Systemic therapy Flashcards
At what level of potential recurrence would you consider adjuvant therapy? When would you not?
Over 20% yes
Under 10% no
What is the benefit of chemoradiation?
The chemotherapy sensitizes the tumour to the effects of radiation
Main side effects of ..
Carboplatin
Myelosupression (especially thrombocytopaenia)
Hypersensitivity reaction
Sterility/ovarian failure
Main side effects of…
Doxorubicin
Cardiotoxicity
Radation recall
Photosensitivity
Red/orange urine
Main side effects of…
Gemcitabine
Myelosupression (often dose limiting)
GI - diarrhoea, stomatitis, mucositis
Fever/flu-like
Pnuemonitis
Mac/pap rash
Main side effects of…
Paclitaxel
Myelosupression
Hypersensitivity reaction
Sensory neuropathy
transient sinus brady
GI: mucositis, diarrhoea
Onycholysis
Who is HIPEC best for and why?
Those who have minimal residual disease because the passive diffusion in to peritoneal tumour nodules is limited.
What is bevacizumab?
humanised anti-VEGF
What is pembrolizumab?
anti-PD-1 antibody
PD-1 blockade has been shown to activate antitumour immunity via T cells - tumour infiltrating lymphocytes (TILs)
What drugs have failed to show improvements in PFS or OS with increased dose intensity?
taxanes and platinum
What is the most common dose-limiting side effect associated with cytotoxic drugs?
Bone marrow suppression with neutropenia being the most common
When does bone marrow suppression typically occur?
7-14 days after the initial drug treatment
How long does the bone marrow suppression persist for?
3-10 days
What can be used to combat the SE bone marrow suppression and when?
G-CSF
(used if risk of febrile neutropenia is more than 20% or if previously had a neutropenic complication in a prior cycle but where dose reduction or treatment delay not an option)
What are the most common SE to systemic therapy
bone marrow supression GI side effects (N/V/D) Alopecia Skin toxicity neurotoxicity GU toxicity Hypersensitivity
What can be used to treat nausea
anti-histamines
5-HT3 antagonists
Steroids
anticipatory nausea - benzos
What can be used to treat oral or oesophageal symptoms and what do you have to consider?
2% lidocaine
Candidiasis and herpes simplex
What can be used to treat Alopecia
preventative measures:
scalp tourniquets
ice caps
What skin complications can occur:
hyperpigmentation
hypersensitivity
radiation recall reactions
nail abnormalities
folliculitis
palmar-plantar erythrodysesthesia
Local extravasation necrosis (requires debridement often)
What is a radiation recall reaction?
Radiation recall is an acute inflammatory reaction confined to previously irradiated areas that can be triggered when chemotherapy agents are administered after radiotherapy
How does neurotoxicity present?
Usually peripheral neuropathy
sometimes: ototoxicity
Who is more susceptible to neurotoxicity
those who have:
underlying neurological problems - diabetes, alcoholism, carpal tunnel syndrome
Most common toxicities of PARPi?
fatigue and haematological toxicity (low Hb, neutrophils and PLT)
Toxicity of VEGFi?
HTN proteinuria bleeding VTE GI - bowel perf and fistula
Toxicity of immune mediated therapy?
Enterocolitis Dermatitis Hepatitis Neuropathies Endocrinopathies Hypophysitis
Definitive chemoradiotherapy and brachytherapy
What should the overall treatment time be
should not exceed 7-8 weeks
EBRT
What should the overall treatment time be
should not exceed 5-6 weeks
what is the total dose of pelvic ERBT that should be used and in what fractions
45-50 Gy with 1.8-2 Gy per fraction (daily)
Often 45 Gy in 25 fractions
