Integrative Support During Antineoplastic Drug Therapy

Question 1

What is induction chemotherapy? When is it used?

Answer 1

Chemo given to induce remission

Used in acute leukemia

Question 2

What is consolidation chemotherapy? When is it used?

Answer 2

Chemo given to sustain remission

Used in acute leukemia

Question 3

What is myoablative chemotherapy? What is it followed by?

Answer 3

High-dose chemo that obliterates bone marrow

Bone marrow or stem cell transplant

Question 4

What is adjuvant chemotherapy? When is it used?

Answer 4

Chemo given to destroy microscopic spread after primary tumor is surgically removed
To prevent recurrence

Question 5

What is neoadjuvant chemotherapy? What is it used for?

Answer 5

Chemo given before surgery

To shrink tumor

Question 6

What is chemoradiosensitization?

Answer 6

Small doses of chemo given to increase efficacy of radiation

Question 7

What is palliative chemotherapy?

Answer 7

Chemo given for symptom management, not to reduce cancer

Question 8

What is dose-dense chemotherapy? Example?

Answer 8

Same dose in shorter cycles, i.e. dose-dense ACT

Question 9

What is fractionated chemotherapy? Example?

Answer 9

Same dose per cycle in multiple administrations, i.e. fractionated paclitaxel

Question 10

What is the most common route of chemotherapy administration?

Answer 10

Peripheral vein intravenous

Question 11

When is a central venous catheter used?

Answer 11

Pt receiving extended rounds of therapy, continuous infusion therapy, or with fragile/ hard to find veins

Question 12

What are the two most common types of central venous catheter?

Answer 12

Peripherally inserted central catheter (PICC)

Implantable venous access port (“port”)

Question 13

Where is the PICC placed? What are the downsides?

How long does it stay?

Answer 13

Through the basilic vein into the SVC
Cannot get wet
Weeks to months

Question 14

Where is the port placed?

How long does it stay?

Answer 14

Directly into the SVC

Years

Question 15

How does tumor burden affect response to chemo tx?

Answer 15

Small tumor burden are more sensitive b/c a higher percentage of cells are dividing and being exposed to chemo

Question 16

How does rate of tumor growth affect response to chemo tx?

Answer 16

Faster growth = more responsive

Question 17

How does tx regimen and dosing affect response to chemo tx?

Answer 17

More sensitive to combination regimens

Dose reductions or delays negatively affect response

Question 18

What is innate drug resistance to chemo? Why does it happen?

Answer 18

Initial exposure to drugs doesn’t produce a response because of mutations in the genome (i.e in tumor suppressor genes in >50%)

Question 19

What is acquired drug resistance? Why does it happen?

Answer 19

From mutations/ gene expression as cancer evolves and is exposed long-term to tx
Mechanisms include induction of drug efflux pumps, decreased affinity/ overexpression of target enzymes, decreased drug activation or increased drug inactivation

Question 20

What is one the primary drug efflux pumps involved with drug resistance?

Answer 20

P-glycoprotein

Question 21

When are cell cycle specific drugs most effects? What regimen is best?

Answer 21

In rapidly divided tumors

Continuous or frequent divided doses

Question 22

When are cell cycle non-specific drugs most effective? What regimen is best?

Answer 22

In tumors with more slowly dividing cells

Large bolus doses