Principles of cancer therapy Flashcards
What is the role of the cancer MDT?
Standardise Continuity Reduce delays Communication Recruitment to clinical trials Education
Neoadjuvant meaning
Chemo/radio given before definitive surgery/radio to optimise outcomes
Adjuvant meaning
Treatment after definitive surgery/radio to reduce recurrence
Maintenance treatment
Maintain remission or slow growth after initial treatment
Curative treatment
Aims for no detectable cancer after treatment
Usually means a systemic treatment because of micro-mets
Palliative treatment
To relieve sx + improve QoL, can affect prognosis but not lead to cure
Performance status
0-asymptomatic
1-fully mobile but restricted in strenuous activity
2-mobile, self-care, but can’t do work activities, in bed <50% of the day
3-limited ability t self-care, in bed/chair >50% of the day
4-completely disabled, not able to self-care
5-dead
How can cancer cells acquire resistance to chemo?
- Efflux pumps
- Reduced drug uptake
- Increased drug metabolism
- Alteration of cell cycle checkpoints
- Impaired apoptosis
- Altered drug target morphology
How do they try to prevent chemo resistance?
- Combination of drugs based on action + not overlapping toxicities
- Some toxicity permissible as need maintained doses when cure realistic
Why are bone marrow cells very sensitive to cytotoxics?
BM cells (+ other rapidly dividing cells) omit the G0 (resting) phase, which is the phase where cytotoxics cannot act
Antimetabolite chemo?
E.g. methotrexate, gemcitabine, fluorouracil, capecitabine
Act at G1 by inhibiting/mimicking DNA bases
Anthracycline chemo
E.g. doxorubicin
Acts at G1 by affecting mitochondrial DNA thus energy generation, and at S phase by inhibiting DNA topoisomerase
Alkylating agents
E.g. cyclophosphamide
Act at S phase by binding DNA helix preventing transcription
Anti-tumour antibiotics
E.g. bleomycin
Act at S phase - break DNA strands
Platinum compounds
E.g. cisplastin
Act at S phase - bind to nucleotide bases = deform double helix
Vinca alkaloids
E.g. vincristine
Act at G2 by inhibiting microtubules and also affect the M phase
Topoisomerase inhbitros
E.g. topotecan
Act at G2 by inhibiting microtubules and also affect the M phase
Taxanes
E.g. docetaxel
Act at G2 by inhibiting microtubules and also affect the M phase