Oncologic Regimen Design Flashcards
Regimen Design Factors
- Tolerability
- Toxicity Limitations
- Theoretic Rationale
- Circumvention of Resistance
- Initial Aggression
Tolerability
- Limits significantly myelosuppressive chemo regimens to Q2-3 weeks
- Designed with agents that have non-overlapping toxicities
Toxicity Limitations
- Some agents cannot be delivered in combination with other agents
- EX: Trastuzumab and anthracyclines
Theoretic Rationale
- Some classes of agents are believed to limit efficacy of other agents
- Don’t give in combination
- EX: Chemotherapy and anti-hormone therapy in breast cancer
Circumvention of Resistance
- May focus on continuously altering type of chemotherapy throughout regimen
- Especially seen in acute leukemia
Initial Aggression
- Some regimens may be more aggressive at the start
- Leukemia to maximize leukemic cell death early on to prevent resistance
Breast Cancer Regimens
- Anthracyclines
- Cyclophosphamide
- Taxanes +/- HER-2 agents
- Hormonal Therapy
Prostate Cancer Regimens
Castration therapy + Antiandrogen agents +/- taxane chemotherapy
Ovarian Cancer Regimen
- Platinum + Taxane based chemotherapy
- Possibility for intra-peritoneal administration
Myeloma Regimen
- Immunomodulators
- Proteosome Inhibitors
- Dexamethasone until CR
- +/- transplant and or maintenance Rx
Leukemia Regimen
- Antimetabolites
- Corticosteroids
- Vinca alkyloids
- Alkylating agents
- Anti-asparagine
- TK-inhibitors
Lymphomas Regimen
- Anthracyclines
- Bleomycin
- Alkylating agents
- Vinca alkyloids
- Corticosteroids
Lung Cancer Regimens
- Small Cell: Platinum + etoposide or irinotecan or vinorelbine or taxane
- Non-small cell: Platinum + etoposide or gemcitabine or taxane +/ PD-LI inhibitors +/- EGFR inhibitors +/- TK inhibitors
Colon Cancer Regimens
- Antimetabolites (5-FU)
- Leucovorin
- Platinum
- Campothecans
- VEGF and EGFR inhibitors
- PD-1 inhibitors
Melanoma Regimen
- CTLA-4 inhibitors
- PD-1 inhibitors
Breast Cancer Treatment Duration
- Chemo: 6-8 months
- HER-2: 1 year
- Hormonal Rx: 5+ years
Ovarian Cancer Treatment Duration
-Chemo: 6-8 months
Prostate Cancer Treatment Duration
- LHRH for remainder of life
- Anti-androgen until relapse and then change
Leukemia Treatment Duration
- ALL: 2.5-3 years
- AML: 4-6 months
Lymphoma Treatment Duration
-6 months
Chemotherapy Basics
- Immune system recovers in ~6 months after completion
- Some ADRs may not resolve
- Dose to max tolerability for many agents, need to know dosing/schedule to prevent ADEs
- N/V is the most bothersome toxicity by chemotherapy patients
- Cancer therapy will have less effect and be more toxic following relapse
- Cancer agents, especially new ones, are the most expensive pharmacotherapy
