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RUSVM SAM 2 > Theraptutic Oncology > Flashcards

Theraptutic Oncology Flashcards

1
Q

What are the main goals of chemotherapy in veterinary medicine?

A

Enhance or at least maintain quality of life

Stabilize, diminish, or eliminate neoplastic process

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2
Q

What type of cells does chemotherapy target?

A

Rapidly dividing cells
—> tumor cells
—> gut, bone marrow, and hair follicles

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3
Q

What is fractionated dosing?

A

Allows recovery of normal tissue between treatment intervals

-cycle =treatment and recovery period

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4
Q

What does it mean to used chemotherapy as an adjunct therapy?

A

Add on to a local therapy (eg surgery)

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5
Q

What does it mean to use chemotherapy as a neoadjuvant?

A

Prior to definitive treatment (surgery) in attempt to shrink tumor

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6
Q

What does in mean to use chemotherapy for induction/maintenance?

A

Sole treatment for measurable disease (Eg LSA)

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7
Q

When would we use chemo as a palliative treatment?

A

Improve quality of life by helping alleviate signs

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8
Q

What information do you require before administration of chemotherapy?

A

Accurate diagnosis —> tumor type that is known to respond to anti neoplastic agents

Appropriate staging

Initial stabilization performed -> correct dehydration, electrolyte imbalance, renal function, hepatic function, and anemia

Client communication

Alternative treatment options explored and discussed with the owner

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9
Q

T/F: chemotherapy is dosed based on efficacy

A

False

Dosed based on toxicity — to prevent treatment failure drugs are administered at highest possible doses

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10
Q

How should chemotherapy doses be calculated??

A

With body surface area —> more accurate predictor of physiological function

Small patients may be overdosed on this basis —> use body weight

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11
Q

In what dog breeds should you decreased your chemotherapy doses?

A

White feet dont treat!
Australian shepherd
Collies
Long-haired whippet

ABCB-1 gene codes for the production of p-glycoproteins pumps, which act to remove drugs from individual cells —> mutated in these does

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12
Q

What chemotherapy drugs have increased risk in collies, and by how much should you decrease the dose?

A

Vincristine
Vinblastine
Paclitaxel
Boxorubicin

30-40% of the required dose

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13
Q

What are the common adverse effects of chemotherapy?

A

Bone marrow suppression: myelosuppression (neutropenia/thrombocytopenia)

Alopecia: non shedding breeds only

Gastrointestinal: crypt cells are destroyed—> vomiting and diarrhea

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14
Q

What percentages of patients receiving chemotherapy have none to minimal side effects?

A

80-85%

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15
Q

What percentages of patients receiving chemotherapy required hospitalization due to significant adverse effects?

A

3-5%

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16
Q

What monitoring of the patient will you do prior to administering their dose of chemotherapy?

A

CBC
In order to give chemo , Neutrophils > 3000/ul and platelets > 100,000/ul (if to low no treatment and recheck in 3-7days)

After 1st chem: CBC at NADIR

  • > shows expected low of BM insult
  • > Check weekly after first dose to establish NADIR
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17
Q

If the neutrophil count at the NADIr is below ________ neutrophils/ul or the platelet count is below ______ platelets/ul, then the subsequent doses of the drug should be decreased by 20 to 25%

A

1500; 60,000

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18
Q

When neutrophils are < 1000/ul, you have myelosuppression. How should you manage these patients?

A

They are at risk for systemic infection —> prophylactic antibiotics
Common choices: clavamox, TMS

Most counts respond in 3-5days, severe cases need ICU
Granulocyte colony-stimulating factor stimulates marrow production (Rarely used )

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19
Q

You chemo patient has a thrombocytopenia <25,000/ul. How are you going to manage this patient?

A

Exercise restriction, close monitoring for bleeding (nose/GI)
Careful with Lomustine and melphalan

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20
Q

What is the MOA by which chemo causes GI toxicity?

A

Direct stimulation of chemoreceptor trigger zone in brain —> vomiting during first 24hrs of treatment

Damage to rapidly dividing cells of the crypts —> anorexia, vomiting, or diarrhea w/in 2-5days

** displaying and doxorubicin

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21
Q

What are the possible MOA of chemotherapy agents ?

A

Cell cycle specific

  • antimitotics
  • antimetabolites

Cell-cycle nonspecific

  • alkylating agents
  • antibiotics
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22
Q

What is the MOA of vinca alkaloids (vincristine/binblastine) and taxanes (paclitaxel and docetaxel)?

A

Antimicotic/microtubule toxins

—> disrupt or immobilize the mitotic spindle which plays critical role in cells function and division

23
Q

What are the specific toxicities of Vincristine?

A

B. A. G
Vesicant
Neuropathy

Ileus

24
Q

Vincristine is used to treat what tumors?

A

LSA

TVT

25
Q

Vinblstine is used to treat what type of tumor and what is its main toxicity?

A

Mast cell tumor (MCT)

B.A.G

26
Q

What should you do if you have extravasation of vincristine/blastine?

A

Dry warm compress

Hyaluronidase -> separate tissue planes and aids in improving absorption of drug into circulation

disperse and dilute

27
Q

Chormabucil, cyclophosphamide, lomustine, melphalan are all what type of drug?

A

Alkylating agents
-> bind DNS and insert alkyl group to change structure of DNA sufficiently to interfere with transcription, replication and repair machinery

28
Q

Melphalan treats wha tumor and has what main toxicity?

A

Myeloma

Bone marrow

29
Q

Cyclophosphamide treats what tumor and has what main toxicity?

A

LSA

Bone marrow, alopecia
Sterile hemorrhagic cystitis

30
Q

Lomustine (CCNU) treats what tumors and has what main toxicity?

A

LSA, MCT, histiocytotic sarcoma

Bone marrow and liver toxicity

31
Q

Cholorambucil treats what tumors and has what main toxicity?

A

CLL (chronic lymphocytic leukemia) and low grade LSA (cat)

Bone marrow

32
Q

Doxorubicin and mitoxantrone have what MOA?

A

Antibiotic agents

33
Q

Doxorubicin (red death) is used to treat what tumors and has what main toxicities?

A

LSA, OSA, mesenchymal and epithelial tumors

GI and dose related cardiotoxicity
VESICANT

34
Q

What do you do if you have doxorubicin extravasation?

A

DO NOT disperse
-localized and neutralize

Cold pack
DMSO
Sodium lactate

35
Q

Mitoxantrone (blue thunder) is used to treat what tumors and has what main toxic effect?

A

TCC, LSA

Bone marrow and GI toxicity

36
Q

Gemcitabine, 5-fluorouracil, and cytosine arabinoside have what MOA?

A

Antimetabolites

-> generally nucleotide analogs or substrates of active metabolic processes within the cell = S-phase

37
Q

What are the usages of cytosine arabinoside?

A

CNS tumors and LSA

38
Q

What is the MOA of carboplatin and cisplatin?

A

Platinum agents = covalent binding to DNS strands, forming inter strand cross linking which is cytotoxic

39
Q

Cisplatin treats what tumors and has what main toxicities?

A

OSA in dog (NOT IN CAT)

Bone marrow and GI
Nephrotoxic

40
Q

Carboplatin treats what tumors? Main toxic effect?

A

OSA and other sarcomas (ok in cats)

Bone marrow

41
Q

MOA of L-asparaginase (ELSPAR) ?

A

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

42
Q

Elspar is used to treat what tumor?

A

LSA release

  • beware of hyper sensitivity rxn (no IV admin)
43
Q

What is tanovea?

A

inhibit DNA synthesis in lymphocytes and LSA cell lines

—> st FDA approved lymphoma treatment for dogs

44
Q

Common adverse rxns with Tanovea?

A 
Neutropenia
Diarrhea
Anorexia
Weight loss 
Lethargy 
Skin problems
45
Q

What is metronomic chemotherapy?

A

All maximum tolerated dose (MTD) therapy requires a “break” period to allow for recovery of normal cells
-remaining viable tumor cells often exploit this time => recurrence

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

46
Q

Metronomic chemotherapy uses what MOA?

A

Antiangiogenesis

Immunomodulation

Direct targeting

47
Q

What is the MOA of MC antiangiogenesis?

A

Prevent blood vessel proliferation required for tumor expansion by blocking COX and circulating endothelial progenitor cells

-> tumor endothelial cells proliferate rapidly during break period, thrombospondin -1 is present in tumor microenvironment (CYC)

48
Q

What is the MOA of MC immunomodulation?

A

Immune effector cells ( lymphocyte and macrophages) in tumor microenvironment influence proliferation of tumor

T-regs normally INHIBIT immune response and suppress the host’s tumor surveillance (this is upregulated by cancer)

Immunomodulation decreases T-regs

49
Q

What is the MOA of MC direct targeting?

A

Even though metronomic chemo (MC) is at lower dose, it has some direct effect on cancer cells

Direct kill also helps block angiogenesis
—> proangiogenic growth factors produced by tumor
—> direct killing of tumor cells if you decrease amount of GF (eg vascular endothelial growth factor, VEGF)

50
Q

What alkylating agent is commonly used in MC protocols?

A

Cyclophosphamide

-inexpensive, low GI/hematologic toxicity
PO route

51
Q

What unique adverse affect is associated with cyclophosphamide ?

A

Sterile hemorrhagic cystitis

Formation/accumulation of ACROLEN in urine —> submucosal edema, hemorrhage, necrosis, and fibrosis of musosal epithelium

52
Q

How can you avoid sterile hemorrhagic cystitis (SHC)?

A

Environmental control - give in morning with free access to water and encourage frequent urination

Concurrent glucocorticoids/furosemide administration —> promote diuresis

53
Q

What is the MOA of tyrosine kinase inhibitors?

A

Inhibition of tyrosine kinase receptors sends single to inhibit growth factor signals that allow the cells to divide

  • also inhibit VEGFR2, PDGFRB, and stem cell factor receptor
54
Q

What is Toceranib?

A

A tyrosine kinase inhibitor

Approved for used in Patnaik grade II or III, recurrent, cutaneous mast cell tumor with or without regional LN involvement

RUSVM SAM 2 (44 decks)

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