Systemic Anti Cancer Therapy

Question 1

Describe the types of drugs used in cancer treatment.

Answer 1

• CYTOTOXIC - target DNA structure/segregation during mitosis
• TARGETED AGENTS - interact with specific molecular targets
• HORMONAL - involved in biochemical pathways related to hormone function
• BIOLOGICAL - macromolecules with specific target/can regulate immune response to kill tumor cells

Question 2

Describe the principles of chemotherapy.

Answer 2

• Cytotoxic agent administered
• Kills differentially - normal cell recovers whilst cancer cells die

Question 3

What are the aims of anti-cancer therapy?

Answer 3

• CURATIVE - preventative, treatment before surgery, concurrent treatment
• PALLIATIVE

Question 4

What patient factors are taken into account during anti-cancer therapy?

Answer 4

• Age
• Organ Function
• Co-morbidity
• Past medical history
• Toxicity response

Question 5

What significant process do cytotoxic cells disturb in cancer cells?

Answer 5

The cell cycle

Question 6

Describe anti-tumour antibiotics.

Answer 6

• Interefere with DNA function
• Several other mechanisms can occur e.g cell membrane alteration, topoisomerase inhibition
• EXAMPLES - Bleomycin, doxorubicin

Question 7

Describe alkylating drugs.

Answer 7

• Form methyl cross bridges between 2 strands of DNA base pairs
• Prevents DNA separation in cell division
• EXAMPLE: Cyclosphamide, platinum agents, dacarbazine

Question 8

Describe antimetabolites.

Answer 8

• Interfere with cell’s ability to utilise cellular metabolites
• Toxic effects induced
• EXAMPLES - methotrexate, 5FU, cytarabine

Question 9

What are some examples of plant derived cytotoxic drugs?

Answer 9

• VINCA-ALKALOIDS inhibit mitotic spindle formation by binding to bulin e.g Vincristine and Vinblastine
• EPIDOPHYLLOTOXINS interfere with topoisomerase II e.g etoposide
• TAXANES - inhibit mitosis by causing disorganised microtubule assembly

Question 10

What are the principles behind combination therapy?

Answer 10

• Avoid drugs with overlapping toxicities
• Administer drugs at optimal dose and schedule - determined in clinical trials
• Chemotherapy given at regular intervals - minimise time between cycles

Question 11

What are three ways chemotherapy is administered?

Answer 11

• Oral
• IV
• Intrathecal

Question 12

Give an example of a combination therapy for a small cell cancer.

Answer 12

• ETOPOSIDE + CARBOPLATIN/CYSPLATIN
• 4-6 cycles
• 3 weekly

Question 13

Give an example of a combination therapy given in non small cell cancers.

Answer 13

• Single agent carboplatin/cisplatin
• Added to non-platinum agents like Pemetrexed

Question 14

What types of healthy cells are most negatively affected by chemotherapy drugs?

Answer 14

• Rapidly dividing cells
• EXAMPLE - cells in skin, bone marrow, GI tract and hair follicles

Question 15

What are some late side effects of chemotherapy?

Answer 15

• Heart, lung and liver damage
• Fatigue
• Infertility
• Neurological effects

Question 16

What principle is hormone therapy based on?

Answer 16

• Cancers can be hormone sensitive - require specific hormones to grow/develop
• Hormone therapies reduce ability of organs to produce these hormones

Question 17

Outline some possible mechanisms of action of biological therapies.

Answer 17

• Act on cellular processes
• Stop cancer cell growth and division
• Encourage immune system to attack cancer cells
• Direct killing of cancer cells

Question 18

Outline some types of biological therapies

Answer 18

• Monoclonal antibodies
• Immunotherapy
• Cancer growth blockers
• Anti-angiogenics

Question 19

Describe monoclonal antibodies

Answer 19

• Attach to cell surface antigen
• Block signal from surface antigen that would otherwise lead to cell growth and replication

Question 20

Describe anti-angiogenics.

Answer 20

• Blocks VEGF - stops growth of blood vessels
• Starves cancer of oxygen and nutrients
• Act on chemicals that cells use to signal each other to grow e.g thalidomide

Question 21

Describe cnacer growth blockers.

Answer 21

• Oral medications
• Block intracellular pathways leading to replication
• Continous treatment until disease progession
• EXAMPLE - Tyrosine kinase inhibitors

Question 22

Describe immunotherapy.

Answer 22

• Stimulate innate immunity and remove check points of immune suppression
• Slows growth and stops spreading
• Done through T cell therapy and monoclonal antibodies

Question 23

Describe checkpoint inhibitors in immunotherapy.

Answer 23

• Cancer suppresses immune response through direct binding to immune cells - undermines clinical efficacy of cancer therapy
• Inhibitors target these methods of immune evasion
• Unblock suppressed immune response - T cells mobilised causing death of cancer cells

Question 24

What are the side effects of immunotherapy?

Answer 24

• Pneumonitis
• Colitis
• Hepatitis
• Pancreatitis
• Endocrine disorders

Question 25

Describe vaccines in anti-cancer therapy.

Answer 25

• Trigger immune system
• Used to prevent precursors to cancer e.g BCG/HPV vaccine
• Direct treatment vaccines in development

Question 26

On a patient level, what should be considered in cancer care?

Answer 26

• See and know the patient - holistic care
• Empower patients
• Concept of ‘no decision about me - without me’
• Be mindful of rollercoaster of emotions that come with tough decisions stemming from cancer diagnosis and treatment