Treatment of Cancer: Surgery, Chemo & Radiation Flashcards
What are the 4 phases of the cell cycle?
- G1 phase: RNA & protein synthesis, cell growth, DNA repair
- S phase: DNA completely replicated
- G2 phase: additional synthesis of RNA, protein & specialized DNA
- M phase: mitosis
Define the following:
- Resting phase?
- Growth fraction?
- Generation time?
- Resting phase
- cells do not engage in synthetic activities - Growth fraction
- proportion of cells in a tumor actively involved in cell division - Generation time
- length of a cell cycle
Chemotherapy Modes of Action
2
- Cell cycle specific
2. Cell cycle nonspecific
Describe the followinig modes of action and in what situations they are most useful in:
- Cell cycle specific
- Cell cycle nonspecific
- Cell cycle specific
- Kills in specific phase of cell cycle
- Most useful in tumors with large proportion of actively dividing cells - Cell cycle nonspecific
- Kills in all phases
- Useful in tumors with low growth index
Which medications work n the following phases of the cell cycle?
- G2 phase? 1
- Mitosis? 1
- S phase? 4
- G1 phase? 2
- G0 state? 1
- Bleomycin
- Vinca Alkaloids
- Antimetabolites
- Antifolates
- Antipyrimidines
- Antipurines
- Asparaginase
- Actinomycin
- Nitrosoureas
What are the phase nonspecific drugs? 3
- Alkylating agents
- Antitumor antibiotics
- Cisplatin
- What reasons do we treat cancer with surgery? 3
- Systemic Chemotherapy: What are the different kinds? 4
- What are the reasons we do radiation? 3
- Surgery
- Definitive
- Staging
- Palliative - Systemic Chemotherapy
- Intravenous vs. oral
- Neoadjuvant vs. adjuvant - Radiation
- Definitive
- Salvage
- Palliative
Describe surgery meant for definitive treatment.
Describe surgery for palliatove treatment?
Definitive: treatment plan that has been chosen as the best one for a patient after all other choices have been considered
Palliative: relieving or soothing the symptoms of a disease without producing a cure
Systemic Chemotherapy is what?
Means of administration? 5
- Type of cancer treatment using drugs to kill the cancer cells
- Means of administration:
- Intravenously
- Injection
- Intraperitoneal
- Orally
- Topically
Classes of Chemotherapy Drugs
6
- Alkylating agents
- Antimetabolites
- Mitotic inhibitors
- Anthracyclines
- Topoisomerase inhibitors
- Miscellaneous
Alkylating Agents:
- MOA?
- Work in which phases of the cell cycle?
- Used to treat many different cancers, including what? 8
- Directly damage DNA to keep the cell from reproducing
- Work in all phases of the cell cycle
- Used to treat many different cancers, including:
-leukemia,
-lymphoma,
-Hodgkin’s disease,
-multiple myeloma, and
-sarcoma,
as well as cancers of the
-lung,
-breast, and
-ovary
Alkylating Agents:
Primary toxicities as a class?
4
Primary toxicities as a class
- Nausea
- Vomiting
- Myelosuppression
- Alopecia
Classes of Alkylating Agents
4
- Nitrogen mustards
- Platinum analogs
- Tiazenes
- Miscellaneous
Alkylating Agents: Nitrogen mustards are which ones? 3
- Mechlorethamine (nitrogen mustard)
- Cyclophosphamide (Cytoxan)
- Ifosfamide (Ifex)
Cyclophosphamide (Cytoxan)….side effect?
What other drug can cause this?
Hemorrhagic cystitis
May also be caused by Ifosfamide (Ifex)
Describe how Hemorrhagic cystitis from Cyclophosphamide (Cytoxan) occurs?
2
- Metabolic products of Cytoxan secreted into the urine
2. Bladder mucosa may become damaged
Bladder mucosa may become damaged from Hemorrhagic cystitis from Cyclophosphamide (Cytoxan). How will this manifest?
3
How can you prevent this?
1
- May shed large segments of bladder mucosa
- Prolonged hematuria - May lead to urinary obstruction (due to clots)
- If urine is concentrated may cause severe bladder damage
- Need to increase fluid intake before and after infusion and empty bladder frequently
Alkylating Agents: Platinum analogues
3
Carboplatin (Paraplatin)
Cisplatin (Platinol)
Oxaliplatin (Eloxatin)
Cisplatin (Platinol)…side effects
2
- Nephrotoxicity
2. Neurotoxicity
How can we prevent nephrotoxicity in Cisplatin pts? 2
What levels may be low from this drug? 3
- Patients must be vigorously hydrated prior, during and after cisplatin administration
- Monitor electrolytes and renal function
- Low potassium,
- sodium and
- magnesium levels can be seen
How will neurotoxicity present in a pt taking Cisplatin? 2
How can we prevent this? 1
- Peripheral neuropathy
- Painful parasthesias - Ototoxicity that can lead to deafness
- Amifostine is given IV to protect against nephro/neurotoxicity from Cisplatin
Leukemia from Alkylating Agents:
1. Describe why this happens?
- In rare cases it can lead to what?
- The risk of leukemia from alkylating agents is dependant on what?
- Risk of leukemia after getting alkylating agents is highest about _______ years after treatment
- Because these drugs damage DNA they can cause long-term damage to the bone marrow
- In rare cases leads to acute leukemia
- The risk of leukemia from alkylating agents is dose-dependent
- 5 to 10 years after treatment
Antimetabolites
- MOA?
- Work during what phase?
- What are they commonly used to treat? 4
- Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA
- Damage cells during the S phase, when the cell’s chromosomes are being copied
- They are commonly used to treat:
-leukemias,
cancers of the
-breast,
-ovary, and
-the intestinal tract,
as well as other types of cancer
Primary antimetabolite toxicities
4
- Myelosuppression
- Nausea and vomiting
- Mucositis
- Dermatologic (rash, injection site reaction, dermatitis, pruritis)
Classes of antimetabolites
3
- Folate antagonists
- Purine analogs
- Pyrimidine analogs
Name the specific drugs in each category of Antimetabolites:
1. Folate antagonists
- Purine analogs
- Pyrimidine analogs 2
- Methotrexate (MTX, Trexall)
- Mercaptopurine (6-MP, Purinethol)
- Fluorouracil (5-FU)
- Gemcitabine (Gemzar)
Methotrexate (MTX; Trexall)
1. MTX toxicity mainly affects cells with what?
- Such as? 2
- Can damage what organs? 2
- Sometimes high dose MTX is needed and what is given to reverse the toxic effects of MTX otherwise the patient may die?
- Rapid turnover
- Bone marrow (myelosuppression)
- Mucosa (mucositis)
- Liver and kidney
- Leucovorin (reduced folic acid)
-Methotrexate (MTX; Trexall)
Complications? 2
- Vigorous hydration and _________ loading prevent ______________________in the renal tubules?
- Drugs that impair MTX excretion? 7
- Decreased renal clearance
- May need prolonged therapy with leucovorin - Effusions
- Will go into the effusions and leak out continuously and expose normal tissue to the drug - bicarbonate, crystallization of the urine
- ASA,
- NSAIDs,
- amiodarone,
- omeprazole,
- PCN,
- phenytoin,
- sulfa compounds
Mitotic inhibitors
- MOA?
- Works in which phases?
- AKA?
- classes in this category? 4
- Work by altering the DNA inside cancer cells to keep them from growing and multiplying
- Work in all phases of the cell cycle
- Also known as Anti-tumor
Antibiotics or Antimicrotubules - Classes
- Vinca Alkaloids
- Taxanes
- Epothilone
- Anthracyclines
- Mitotic inhibitors are derived from what?
- They work by stopping mitosis in the ___ phase of the cell cycle but can damage cells in ___ phases
- How do they accomplish the above?
- plant alkaloids and other compounds derived from natural products
- M, all
- keeping enzymes from making proteins needed for cell reproduction
Mitotic inhibitors: Toxicities?
3
Used to treat many different types of cancer including: 5
- myelosuppression,
- anaphylactic reactions,
- peripheral neuropathy
- breast,
- lung,
- myelomas,
- lymphomas
- leukemias
Mitotic inhibitors are what drug categories?
4
- Taxanes:
- Epothilones:
- Vinca alkaloids:
- Estramustine (Emcyt)
Which drugs are in the following Mitotic inhibitors?
- Taxanes 2
- Epothilones 1
- Vinca alkaloids 3
- paclitaxel (Taxol)
- docetaxel (Taxotere)
- ixabepilone (Ixempra)
- vinblastine (Velban),
- vincristine (Oncovin),
- vinorelbine (Navelbine®)
Vinca Alkaloids
interfere with what phase?
M phase
Vincristine (Oncovin)…side effect?
Neuropathy
Neuropathy caused by Vinca Alkaloids:
- Most commonly caused by which agent?
- How can it manifest? 3
- Vincristine (Oncovin)
- Paresthesias in the fingers and toes (mild)
- Symptoms can move distal to proximal and result in significant weakness
- Constipation is the most common symptom of autonomic neuropathy