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Immunology Drugs > Principles of Chemotherapy > Flashcards

Principles of Chemotherapy Flashcards

1
Q

What are the possible approaches to the management of cancer?

A

Surgery
Radiation
Chemotherapy

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2
Q

What does the approach to management depend on?

A

The type of cancer

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3
Q

What is neoadjuvant chemotherapy?

A

Chemotherapy that is given before the surgery to shrink tumour

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4
Q

What is adjuvant chemotherapy?

A

Chemotherapy that is given to treat or prevent micro-metastases after the surgery and radiation treatment

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5
Q

What is maintenance chemotherapy?

A

Chemotherapy that is given at lower doses to prolong remission/prevent recurrence of tumour

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6
Q

What is palliative chemotherapy?

A

Chemotherapy that is given when neoplasms are disseminated and not amenable for surgery

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7
Q

What are the characteristics of cancer cells?

A

Uncontrolled proliferation
Immortalisation
Loss of function
Invasiveness & Metastasis
Neovascularization

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8
Q

what is Gompertzian Kinetics?

A

Slow linear growth at smallest and largest tumor sizer
Exponential growth in between

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9
Q

What is the “Log Kill” Hypothesis?

A

Drugs are given at a specific dose kills the same fraction of cancer cells every time, independent of the total number of cancer cells

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10
Q

Why is the “Log Kill” Chemotherapy treatment given in repeated doses?

A

Only a fraction of the cells die with each dose so there has to be repetition in order to continue on reducing the size of the tumour.

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11
Q

What controls/limits the chemotherapy cycle of the “Log Kill” chemotherapy?

A

The toxicity to the patient

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12
Q

What is the one thing that you cannot prevent with the “Log Kill” chemotherapy?

A

There will be a fraction of cells that will “rebirth” in between cycles

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13
Q

What does the fraction of cell killed vary on?

A

The cell growth rate

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14
Q

What is the solution for the “disadvantages” of the “Log Kill” chemotherapy?

A

Combination therapy and repeated cycles of treatment

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15
Q

Why is combination therapy more effective than monotehrapy?

A

Different drugs may be effective against a particular tumour via different mechanisms

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16
Q

What is the method used in order to avoid cumulative adverse effects?

A

Drugs of different toxicities can be used

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17
Q

What is another “advantage” of combination therapy?

A

The use of different drugs decreases the risk of resistance to the chemotherapy regimen

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18
Q

What are the problems of anticancer chemotherapy?

A

Lack of highly selective toxic agents
There are once a few selective drug targets
Adverse effects
Resistance

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19
Q

What are the adverse effects of anti-neoplastic drugs?

A

They affect and destroy rapidly dividing normal cells

Very narrow therapeutic index, serious side effects observed during therapeutic index as well

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20
Q

What are examples of normal rapidly dividing cells targeted by anti-neoplastic drugs?

A

Bone marrow
Gut epithelium
Spermatogenic cells
Lymphoid tissue
Hair follicles
Fetus

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21
Q

What are the most common side effects of antineoplatics?

A

Severe GI disturbances
Severe stomatitis
Alopecia

Toxicities such as myelosuppression & immunosuppression

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22
Q

Some toxicities are specific to:

A

Certain drugs

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23
Q

What are the specific side effects of Cisplatin?

A

Ototoxicity
Nephrotoxicity
Nausea/Vomiting

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24
Q

Which drug has the specific side effect of cardiotoxicity?

A

Doxorubicin/Daunorubicin

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25
Q

What is the specific side effect of Bleomycin/Busulfan?

A

Pulmonary toxicity

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26
Q

Which drug has specific side effect of hemorrhagic cystitis?

A

Cyclophosphamide/Ifosfamide

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27
Q

Which drugs have the common side effect of peripheral neuropathy?

A

Oxaliplatin
Vincristine
Taxanes

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28
Q

What is the specific side effect of Irinotecan?

A

Diarrhea

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29
Q

What are the different kinds of resistance that may develop?

A

Innate or Acquired

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30
Q

What is innate resistance?

A

Most of the cells in the tumour are resistant to initial treatment

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31
Q

What is acquired resistance?

A

Initial treatment kills the cells in the tumour and the later cells become resistant to the next cycles

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32
Q

What are the two categories of antineoplastic drugs?

A

Cell-cyle phase independent drugs
Cell-cycle dependent drugs

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33
Q

Which kind of antineoplastic drugs have the concentration dependent effect?

A

Cell-cycle phase independent drugs: as dose increases so does cell kill

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34
Q

What are examples of non-cell cycle specific drugs?

A

Alkylating gents
Antitumor antibiotics
Nitrosoureas

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35
Q

What are examples of M phase inhibitors?

A

Vinblastine
Vincristine
Paclitaxel

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36
Q

What are examples of S-phase specific drugs?

A

Cytarabine
Mercaptopurine
Thioguanine
Fluorouracil
Methotrexate
Hydroxyurea
Irinotecan
Etoposide

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37
Q

How are the growth promoting hormones stopped?

A

Anti-hormones

38
Q

How is the tumor blood supply inhibited?

A

Angiogenesis inhibitors

39
Q

How is DNA synthesis inhibited?

A

Antimetabolites

40
Q

How is DNA production inhibited?

A

DNA alkylating agents and topoisomerase inhibitors

41
Q

How are proteins inhibited?

A

Tyrosine kinase inhibitors
Monoclonal antibodies

42
Q

How is microtubule assembly inhibited?

A

Tubulin-binding drugs

43
Q

What are examples of alkylating agents & related compounds?

A

Nitrogen mustards
Platinum compounds

44
Q

What is an example of nitrogen mustard?

A

Carmustine

45
Q

What is an example of platinum compounds?

A

Cisplatin

46
Q

What are alkylating gents?

A

Contain chemical groups that can form covalent bonds with particular substances in the cell, DNA, RNA & proteins

47
Q

What are some of the side effects of alkylating agents?

A

They kill rapidly proliferating normal cells and also kill non-proliferating cells because of the bond they create with the DNA, RNA and proteins

48
Q

What are the examples of cytotoxic antibiotics?

A

Anthracyclins
Bleomycins

49
Q

What is an example of anthracyclins and bleomycin?

A

Anthracyclins: doxorubicin
Bleomycins: bleomycin

50
Q

What are the cytotoxic agents?

A

Drugs that owe their antineoplastic actions to their interactions with DNA (intercalation and cross-linking)

51
Q

Hormones and Hormone Antagonists are an example of:

A

Endocrine Therapy of Cancer

52
Q

Which tumors might be hormone-dependent?

A

Tumors derived from hormone-sensitive tissues like breast and prostate

53
Q

Growth of hormone dependent tumors can be inhibited by: ?

A

Hormone antagonists
Agents inhibiting the synthesis of relevant hormones

54
Q

What are examples of Hormone antagonists?

A

Tamoxifen in breast cancer

55
Q

What are examples of agents that inhibit the synthesis of relevant hormones?

A

Aromatase inhibitors that block oestrogen synthesis in breast cancer

56
Q

What is an example of aromatase inhibitor?

A

Anastrozole

57
Q

What is the main advantage of endocrine therapy?

A

Far fewer serious adverse effects than cytotoxic agents

58
Q

What are examples of antimetabolites?

A

Folate antagonists
Pyrimidine analogues
Purine analogues

59
Q

What is an example of folate antagonists?

A

Methotrexate

60
Q

What is an example of pyrimidine analogues?

A

5-fluorouracil

61
Q

What is an example of purine analogues?

A

6-mercaptopurine

62
Q

What are anti-metabolites?

A

They are structurally related to normal cellular components, for instance metabolites for DNA synthesis

63
Q

What is the MOA of anti-metabolites?

A

They interfere with the availability of normal metabolites. Inhibit utilisation of the natural metabolite, for instance; DNA synthesis

64
Q

What is folic acid?

A

An essential dietary factor that is converted by DHFR to a series of FH4 co-factors that are required fro the synthesis of DNA and RNA

65
Q

How do anti-metabolites (folate inhibitors specifically like Methotrexate) relate to folic acid and DNA synthesis?

A

Anti-folates inhibit DHFR and thus DNA synthesis and replication.

66
Q

What are the side effects of Methotrexate?

A

Can lead to hematological disturbances like anemia that mimic folic acid deficiencies

67
Q

What is the solution for the Methotrexate disadvantage?

A

Administering Folinic acid which by-passes the inhibited DHFR enzyme

68
Q

What is the name of the Folinic acid?

A

Leucovorin

69
Q

Tubulin/Microtubule Binding Agents are examples of:

A

Mitotic Inhibitors

70
Q

What are examples of Tubulin/Microtubule binding agents?

A

Vinca Alkaloids
Taxanes

71
Q

What are examples of Vinca Alkaloids?

A

Vincristine and Vinblastine

72
Q

Where are vincristine and vinblastine found?

A

Periwinkle plant

73
Q

What is the MOA of Vinca alkaloids?

A

They bind tubular & prevent its polymerization into microtubules

Prevention of spindle formation in cells at mitotic stage

Cells are arrested at metaphase

Cells cannot complete mitosis and die

74
Q

what is an example of taxanes?

A

Paclitaxel

75
Q

What is the MOA of taxanes?

A

Microtubules are stabilised by taxanes:

Taxanes bind to microtubules and inhibit depolymerization into tubules.

Cells remain in metaphase

Cannot divide into daughter cells

76
Q

Where do taxanes come from?

A

Yew tree

77
Q

What is the function of Topoisomerase Enzymes?

A

Topoisomerase I and II are necessary for DNA replication

78
Q

What is the function of Topoisomerase Inhibitors?

A

They cause irreversible DNA breaks, leading to apoptosis and anti-cancer effect

79
Q

What are examples of Topoisomerase I Inhibitors?

A

Camptothecins

80
Q

What are examples of Camptothecins?

A

Topotecan & Irinotecan

81
Q

What are examples of Topoisomerase II Inhibitors?

A

Epipodophyllotoxins

82
Q

What are examples of Epipodophyllotoxins?

A

Etoposide & Teniposide

83
Q

What are Miscellaneous Anti-neoplastic Drugs?

A

Biological or Targeted Therapies

84
Q

What are examples of Biological or Targeted Therapies?

A

Angiogenesis Inhibitors
Tyrosine Kinase Inhibitors
Monoclonal Antibodies
Immunotherapies

85
Q

What is an example of angiogenesis inhibitors?

A

Avastin

86
Q

What is the function of angiogenesis inhibitors?

A

Designed to stop tumors from developing a blood supply which is a pre-requisite for tutor growth and metastasis

87
Q

What are examples of tyrosine kinase inhibitors?

A

Imatinib and Geftinib

88
Q

What is the function of tyrosine kinase inhibitors?

A

Inhibition of phosphorylation of growth-promoting proteins

89
Q

What is an example of monoclonal antibodies?

A

Trastuzamab

90
Q

What is the function of monoclonal antibodies?

A

Neutralise the actions of growth factor receptors signalling that promote cancer growth

Example: HER2 in breast cancer

91
Q

What is an example of Immunotherapies?

A

Interferon; Checkpoint Inhibitors

92
Q

What is the function of immunotherapies?

A

Designed to boost the body’s natural defense to fight cancer

Immunology Drugs (7 decks)

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