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SAM II > Therapeutics of Oncology > Flashcards

Therapeutics of Oncology Flashcards

1
Q

what normal cell populations do chemotherapy drugs target as they target ALL rapidly dividing cells?

A

guts, BM, and hair follicles

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2
Q

a type of dosing that allows recovery of normal tissue between treatment intervals

A

fractionation

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3
Q

adjunct to local therapy (targets microscopic dz after surgery)

A

adjuvant

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4
Q

prior to definitive tx in an attempt to shrink tumor

A

neoadjuvant

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5
Q

sole tx for measurable dz

A

induction/maintenance

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6
Q

improve QOL by helping alleviate signs

A

palliative

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7
Q

what are three things that are important to communicate to the client prior to administration of chemotherapy?

A

cost, potential toxicities, and logistical requirements

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8
Q

T/F: chemotherapy drugs are dosed based on toxicity rather than efficacy

A

TRUE (MTD, administered at highest possible tolerable dose)

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9
Q

what chemo drugs should you be careful in dosing for small dogs (increased risk when dose based on BSA)?

A

doxorubicin, melphalan, cis- & carboplatin (consider dosing in mg/kg instead)

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10
Q

what are the “4 R’s” considered prior to any chemo tx?

A

right drug, right dose, right route, right patient

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11
Q

_____ codes for the production of p-glycoprotein (Pgp) pumps, which act to remove drugs from individual cells

A

ABCB-1 gene (used to be MDR-1 gene)

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12
Q

what drugs are substrates of the ABCB1 pump and are therefore an increased risk when used in animals with the mutation?

A

vincristine, vinblastine, paclitaxel, and doxorubicin (adjust dose 30-40%!!)

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13
Q

what are three most popular breeds (among others) with the ABCB-1 gene mutation?

A

australian shepherd, collie, and long-haired whippet

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14
Q

what are the common adverse events seen with chemotherapy?

A

BM suppression, alopecia (non-shedding breeds ONLY = poodles, old english sheep dogs, shih tzu’s & terriers), GI signs (v/d)

“BAG of SEs”

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15
Q

what must you do the day of chemotherapy tx before administration?

A

CBC

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16
Q

how many neutrophils and platelets are required in order to give chemotherapy?

A

neutrophils >3000/ul
platelets > 100,000/ul

too low? recheck CBC in 3-7 days

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17
Q

expected low point of BM insult

A

NADIR, check CBC weekly to establish (typically 5-10 days…carboplatin = 7-14 d)

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18
Q

at what point would you decrease your chemo drug by 20-25%?

A

neutrophils below 1500 or platelets below 60,000 at the nadir

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19
Q

your patient on chemo is myelosuppressed (neutropenia of <1000). what prophylactic antibiotics might you consider?

A

clavamox & baytril, sulphadiazine-trimethoprim

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20
Q

your myelosuppressed chemo patient has been given prophylactic antibiotics but is still in bad shape, what last resort treatment could you consider?

A

nupogen (filgastim)

human form = neutralizing Abs > ONE TIME USE

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21
Q

how do you manage a chemo patient with thrombocytopenia (<25,000)?

A

exercise restriction, close monitoring for bleeding (nose, GI)

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22
Q

what are some signs of nausea to look for (especially in really stoic animals) in chemo patients?

A

ptyalism, constant licking, packing, chewing and aggression/redirected aggression

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23
Q

what two drugs are most known for causing GI toxicity in chemo patients?

A

cisplatin and doxorubicin

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24
Q

what are the two major categories of drugs with cell-cycle specific MOA?

A

antimitotics (M phase > mitotic) and antimetabolites (S phase > DNA synthesis)

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25
Q

what are the two major categories of drugs with cell-cycle nonspecific MOA?

A

alkylating agents and antibiotics

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26
Q

name two antimitotic drugs used in chemotherapy?

A

vinca alkaloids (vincristine/vinblastine) and taxanes (paclitaxel and docetaxel)

27
Q

what is vincristine used for and what are the common clinical signs seen?

A

LSA & TVT

GI, vesicant, ileus, neuropathy (usually dragging back legs)

28
Q

shit! you extravasated vincristine in your patient! what now?!

A

dry WARM compress 20-30 min q6 x 24-48 hrs

disperse & dilute

give hyaluronidase (separates tissue planes & aids in improving absorption of extravasated drug into circulation)

29
Q

chlorambucil, cyclosphosphamide, lomustine (CCNU), melphalan, dacarbazine and ifosamide are all what type of chemo drugs?

A

alkylating agents > bind DNA strands, insert alkyl group and change structure of DNA to interfere with transcription, replication & repair machinery

30
Q

what category of BAG do alkylating agents cause?

A

bone marrow suppression

31
Q

in addition to BM suppression and alopecia, what is a major side effect of cyclophosphamide?

A

sterile hemorrhagic cystitis (acrolein)

32
Q

in addition to BM suppression, what organ is affected most by lomustine (CCNU) and what can you give in addition to prevent the effects?

A

liver, give w/ denamarin (hepatoprotectant)

33
Q

name some common antibiotic agents used for chemotherapy

A

doxorubicin (“red death” = adriamycin), mitoxantrone (“blue thunder”), actinomycin-D, and idarubicin

34
Q

what are the common clinical signs seen when using doxorubicin?

A

GI, dose related cardiotoxicity (prescreen boxers/dobies), tinnitus and vesicant

give w/ dexrazoxane (zinecard) = reduces cardiotoxicity

35
Q

T/F: doxorubicin is more cardio sparing than mitoxantrone

A

FALSE, opposite

36
Q

shit! you extravasated doxorubicin in your patient! what now?!

A

ICE!!! localize and neutralize

37
Q

covalent binding to DNA strands, forming interstrand crosslinks which is cytotoxic

A

platinum agents

38
Q

inhibits protein synthesis in cells by hydrolysis of L-asparginase to L-aspartic acid

A

l-asparaginase (elspar)

hypersensitivity rxn > NO IV ADMIN.

39
Q

_____ = SPLATS CATS! do not use

A

cisplatin

use for OSA in dogs (BM suppression, GI, and nephrotoxic SEs…vigorous diuresis)

40
Q

what is carboplatin (a cell-cycle phase-nonspecific chemo drug) typically used for?

A

OSA and other sarcomas (BM suppression and NO nephrotoxicity)

41
Q

what is the 1st FDA approved lymphoma treatment for dogs used as “RESCUE” therapy?

A

tanovea - CA1

inhibits proliferation of lymphocytes & LSA cell lines by inhibiting DNA synthesis

42
Q

revolves around concept of eliminating break period by giving low dose continuous chemotherapy

A

metronomic chemotherapy

43
Q

what are the three main MOA for metronomic chemotherapy?

A

antiangiogenesis, immunomodulation, and direct targeting

44
Q

how does MC antiangiogenesis work?

A

blockage of COX & circulating endothelial progenitor cells (CEP’s)

upregulation of endogenous angiogenesis inhibitor thrombospondin-1

45
Q

Treg’s =

A

CD4 + CD25 + regulatory T cells

INHIBIT immune response = suppression of host tumor surveillance…UPREGULATED BY CANCERS

MC decreases

46
Q

formation/accumulation of ACROLEIN and 4-hydroxymetabolites (by-products of cyclophosphamide metabolism) in the urine

A

sterile hemorrhagic cystitis (unique SE of cyclophosphamide = alkylating agent commonly used in MC protocols)

47
Q

what is the incidence of sterile hemorrhagic cystitis in MC protocols involving cyclophosphamide?

A

7-32%

48
Q

how can you avoid sterile hemorrhagic cystitis in a patient given cyclophosphamide?

A

give in AM w/ free access to water to encourage urination as well as concurrent glucocorticoid or furosemide

49
Q

what type of chemotherapy agent is palladia?

A

FDA approved tyrosine kinase inhibitor (tyrosine kinase receptors involved in activation & signal transduction)

blocks variety of receptor tyrosine kinases expressed on cell surface…acts as reversible competitive inhibitor of adenosine triphosphate binding

50
Q

what cancer is palladia approved for use in?

A

patnaik grade II or III, recurrent, cutaneous MCTs w/ or w/o regional LN involvement

51
Q

form of cancer tx that boosts body’s natural defenses to fight cancer

A

immunotherapy (biologic therapy)

52
Q

what type of immunotherapy is more commonly used in vet med?

A

tumor vaccines

53
Q

first DNA-based vaccine for cancer in either animals or humans (FDA approved)

A

canine melanoma vaccine

-uses human tyrosinase to generate immune response against protein on canine melanoma cells, labeled for dogs w/ stage II or III oral melanoma, used in conjunction with sx and/or RT

54
Q

listeria-based antigen delivery system > vaccine freeze-dried formulation of modified-live, attenuated Listeria strain that activates cytotoxic T cells (listeria strain expresses tumor-associated antigen = activated T cells directed to fight cancer cells)

A

pipeline (OSA)

MST = 956 days vs. 423 days

55
Q

what alternative therapy has shown to significantly delay progression of abdominal metastases in dogs w/ splenic HSA?

A

coriolus versicolor mushroom (turkey tail)

-contains PSP that causes cell-cycle arrest at G1/S checkpoint w/ alterations in apoptogenic & extracellular signaling proteins > reduction in proliferation and increase in apoptosis of cancer cells

56
Q

class-1 protected chinese medication shown to improve clotting and enhance platelet function

A

yunnan baiyao

prolong survival times in dogs w/ HSA > dose & time dependent HSA cell death through initiation of caspase-mediated apoptosis

57
Q

early responding tissue (RT)

A

epithelial layers of skin or mucosa and bone marrow

effects seen w/in weeks

58
Q

late responding tissue (RT)

A

nervous tissue and bone

effects seen w/in months or years

59
Q

what are the “big 3” variables that dictate the response of tissue to radiation?

A

total dose, fraction size, and duration of treatment

60
Q

RT total dose divided into larger doses given over a shorter period of time

A

hypofractionated dosing (i.e. oral malignant melanoma treatment)

61
Q

what is the most common modality for teletherapy?

A

megavoltage (deep) used for abdominal or deep seated tumors, xrays from cobalt and linear accelerator (linac) produces electrons to tx superficial lesions

even, predictable distribution & deep penetration

62
Q

what are the two types of 3D- CRT (conformal radiation therapy)

A

intensity-modulated RT (IMRT) > inability to conform tx volume to concave shapes

stereotactic RT (SRT) > allows precision delivery over dose, high dose fractions

63
Q

RECIST (response evaluation criteria in solid tumors)

A

complete response (100% resolution), partial response (>30% reduction in size), progressive dz (>20% increase tumor size), stable dz (<30% reduction, <20% increase tumor size)

SAM II (3 decks)

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