principles of cancer treatment Flashcards
what is systemic anticancer therapy? 4 of them
- Cytotoxic chemotherapy
- Biological (targeted) therapies
- Hormonal therapies
- Immunotherapy
what is the general principle of cancer chemo?
Chemotherapy is a chemical that is toxic to multiplying cells (in the cell cycle)
Do all chemotherapy drugs work the same way?/place?
Different chemotherapy drugs affect different stages
of the cell cycle
Hence chemotherapy protocols often have a
combination of treatments
what does FOLFOX contain?
- Oxaliplatin (alkylating agent) – non cell cycle
specific - Fluorouracil (antimetabolite) – cell
cycle specific
what is cell cycle non-specific chemo?
- Kills cell at all phases of cell cycle, including resting
- Often given as a large bolus dose on day 1
works even when cells are resting and not dividing- will kill cells no matter what phase they are in
what is cell cycle specific chemo?
- Kills cell at specific point in cell cycle
- Often given more than once over several days
- Can be given as continuous infusion over several days
this is a more targeted type of chemo
what level does chemotherapy need to reach in order to work?
Chemotherapy needs to reach a high enough level in the blood to kill cancer cells but not too much so that the patient cannot tolerate it
what is the benefit of repeated administration of chemotherapy?
Repeated administration results in a proportional cell kill
* Tumour burden may be reduced to undetectable levels
* Further courses required to reduce tumour cell count to an absolute minimum
when can cancer relapse?
when there is a few cells remaining and the body’s immune system cannot destroy it.
these cells regrow
how do we monitor the toxicity associated with chemotherapy?
frequent blood counts
close clinical support
why do we monitor toxicity?
as chemo will damage healthy cells too
what are the 4 different aims of chemo?
curative
adjuvant- after definitive treatment
neoadjuvant- prior to procedure eg shrink tumour
palliative- control symptoms and improve QOL
when does curative chemo work best?
in acute leukaemia
what do you have to consider when balancing the risks and benefits?
are they well enough to have this chemo?
how can they manage their side effects?
how do cells become resistant to chemo?
some cells that are left over are able to mutate and develop resistance to the drug/ learn how to repair their DNA breaks
how long is chemo usually given for?
usually 3-4 week time period
what does the number of cycles depend on?
depends on treatment intention and may vary for different cancers
how does metabolism and excretion vary between patients?
- Renal and hepatic function
- Absorption orally
- Drug interactions
how does toxicity vary?
- May be related to efficacy
- Treatment intention important when assessing
toxicities
what do we have to monitor during chemo?
monitor the response to treatment
toxicity review
how would you monitor the patients response to treatment?
- Dependent on:
– Disease
– Treatment intention - Tumour markers
- Imaging
how would you review a patients toxicity?
- Full blood count
- U&Es
– Renal function
– Liver function tests - Symptom review
- Weight
- Doses adjusted depending
on response to treatment
and blood profile
how can hormone therapy be used?
Can be used for hormone driven cancers
* To shrink a tumour
* To slow down or stop growth (instead of surgery or
radiotherapy), or reduce symptoms
* Combined with other treatments
* To make cancer less likely to return/spread
* To reduce the risk of breast cancer in healthy ‘at risk’
women
what is the general principle of hormone therapy?
Either reduce amount of hormone or antagonist at hormone receptor
how long do you give hormone therapy for? give an example
unlike chemo, tend to give for longer time periods
eg-surgery and adj chemo and tamoxifen- reducing the risk of returning for 10 years
- combination for best result
what is targeted therapy?
Targets the changes in cancer cells that help
them grow, divide, and metastasise
what are the variable MOA of targeted therapy?
– Induce immune response
– Inhibit cancer cell growth
– Inhibit angiogenesis
– Release cytotoxic agents at site of action
– Induce apoptosis
– Inhibit hormone dependent growth
what is the benefit of targeted therapy?
More precise treatment with (hopefully) fewer side effects
what are the two main types of targeted therapy?
Monoclonal antibody- MAB
Small molecule
how does monoclonal antibody targeted therapy work?
- Some block receptors on surface of cancer cell
- Some activate WBC (immunotherapy)
- Manufactured using living cells (biological therapy)
- Some delivery chemotherapy to cancer cells
- Normally IV every one to three weeks
how does small molecule targeted therapy work?
- Less specific than antibodies
- Most block kinase (tyrosine kinase inhibitors)
- Normally taken orally every day
what is immunotherapy and what are the 3 main groups?
- Treatment that works via the immune
system - Three main groups:
- Monoclonal antibodies
- Checkpoint inhibitors
- CAR T cell therapy
how does immunotherapy work?
normal T cells- normally help to identify and kill cancer cells
checkpoints turn T cells on and off
cancer cells can affect this function- as they keep them turned off
what is CAR T cell therapy?
removing normal T cells and reintroducing into blood in hope they can fight cancer
what is radiotherapy?
Radiotherapy uses high-energy rays, such as x-
rays, to treat cancer
It destroys cancer cells in the area where it is
given, but can also destroy healthy cells in
that area
why may radiotherapy be given?
– Radical
– Chemoradiation
– Adjuvant
– Neoadjuvant
– Palliative
what are the two types of radiotherapy?
external beam- using machine to aim beams at cancer
internal beam- from inside the body- eg radioactive liquid-iodine- accumulates in thyroid
when may surgery be used?
– diagnose cancer
– remove cancer
– find out how big the cancer is and if it has spread to other
parts of the body
– control symptoms of cancer
– restore parts of the body (for example, bladder
reconstruction)
– improve the appearance of part of the body (for example,
breast reconstruction)
