Principles of Cancer Therapy

Question 1

Give the 6 key properties of cancerous cells

Answer 1

Self-sufficient growth signals 
Insensitivity to anti-growth signals 
Evade apoptosis
Sustained angiogenesis
Limitless replicative potential 
Tissue invasion and metastases

Question 2

What is a neoadjuvant therapy?

Answer 2

Administration of a therapeutic agent before definitive treatment to shrink tumors and optimise outcomes.

Question 3

What is an adjuvant therapy?

Answer 3

Treatment given after the initial treatment in order to reduce the risk of disease recurrance

Question 4

What is palliative therapy?

Answer 4

Treatment to relieve symptoms and improve quality of life

Question 5

What is chemotherapy?

Answer 5

Treatment of cancer using drugs. The drugs will target wither the chemistry of nucleic acids, DNA/RNA production or the mechanics of cell division. The damaged cell is unable to repair itself so goes through apoptosis.

Question 6

Describe the mechanism of 5-FU

Answer 6

Inhibits thymidylate synthase which reduced DNA and RNA synthesis

Question 7

Describe the mechanism of alkylating agents

Answer 7

Bind to DNA so cell can no longer function

Question 8

Describe the mechanism of Cisplatin

Answer 8

Binds to DNA and inhibits synthesis

Question 9

Describe the mechanism of topoisomerase inhibitors

Answer 9

Cleave DNA at abnormal sites and promote mutations which will trigger cell death

Question 10

Describe mechanisms that a cancer cell can become resistant to chemotherapy

Answer 10

Decreases uptake of drug 
Increases drug metabolism 
Increases efflux 
Alters cell cycle checkpoints 
Alters drug targets
Impairs the apoptotic pathway

Question 11

How are chemotherapy drugs dosed?

Answer 11

BMI

Liver/renal function

Question 12

What ways can chemotherapy be administered?

Answer 12

IV 
SC
PO 
Intralesional 
Intrathecal
Topical 
IM

Question 13

Give 5 side effects of chemotherapy

Answer 13

Hair loss 
Pneumonitis
PE
Peripheral neuropathy 
Fatigue 
Electrolyte disturbance
Cardiomyopathy 
Vomiting 
Deranged LFTs
Mucositis
Myelosuppression 
Rash 
Diarrhoea/constipation 
AKI
Hemorrhagic cystitis
Decreased fertility 
Decreased libido

Question 14

What are immunotherapy and targeted therapies?

Answer 14

Drugs which use the immune system to recognise, target and destroy cancer cells.

Question 15

What are passive immunotherapy drugs?

Answer 15

Ex-vivo activated cells, molecules once found inside the body given to compensate for missing or deficient immune functions.

Question 16

What are active immunotherapy drugs?

Answer 16

Stimulates in vivo functions. Requires patients immune system to be able to respond, be stimulated and then mediate effector functions.

Question 17

Give examples of passive immunotherapy agents

Answer 17

Tumour specific monoclonal antibodies
Cytokines
Adoptive cell transfer

Question 18

Give examples of active immunotherapy agents

Answer 18

Checkpoint inhibitors
Oncolytic vaccines
Peptide vaccines
DC vaccines

Question 19

What is the mechanism of a monoclonal antibody?

Answer 19

Bind to a specific antigen on the cancer cell surface to block signalling pathways and stop cell proliferation.

Question 20

Give an example of a monoclonal antibody

Answer 20

Eg. HER2 inhibitor (Herceptin), VEGR inhibitor (Bevacizumab), EGFR inhibitor (Cetuximab)

Question 21

Give 3 side effects of monoclonal antibodies

Answer 21

Skin toxicity 
Poor hair growth 
Pruritus
Fatigue
GI perforation 
Myelosuppression 
Diarrhoea
Nausea
Hypertension 
Cardiac ischaemia