Treatment of cancer & Oncology Emergencies Flashcards
What systemic therapy can be offered for cancer
Chemotherapy
Biologics
Hormonal therapy
Immunotherapy
What are aims of Rx
Adjuvant
Neoadjuvant
Palliative
Curative or radical
What is adjuvant
After definite and curative rx to eradicate micromets
What is neoadjuvant
Adjuvant Rx given before to improve chance of cure
What are SE of chemotherapy
Relate to rapidly dividing tissue as that is what is attacked Alopecia Mouth ulcer Diarrhoea Neutropenia Thrombocytopenia
What are 7 major classes of systemic chemotherapy
- Alkylating agent - disrupt DNA integrity
- Anti-metabolites - disrupt DNA synthesis
- Mitotic inhibitor (vinca alklaloid) disrupt microtubule function
- Toposomerase inhibitor - regulate DNA unwinding
- Platinums cause cross linking of DNA strands
- Taxanes disrupt microtubule function
- Anthracyclines intercalate between base pairs in RNA/DNA thereby preventing synthesis.
What are anti-metabolites
- Purine (fludarabine)
- Pyrimidine (5-fluorouracil,
- gemcitabine)
- Folate (methotrexate, pemetrexed)
what are aklyating agent
Cyclophosphamide
Ifosfamide
Give examples of mitotic inhibitor or vinca alklaloids
Name one common side effect
- Vincristine
- Vinblastine
- SE: neuropathy
What is topoisomerase inhibitor / Ax
Etoposide
Irontecan
What is a common SE of alkylating agents
Haemorrhagic cystitis
What are common SEs of anthracyclines [3]
What are 2 examples: doxorubicin, epirubicin
Side effects
* Myelosuppression
* Cardiotoxicity
* Leukaemia (doxorubicin)
SE of bleomycin
Lung fibrosis
SE of Anti-metabolites
SE of methotrexate
- Hepatotoxicity
- Ulcerative stomatitis
- Pneumonitis, pulmonary fibrosis (methotrexate).
SE of 5-FU
Myelosuppression
Mucositis
Dermatitis
What does vinblastine / docetaxel do and what are SE
Inhibit formation of microtubule Peripheral neuropathy Paralytic ileus Myelosuppression Neutropenia = docetaxel
SE of cisplatin
Ototoxicty
Peripheral neuropathy
HypoMg
SE of hydroxyurea
Myelosuppresson
What do biologic agents do and what are there categories
Inhibit orogenic stimulus that is driving cancer growth
Monoclonal Ab - imab
Tyrosine kinase inhibitors - inib
What is ritixumab useful for
Anti-CD20 so useful in B cell lymphoma which express
What has revolutionised CML Philadelphia chromosome +ve
Imatinib
What causes ligand inactivation
Bevacilumab
Stops VEGF which is over expressed in many cancer
What cause receptor inactivation
Tratuzumab against HER-2
What hormone therapy in breast
Anti-oestrogen - tamoxigen
Aromatose inhibitor
GnRH agonist (goserelin)
What hormone therapy in prostate cancer
Androgen suppression - goserelin or orchidectomy
Anti-androgen
What hormone therapy in endometrial
Progesterone
What is systemic immunotherapy
Stimulates whole immune system
Interferon
Interluekin
What are toxicity interferon
Flu like Nausea Lethargy Anorexia LFT
What are toxicity IL
Hypotension
Renal failure
Cardiac - may need ITU
How do many cancers evade detection
Suppress T cell function through PD-1 on T cell or PDL-1 on tumour
What Ab target this
PD-1 Ab - nivolumab / pemprolizumab
PDL-1 Ab - atezolizumab
What are SE related to overactive T cells which are key in killing cancer
Dry / itchy skin = most common N+V Decreased appettite Diarrhoea Fatigue SOB Dry cough
What is radiation dose
Energy deposited per unit mass = absorbed dose (Gray)
1 gray = 1 joule of energy in 1kg
What is radiation tolerance
Amount of radiation tissue can receive and still remain functional
What is tolerance dose
Dose that there is a high probability of serious Rx compliction
What is external beam
Most common
Linear accelerator delivers X-ray