Treatment Modalities

Question 1

Cell Cycle Phases

Answer 1

G0 - resting (few hours to years)
Gap 1 - (8-30 hours) - cell contents (excluding chromosomes duplicated)
Synthesis - (18-20 hours) - chromosomes duplicated
Gap 2 - (2-10 hours) - cell double checks chromosomes, makes repairs
Mitosis - (30-60 min)

Question 2

Cell cycle time and chemo

Answer 2

Continuous chemo provide greater kill in cells with SHORT cycle time

SHORT cell cycle results in high kill with cell cycle SPECIFIC drugs

Question 3

Growth fraction

Answer 3

Percentage of cells dividing at any one given point

Tumors with HIGH growth fraction result in higher cell kill with cell cycle SPECIFIC drugs

Tumors with cells in G0 are sensitive to cell cycle NON-SPECIFIC drugs

Question 4

Tumor burden and growth rate

Answer 4

Tumor burner is volume of cells

As tumor burden increases, growth rate slows down

Question 5

Cell Cycle NON-SPECIFIC chemo (general)

Answer 5

Exerts effects in all phases

Alkylating agents, hormones, nitrosureas

Given in patients with slowly dividing tumors
Breaks DNA helix strand interfering with replication
Intermittent schedule

Question 6

Cell Cycle SPECIFIC chemo

Answer 6

Exerts effects in specific phase

Given frequently in divided doses, or continuous infusion

Question 7

S phase chemo

Answer 7

Antimetabolites and anti-tumor antibiotics

Antimetabolites-Antifolates: methotrexate

Antitumor antibiotics: mitomycin, dactinomycin, doxorubicin

Question 8

M phase chemo

Answer 8

Plant alkaloids and taxanes

Plant alkaloids: Vincristine, vinblastine
Taxanes: Paclitaxel, Docetaxel

Antimicrotubule agents

Question 9

Combo vs. single agent chemo

Answer 9

Super-additive effect
Increases cell kill
Reduces cross resistance

Question 10

Dose dense chemo

Answer 10

Shorten time between given

Diminishes tumor re growth

Question 11

Dose intensity

Relative dose intensity

Answer 11

Intensity: amount of drug over time
Relative: actual percentage of received dose

Question 12

Chemo plan (treatment plan) selection

Answer 12

Tumor cell type and grade
Stage
Goal: cure, control, palliation
General pt condition
Drug sensitivity

Question 13

Vesicants

Answer 13

Anthracylines
Taxanes
Antitumor antibiotics
Plant Alkaloids

Also, mitoxantrone, trabectdein, mechlorethamin

Question 14

Irritant Agents

Answer 14

Melphalan (Alkylating agent) [mucositis - ice]
Oxaliplatin (Alkylating) [ can’t eat cold food]
Vinorelbine (plant alkaloid)
Irinatecan
Rituxan (local allergic rxn)
Ipilumab, nivoluman, pemrolizumab (irritant potential may cause thrombophlebitis)
Carfilzomin

Question 15

Irritant Flare reaction

Answer 15

Cold pack: 15-20 minutes/ QID first 24 hours

Exception: Oxaliplatin and Vinorelbine - use warm pack for 24-28 hours { plant alkaloid - to disperse}

Oxaliplatin: add dexamethasone 8 mg BID for up to 14 days

Question 16

Flare reaction symptoms vs. vesicant symptoms

Answer 16

Flare: local allergic rxn of peripheral vein
Symptoms: pruritis and urticaria, blood return PRESENT

Vesicant: pruritis in absence of pain, NO blood return

Question 17

Alkylating Agents side effects

Answer 17

Bone marrow depression
N/V
Gonadal dysfunction
SECONDARY malignancies

Question 18

Antimetabolites-Antifolates side effects

Answer 18

Bone marrow depress
N/V
Stomatitis
Diarrhea
Hepatotoxicity
Renal toxicity

Question 19

5-Fluropyrimidines side effects

Answer 19

Bone marrow depression
N/V
Stomatitis
Diarrhea
Hepatotoxicity

Question 20

Cytosine analogues

Answer 20

Bone marrow depression
N,V
Stomatitis
Diarrhea
Hepatotoxicity
Neurotoxicity

Question 21

Anthracyclines and anti-tumor antibiotics side effects

Answer 21

Cardiopulmonary toxicity
Bone marrow suppression
Vesicant

Question 22

Antimicrotubule agents side effects

Answer 22

Bone marrow suppression
Peripheral neuropathy
Hypersensitivity reactions

Question 23

Topoisomerase Inhibitors side effects

Answer 23

Bone marrow suppression
Peripheral neuropathy
Hypersensitivity reactions

Question 24

Nitrosureas side effects

Answer 24

PROLONGED bone marrow suppression
N/V
Renal toxicity
[cross blood brain barrier]