi-functional alkylating agent
Paclitaxel MECHANISM
Microtubule stabilizer inhibiting depolymerizer
Thiotepa MECHANISM
Polyfunctional alkylator with loss of aziridine (alkylator) moiety
Carboplatin ISSUES
Allergic (platinum) reactions. Dose-related myelo-suppression; cumulative anemia. Dose related N/V. Blood chemistry dyscrasia, increase hepatic enzymes, BUN & creatinine.
Cisplatin ISSUES
Allergic (platinum) reactions. Dose-related severe nephrotoxicity, myelosuppression, & N/V. Significant ototoxicity (tinnitus and occasionally deafness) reported in children
Cyclophosphamide ISSUES
Blood dyscrasias leading to anemia/infection. Renal compromise, hemorrhagic cystitis (mesna is protective), N/V, rashes. Amenorrhea/infertility. Monitor for 2° malignancies. Pulmonary fibrosis
Doxorubicin ISSUES
Myelosuppression, CHF, hepatic disease. 2° malignancies, extravasational necrosis, N/V
Mitomycin C ISSUES
Pancytopenia (when used IV); chemical cystitis; contact dermatitis but also as palmar and plantar erythemas if contact made with instillate solution or void volume
Paclitaxel ISSUES
Taxane hypersensitivity; myelosuppression; Myalgia & arthralgia
Thiotepa ISSUES
Pancytopenia (when used IV); dysuria, urinary retention, chemical/hemorrhagic cystitis; renal dysfunction
