Treatment: Systemic Anti-Cancer Therapy Flashcards
What are the four branches of systemic anti-cancer therapy?
- Chemotherapy
- Hormonal therapy
- Immunotherapy
- Targeted therapies
How does chemotherapy work?
Agents mainly directly targeting DNA structure or segregation of DNA as chromosomes in mitosis
How do targeted agents work?
Small molecules or “biologicals” designed and developed to interact with defined molecular target important in either maintaining malignant state or selectively expressed by the tumour cells
How do hormonal therapies work?
Capitalise on the biochemical pathways underlying oestrogen and androgen function and action as a therapeutic basis for approaching patients with tumours of breast, prostate, uterus, and ovarian origin
How do biologic therapies work?
macromolecules that have a particular targets (e.g. antigrowth factor or cytokine antibodies) or may have the capacity to orchestrate or regulate the host immune response to kill tumour cells
What is the rationale for treatment in neo-adjuvant chemotherapy?
- Given before surgery to increase likelihood of cure
- Induction chemotherapy: used to downstage tumours, rendering them operable/amenable to radiotherapy treatment
What is the rationale for treatment in radical chemotherapy?
As the main treatment modality used to treat the cancer e.g. germ cell tumours very responsive to chemotherapy
What is the rationale for treatment in adjuvant chemotherapy?
Given after surgery to increase likelihood of cure e.g. FEC100 in breast surgery
What is the rationale for treatment in palliative chemotherapy?
Incurable disease
Aims to extend life, obtain period of disease control, palliate symptoms e.g. carboplatin/paclitaxel in stage 3/4 ovarian cancer
What factors must be considered in starting SACT?
- Tumour factors:
- Stage
- Pathological features
- Treatment intent - Patient factors
- Fitness for treatment (ECOG/performance status)
- Co-morbidities
- Patient wishes
Describe details of ECOG score/performance status
0 = Full active, able to carry out all pre-disease performance without restriction
1 = restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature e.g. light house work
2 = ambulatory and capable of self-care and resting for <50% of the day
3 = Capable of limited self-care
Resting for >50% of the day
4 = Completely bed-bound
5 = Dead
Why do chemotherapy drugs have many side-effects?
- Cytotoxic agents damage both normal replicating cells and tumour cells indiscriminately
- Normal cells at risk = GI tract/bone marrow/hair follicles/mucosal surfaces
- By remembering this we can remember where and why side-effects occur
List the common side-effects of chemotherapy
Fatigue (anaemia) Infection/ neutropenic sepsis N&V, anorexia Diarrhoea Constipation Mucositis Thrombocytopenia (↓plts) Hair loss Hypersensitivity reactions Peripheral neuropathy (platinum based chemotherapies directly toxic to myelin) Palmar-plantar erythema Hepatic, renal dysfunction
List some other risks associated with chemotherapy
- Extravasation
- Sub-fertility/infertility
- Thrombosis
Which anti-emetic would you prescribe in patients at low-risk of symptoms?
Metoclopramide
