ONCOLOGY Flashcards
what is cancer?
Uncontrolled cellular growth- gene translocation, tumor stem cell repeat cell growth, proliferation. Radiation, Viral- turn on genes
What is definite goals for cures of cancer?
Must eradicate all cancer cells. Control of Cancer. Palliation-relief of SX. 50% of pts cured. 10% cured w/ chemo
What are treatments for Cancer?
surgery, radiation, chemo-drugs, hormonal, immunotherapy, molecular targeted therapy
What is most effective and traditional modality?induction therapy?
induction therapy. Other Neoadjuvant-B4, Adjuvant
Why does cancer inc fast, then plateau?
Environment either space of lack of metabolism ceases, thus sx start to occur.
Why is chemo given in cycles?
Time for health cells to recover. Chemo response depend on tumor growth curve. Maximizes malignant cell kill. DEC drug resistance
What is chemo schedule and dosing based on?
Body surface area using ht and wt
How do tumor cell become resistant
- Primary- non response 2. Acquired-MDR1 gene make protein to efflux the drug. like erythromycin
Describe the cell cycles?
G0- resting G1- makes proteins for DNA S- DNA replication G2-components for mitosis M- mitotic cell divides
What occurs if the cell detect DNA damage?
Cell cycle stops at check point 1 and after G2 p53 triggers apoptosis
How do drugs use the cell cycle?
RX either 1. cell cycle specific-ONLY for replicating cells or Cell cycle non specific- active in proliferating and resting phase
What CCSA affect G1-S phase?
Topoisomerase II inhib G1-S- Etoposide
What CCSA affect S phase?
Antimetabolites- MTX purine etc
What agents CCSA block G2-M phase?
Topoisomerase I- -otecan,
What agents affect the M phase?
Taxanes- taxels
What agent affect eh microtubules during M phase?
Tubulin interactive agents- stines
What agent act in both cell and non cell cycle?
Antitumor ABX- Bleomycin-Mphase ONLY
What agents are Cell cycle Nonspecific?
Alkylating-zine+ 2. Antitumor 3. Platinum-platin 4 Anthracycline-rubicin
What do hormonal agents affect?
Growth G1
All chemotherapy may have this ADE?
- Myelosuppression- BM neutropenia falls 1. 5-7, 2. nadir lowest point at 7-10 day 3. Recover 14-26 day (hence chemo 21-28 cycle . Anemia, Thrombocytopenia B. GI-MTX d/t cell turnover fast and die fast, SEVERE N/V/D, constipation C. Alopecia- rapid turnover cells D- Paresthesia
What agent attache an analog like guanin to DNA to break or link DNA strands so the cell cannot read DNA correctly? What are results
Cyclophosphamide Ifosfamide- Alkylating
How do cells build resistance to Alkylating agents?
- INC repair of DNA 2. DEC uptake of RX 3. INC glutathione
WHat is MC unique ADE from Cyclophosphamide?
Hemorrhagic cystitis and severe N/V D/t Acrolein metabolite
What agent that is alkylating causes skin pigmentation, pulmonary fibrosis, and adrenal dfx?
Busulfan
What are mech to prevent hemorrhagic?
MESNA-mercaptoethanesulfonate Na- binds to acrolein in bladder to form nontoxic and excretion
What agents are similar in crosslinking DNA straing like alkylating agents, disrupts DNA synthesis, and any cell cycle phase?
Cisplatin, Carboplatin, Oxaliplatin
Which platin requires saline sol, avoid if SCr>1.5, with the MOST N/V, Ototoxicity, Peripheral neuropathy
Cisplatin
Which platin cause thrombocytopenia?
Carboplatin
Which platin cause neurological abnormal sensation to cold, Remind pt to where gloves, moisturize avoid cold,. may lead to sensory loss?
Oxaliplatin
This agent are ferment of species of streptomyces and inhibit topoisomerase?
Antitumor ABX-Doxorubicin, Epirubicin, Bleomycin
What are the most concerning ADEs in antitumor ABX?
Cardiotoxicity, flushing
Which antitumor toxicity agent causes pulmonary issue, avoid COPD, and causes hyperpigmentation of the hands?
Bleomycin
Why are ECG baseline required for Doxorubicin and Daunorubicin?
*IRREversible cardiotoxicity- Arrhythmias, dilated cardiomyopathy, CHF- Risk: elderly, children, female, HTN. AVOID if ejection fraction <45%, angina, arrhythmia, or MI
What dose should not be exceed in DD, if given previous radiation therapy involved in heart?
550mg if
What can protect heart with Doxo and Dauno?
Iron chelator-Dexrazoxane
What agents cause palmar erythrodysesthesia and red color urine?
Doxorubicin and Daunorubicin
What agents are antimetabolites that interfere with DNA RNA formation, thus inhibiting enzymes important to DNA synthesis>
ANTIMETabolites- Folate: MTX, Pemetrexed, Pyrimidine- KFU, Capecitabine, Gemcitabine
Which antimetable are for colon and breast?
5FU and Capecitabine
MTX inhibits dihydrofolate reductase, but this leads to what ADE?
Stomatitis, mucosit, skin, myelosuppression. Renal toxic, Hepatotoxicity, pulmonary fibrosis
WHich agent will rescue host tissue from MTX relying on fact that some cancer cells do not express folate and cannot take up?
LEUCOVORIN. Give in combo* to DEC MTX toxicity in high dose
WHat agent is used w/ planttinum TX for lung cancer and Folic and B12 reduce toxic?
PEMETREXED
What pyrimidine analog blocks DNA and is used as cream for actinic keratosis for basal cell carcinoma?
5 fluorouracil- ADE Hyperpigmentation. Hand foot syndrome
WHat is the antidote for OD of 5FU
Uridine Triacetate-prevent cell death via RNA
Which agent has less ADE of common antimetabolite and converts to 5-FU in liver?
CAPECITABINE
What agents are derived from periwinkle vinca alkaloid plant and inhibit tubulin in mitosis during M phase?
Vinblastine, Vinorelbine, Vincristine
Which vinca alkaloid cause paresthesia in fingers and toes, stocking glove like?
VINCRISTINE- vesicants can escape from vein
What agents are derived from periwinkle vinca alkaloid plant and enhance tubulin polymerization inhibiting mitosis during M phase?
Paclitaxel and Docetaxel- peripheral neuropathy, Allergic rxn, PRE trex with antihistamine, steroids.
Which antimicrobic has less ADE?
Albumin bound paclitaxel nanoparticle
Which agent used G2/M cell cycle, uses microtubule, but has LESS drug resistance d/t efflux and affinity?
ERIBULIN- from marine sponge
What is ADE of Eribulin?
QT prolong and Peripheral neuropathy
Which taxane has poor affinity multidrug resistance in resistant tumors?
CABAZITAXEL
This agent inhibit topoisomerase, which inhibit unwinding of DNA strand w/ ADE of neutropenia?
Topotecan-ovarian cancer
This TOP I has diarrhea toxicity?
Irinotecan- colon
WHat dose Etoposide Topoisomerase II inhib treat?
LUNGs
