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(LUSUMA) Clinical Pharmacology & Therapeutics > S7) Cancer Chemotherapy > Flashcards

S7) Cancer Chemotherapy Flashcards

1
Q

What is the aim of chemotherapy?

A

The aim of chemotherapy is to kill/prevent replication of tumour cells at a greater rate than normal healthy tissue

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2
Q

What is the role of chemotherapy?

A
  • Curative

OR

  • Palliative
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3
Q

When is chemotherapy usually given?

A
  • Given as an adjunct to surgery/radiotherapy

OR

  • Given in isolation
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4
Q

What are the factors leading to increased tumour growth?

A
  • Increased growth fraction
  • Decreased duration of cell cycle
  • Decreased rate of cell loss
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5
Q

How can one classify tumours according to chemosensitivity?

A
  • High sensitivity
  • Modest sensitivity
  • Low sensitivity
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6
Q

Identify five types of high sensitivity tumours

A
  • Lymphomas
  • Germ cell tumours
  • Small cell lung tumours
  • Neuroblastoma
  • Wilm’s tumour
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7
Q

Identify five types of modest sensitivity tumours

A
  • Breast tumours
  • Colorectal tumours
  • Bladder tumours
  • Ovary tumours
  • Cervix tumours
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8
Q

Identify four types of low sensitivity tumours

A
  • Prostate tumours
  • Renal cell tumours
  • Brain tumours
  • Endometrial tumours
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9
Q

Identify the four groups of chemotherapy

A
  • Antimetabolites
  • Antibiotics
  • Alkylating/Platinating agents
  • Mitotic spindle inhibitors
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10
Q

Provide two examples of alkylating/platinating agents

A
  • Platinating – Cisplatin
  • Alkylating – nitrogen mustards e.g. Chlorambucil
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11
Q

Describe the mechanism of action of alkylating/platinating agents

A
  • Target DNA synthesis in G1/S phase
  • Forms covalent bonds with DNA nucleosides disrupting structure and preventing replication
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12
Q

Identify some specific ADRs of alkylating/platinating agents

A
  • Peripheral, sensory and motor neuropathy
  • High frequency ototoxicity
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13
Q

Describe the three possible mechanisms of resistance to alkylating agents

A
  • Decreased entry or increased exit of agent
  • Inactivation of agent in cell
  • Enhanced repair of DNA lesions produced by alkylation
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14
Q

Provide some examples of microtubule poisons

A
  • Vinca Alkaloids
  • Taxanes
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15
Q

Describe the mechanism of action of microtubule poisons

A
  • Target tubulin proteins in the mitotic phase
  • Chromosomes can’t align and separate into two daughter cells in synchrony
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16
Q

How do microtubule-binding agents affect microtubule dynamics?

A
  • Inhibit polymerisation
  • Stimulate polymerisation and prevent depolymerisation
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17
Q

Identify the specific ADR of microtubule poisons

A

Neurotoxicity: glove and stocking peripheral neuropathy

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18
Q

Provide an example of a glycopeptide antibiotic

A

Bleomycin

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19
Q

Describe the mechanism of action of glycopeptide antibiotics

A

Most effective in G2 stage:

  • Forms free radicals when chelated with Fe2+ which attack phosphodiester bonds in DNA
  • Results in cutting (scission) of DNA strands
20
Q

Identify the specific ADR of glycopeptide antibiotics

A

Pulmonary Fibrosis (10%)

21
Q

Provide an example of an anthracycline antibiotic

A

Doxorubicin

22
Q

Describe the mechanism of action of anthracycline antibiotics

A

Targets DNA synthesis in “S” phase:

  • Intercalate between the base pairs in DNA which interferes with transcription/replication
  • Topoisomerase II inhibition
  • Generate free radicals – damage DNA
23
Q

Identify the specific ADR of anthracycline antibiotics

A

Cardiotoxic

24
Q

Provide two examples of antimetabolites

A
  • Methotrexate
  • 5-Fluorouracil
25
Q

What is the mechanism of action of methotrexate?

A

Methotrexate inhibits dihydrofolate reductase, preventing DNA synthesis

26
Q

What is Tamoxifen?

A

Tamoxifen is a SERM (selective oestrogen receptor modulator) and acts as antagonist of the oestrogen receptor in breast tissue

27
Q

Describe the metabolism of Tamoxifen

A

Tamoxifen is a prodrug and is metabolised by liver to its active form which can competitively bind to oestrogen receptors

28
Q

Describe the mechanism of action of Tamoxifen

A

Tamoxifen causes cells to remain in the G0 and G1 phase of the cell cycle

29
Q

When can Tamoxifen therapy be used?

A

To be eligible for therapy those with breast cancer must be ER (oestrogen receptor) positive

30
Q

Identify some common side effects of Tamoxifen treatment

A
  • Hot flushes/sweats
  • Increased DVT/PE risk
  • Weight gain
  • Increased risk of endometrial cancer
31
Q

What is the predicted response to chemotherapy dependent on?

A
  • Performance score
  • Clinical stage
  • Prognostic factors/score
  • Molecular / cytogenetic markers
32
Q

What are the different routes of administration for chemotherapy?

A
  • IV
  • PO
  • SC (community setting)
  • Into a body cavity (bladder, pleural effusion)
  • Intralesional
  • Intrathecal (lumbar puncture / omaya reservoir – directly into ventricles)
  • Topical
  • IM (rarely)
33
Q

Identify some common side effects of chemotherapy

A
34
Q

Explain how acute renal failure occurs as a side effect of chemotherapy

A

Acute renal failure – hyperuricaemia caused by rapid tumour lysis leads to precipitation of urate crystals in renal tubules

35
Q

Vomiting is multifactorial but includes direct action of chemotherapy drugs on the central chemoreceptor trigger zone.

What are the different patterns of emesis?

A
  • Acute phase (4 - 12 hours)
  • Delayed onset (2 - 5 days later)
  • Chronic phase (persist up to 14 days)
36
Q

Mucositis is due to GI tract epithelial damage.

Where does it commonly occur?

A
  • May be profound and involve whole tract
  • Commonly worst in oropharynx
37
Q

Mucositis is due to GI tract epithelial damage.

How does this present?

A
  • Sore mouth/throat
  • Diarrhoea
  • G.I. bleed
38
Q

What causes variability in the pharmacokinetics of chemotherapy?

A
  • Abnormalities in absorption
  • Abnormalities in distribution
  • Abnormalities in elimination
  • Abnormalities in protein binding
39
Q

What is the result of the abnormalities in absorption?

A
  • Nausea
  • Vomiting
  • Compliance
  • Gut problems
40
Q

What is the result of the abnormalities in distribution?

A
  • Weight loss
  • Reduced body fat
  • Ascites
41
Q

What is the result of the abnormalities in elimination?

A
  • Liver dysfunction
  • Renal dysfunction
  • Other medication
42
Q

What is the result of the abnormalities in protein binding?

A
  • Low albumin
  • Other drugs
43
Q

Other drugs may increase plasma levels of the chemotherapy drug.

What are the important drug reactions that should be considered during chemotherapy?

A
  • Vincristine and itraconazole (common antifungal)
  • Capecitabine (oral 5FU) and warfarin
  • Methotrexate and penicillin, NSAIDs
  • Capecitabine and grapefruit juice
44
Q

Which three factors should be monitored during chemotherapy treatment

A
  • Response of cancer – radiological imaging, tumour marker blood tests, bone marrow/cytogenetics
  • Drug levels
  • Organ damage – creatinine clearance, echocardiogram
45
Q

What principles can one learn from the fractional kill hypothesis?

A
  • Bone marrow cells recover quicker than tumour cells
  • Hence a new dose of chemotherapy is given after bone marrow regeneration has occurred
46
Q

Provide two examples of vinca alkaloids

A
  • Vincristine
  • Vinblastine

(LUSUMA) Clinical Pharmacology & Therapeutics (29 decks)

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