Oncology (2) Flashcards
1
Q
Aims of treatment
Curative, adjuvant and palliative
A
- Curative
- Aims for the complete cure of the disease
- Rarely possible for solid tumours with chemotherapy alone (surgery is often used)
- Haematological cancers; a cure is possible with chemotherapy alone, though radiotherapy may be used as well
- Adjuvant
- Treatment is given to prevent the return of cancer, following local treatment
- NB- Neoadjuvant treatment is when a tumour is too large to be easily removed
- Palliative
- Aims to control cancer, and attempts to prolong life and reduce symptoms
- NB- Palliative treatment should not be confused with palliative care
2
Q
Types of treatment
A
- Surgical
- Radiotherapy
- Chemotherapy
- Cytotoxic agents
- Hormonal therapies
- Immunomodulation
- Targeted treatments
- Biological therapies
3
Q
A
4
Q
The terminology of describing chemotherapy
A
- Induction- high dose combination chemotherapy, given with the intent of inducing a complete remission when initiating curative chemotherapy
- Consolidation- repetition of the induction regimen, with the intention of increasing cure rate or prolonging remission
- Intensification- chemotherapy after complete remission, often with higher doses and/or alternate combinations, with the intention of increasing cure or remission duration
5
Q
Terminology for describing chemotherapy (2)
A
- Maintenance- long term usually low dose or biological therapy in patients who have achieved complete remission, with the intention of delaying re-growth of micro-residual disease
- Adjuvant- a course of chemotherapy in patients with no evidence of residual cancer after surgery or radiotherapy, given with the intent of destroying any residual tumour cells
- Neo-adjuvant- a course, usually shorter than adjuvant chemotherapy, given with the intent of down-sizing the primary tumour to make it more amenable to surgery or radiotherapy
6
Q
Terminology for describing chemotherapy (3)
A
- Palliative- chemotherapy is given to control symptoms or prolong life in patients in whom cure is unlikely
- Salvage- potentially curative combination chemotherapy given to patients who have failed or recurred after curative chemotherapy
7
Q
Principles of chemotherapy
A
- re watch
8
Q
Chemotherapy treatment (SCLC)
A
9
Q
Examples of common chemotherapy regimens
A
10
Q
Principles of combination chemotherapy- a selection of drugs for combinations
A
- Drugs with known single-agent activity- drugs with the potential for complete remission should be included
- Drugs with different mechanisms of action
- Groups of drugs which have shown additive or synergistic activity
- Drugs with different dose-limiting toxicities, so that individual agents can be given at their maximum dose, without overlapping toxicities so minimising the damage to anyone organ
- Drugs should be used at their optimal dose and schedule
- Drugs with different patterns or mechanisms of cellular resistance should be combined to minimise cross-resistance
- The treatment-free interval should be minimised with the cycle length been the shortest recovery time of the most sensitive normal tissue
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11
Q
First-line chemotherapy for advanced malignant disease: treatment intent
A
12
Q
Cancer tends to involve multiple mutations
A
- Benign tumour cells grow only locally and cannot spread by invasion or metastasis
- Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites
13
Q
Why does chemotherapy fail
A
- Failure to achieve log kill
- Existence of multiple resistant or non-responsive clones
- Tumour sanctuary sites- brain, testes
- Pharmacological- altered, by mutation or up or down-regulation of required proteins; drug activation/inactivation
- Increased repair of drug-induced cell damage
- Altered drug targets
- Utilisation of alternative intra /intercellular pathways
14
Q
How cancer develops resistant to the P-gp pump
A
- Over expression of MDR1 (multi-drug resistant) gene which encodes for a cell surface P-gp
- This is an energy dependent flux pumps which naturally removes toxins or endogenous metabolites from the cell
- Tumours that intrinsically express the MDR1 gene prior to chemotherapy are characteristically resistant to chemotherapy from the outset
15
Q
More lines of chemotherapy
A
- There has been massive increase in utilization fo chemotherapy
- Around 60% in 4 years
- Undoubted benefits for many thousands of patients
21
Q
Routes of administration
A
