Principles of systemic anti-cancer therapy

Question 1

List the main types of cancer therapy.

Answer 1

Surgery
Hormone therapy
Radiotherapy
Systematic anti-cancer therapy
- cytotoxic chemo
- biological therapy (targeted or immunotherapy)

Question 2

What are the 2 main factors that influence the growth rates of tumours?

Answer 2

• Type of cancer

- Stage of disease

Question 3

what is the difference in DOUBLING TIME between acute leukaemia and breast cancer?

Answer 3

Acute leukaemia 2 weeks vs breast cancer 2-4 months

Question 4

Characteristics of presence of malignancy (cancer)?

Answer 4

Doubling time of 30
1-2 cm mass, 1 g
10^9 cells

Question 5

Lethal solid tumour mass volume?

Answer 5

1 x 10^12 cells

Question 6

What are the implications of chemotherapy given to sensitive cells ?

Answer 6

• 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

Question 7

What are the 4 ways chemotherapy can be used?

Answer 7

Curative
Adjuvant
Neoadjuvant
Palliative

Question 8

WHEN and WHY is an ADJUVANT used in chemo?

Answer 8

WHEN: Given after definite treatment (surgery/radiotherapy)

WHY: To improve cure rate and eradicate metastasis

Question 9

WHEN and WHY is a NEOADJUVANT used in chemo?

Answer 9

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

Question 10

WHY palliative chemo used ?

Answer 10

Used to control symptoms and improve QoL

doesn’t always prolong life but can in some cases

Question 11

Prescribing of cancer drugs

Answer 11

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

Question 12

Advantages of oral chemotherapy?

Answer 12

• More convenient for patient
• Less toxicity
• it’s cheaper (most cases, depends on drug)
• Avoids complications of IV access

Question 13

Disadvantages of oral chemotherapy?

Answer 13

• Adherence
• Variable pharmacokinetic profie (PK)
• More management of drug interactions
• Nausea and vomitting

Question 14

How are doses calculated for cancer drugs?

Answer 14

• Using BSA
• Many hospital trusts using Dose Banding

TDM (therapeutic dose monitoring - measures conc. of drug in the bloodstream) not routinely carried out

Question 15

In terms of metabolism and excretion , how does patient variability vary in terms of the drug?

Answer 15

• Varying levels of oral absorption
• Renal and hepatic function
• Genetic differences
• Drug interactions (taking a combo of diff meds)

Question 16

Key 2 principles in monitoring for cancer drugs ?

Answer 16

1. Measure response
   - Tumour markers
   - Imaging
2. Monitor toxicity
   - U&Es (renal and LFTs)
   - FBC
   - Weight
   - Toxicity/symptom review

Question 17

Where do biological therapies derive from? What are examples of biological therapies?

Answer 17

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

Question 18

List the mechanisms of action for targeted therapies

Answer 18

Induce immune response
Induce apoptosis

Inhibit angiogenesis
Inhibit cancer cell growth
Inhibit hormone dependent growth

Release cytotoxic agents at site of action

Question 19

What is the major obstacle of curing cancer with drugs ?

Answer 19

Drug resistance

3 types: Intrinsic
Acquired
Cross resistance

Question 20

What standards are used for Clinical Pharmacy Verification of systemic anticancer therapy ?

Answer 20

BOPA standards

British Oncology Pharmacy Association