Principles of systemic anti-cancer therapy Flashcards
• Be aware of the role of systemic anti-cancer treatment in the management of malignant disease • Be familiar with the types of systemic anti-cancer treatments • Know how systemic cancer treatment is prescribed and the steps involved in clinical verification by a pharmacist.
List the main types of cancer therapy.
Surgery Hormone therapy Radiotherapy Systematic anti-cancer therapy - cytotoxic chemo - biological therapy (targeted or immunotherapy)
What are the 2 main factors that influence the growth rates of tumours?
- Type of cancer
- Stage of disease
what is the difference in DOUBLING TIME between acute leukaemia and breast cancer?
Acute leukaemia 2 weeks vs breast cancer 2-4 months
Characteristics of presence of malignancy (cancer)?
Doubling time of 30
1-2 cm mass, 1 g
10^9 cells
Lethal solid tumour mass volume?
1 x 10^12 cells
What are the implications of chemotherapy given to sensitive cells ?
- Cell death (with repeated administration)
- Tumour burden may reduced to undetectable levels (under 10^9 cells)
- NORMAL immunosurveillance can achieve a cure in sensitive cells
What are the 4 ways chemotherapy can be used?
Curative
Adjuvant
Neoadjuvant
Palliative
WHEN and WHY is an ADJUVANT used in chemo?
WHEN: Given after definite treatment (surgery/radiotherapy)
WHY: To improve cure rate and eradicate metastasis
WHEN and WHY is a NEOADJUVANT used in chemo?
WHEN: Given prior to definite treatment
WHY: To aid/facilitate the procedure, improve cure rate
Sometimes to shrink large tumours to make it more operable
WHY palliative chemo used ?
Used to control symptoms and improve QoL
doesn’t always prolong life but can in some cases
Prescribing of cancer drugs
Prescribed in cycles
- Usually 3-4 weeks per cycle
- May all be given on day 1 or can
be given at different time points within
the cycle
Advantages of oral chemotherapy?
- More convenient for patient
- Less toxicity
- it’s cheaper (most cases, depends on drug)
- Avoids complications of IV access
Disadvantages of oral chemotherapy?
- Adherence
- Variable pharmacokinetic profie (PK)
- More management of drug interactions
- Nausea and vomitting
How are doses calculated for cancer drugs?
- Using BSA
- Many hospital trusts using Dose Banding
TDM (therapeutic dose monitoring - measures conc. of drug in the bloodstream) not routinely carried out
In terms of metabolism and excretion , how does patient variability vary in terms of the drug?
- Varying levels of oral absorption
- Renal and hepatic function
- Genetic differences
- Drug interactions (taking a combo of diff meds)
Key 2 principles in monitoring for cancer drugs ?
- Measure response
- Tumour markers
- Imaging - Monitor toxicity
- U&Es (renal and LFTs)
- FBC
- Weight
- Toxicity/symptom review
Where do biological therapies derive from? What are examples of biological therapies?
Use substances derived from living organisms or laboratory-synthesised versions of the substance
E.g. monoclonal antibodies (mAb)
Cancer vaccines
Cancer growth blockers
Immunotherapy
Gene therapy
List the mechanisms of action for targeted therapies
Induce immune response
Induce apoptosis
Inhibit angiogenesis
Inhibit cancer cell growth
Inhibit hormone dependent growth
Release cytotoxic agents at site of action
What is the major obstacle of curing cancer with drugs ?
Drug resistance
3 types: Intrinsic
Acquired
Cross resistance
What standards are used for Clinical Pharmacy Verification of systemic anticancer therapy ?
BOPA standards
British Oncology Pharmacy Association
