Term
| Where did cancer rank on US causes of death in 2004? |
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Definition
| 2nd. 559,888 deaths. 23.1% of all deaths. |
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Term
| What are the top two killer cancers for men and women? |
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Definition
Men: lung & bronchus 31%, colon & rectum 10%.
Women: lung & bronchus 26%, breast 15% |
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Term
| What is the definition of cancer? |
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Definition
| A dz of cell proliferation which is characterized by a loss of normal control mechanisms which regulate orderly cell growth/differentiation and function. |
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Term
| What makes cancer cells so problematic? |
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Definition
| they have the ability to invade adjacent tissue and metastasize |
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Term
| Where do these cancers like to metastasize to? Melanoma, Breast, Colorectal, Prostate. |
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Definition
| Melanoma - lungs. Breast - bone. Colorectal - liver. Prostate - bone |
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Term
| When is chemo tx most/least effective? |
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Definition
| most effective for early or locally advanced dz. least effective for recurrent or metastatic dz. |
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Term
| What are 4 patient specific factors to consider before doing chemo tx? |
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Definition
| performance status - comborbities - end organ dysfunction - personal choice |
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Term
| What is the general concept of chemo tx? |
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Definition
| To eradicate the malignant cells by exploiting the differences b/t the malignant and normal host cells while minimizing the toxic effect of normal host cells. |
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Term
| How is chemo usually given? |
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Definition
| in combinations and in cycles |
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Term
| What are 4 considerations when designing a chemo regimen? |
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Definition
| 1) select drugs which have single agent activity. 2) include drugs with different MOA and which have non-overlapping toxicities. 3) use optimal dose intensity. 4) consider using drugs which demonstrate synergy. |
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Term
| When is adjuvant chemotherapy done? |
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Definition
| after the definitive, local therapy (surgery) to reduce the risk of occurrence |
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Term
| When is neo-adjuvant chemotherapy done? |
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Definition
| prior to definitive local therapy (surgery) in an attempt to shrink tumor and may make an "inoperable" tumor operable |
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Term
| When is metastatic chemotherapy done? |
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Definition
| to minimize the extent/size of tumor burden, pain control, palliation; weigh side effects of chemo vs symptom mgmt |
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Term
| How do tumor cells exhibit resistance to chemo? |
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Definition
| develop drug efflux pumps which remove drug from the cytoplams |
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Term
| Where is chemo virtually ineffective? |
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Definition
| the blood brain barrier allows tumor cells, but not cytotoxic drugs, to enter the CNS. in certain circumstances, chemo may be given intrathecally. |
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Term
| How are chemo agents dosed? |
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Definition
| with the Mostellar equation which uses a pts body surface area (mg/m2). doses are adjusted based on hepatic/renal dysfunction or based on toxicity experienced in previous cycles (determine pt's dose limiting toxicity) |
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Term
| What are two exceptions to determining dose through the Mostellar equation? |
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Definition
| Carboplatin (AUC) and intrathecal doses (mg) |
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Term
| Which 5 types of chemo drugs interact with DNA? |
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Definition
| Alkylating agents - Antimetabolites - Anthracyclines - Mitotic inhibitors - Topoisomerase inhibitors |
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Term
| Which 3 types of chemo drugs DO NOT interact with DNA? |
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Definition
| Hormonal agents - Monoclonal antibodies - "Targeted" therapy |
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Term
| What type of drugs coavlently bind to guanine bases of DNA and thereby interfere with normal function resulting in single or double stranded DNA breaks? |
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Definition
| Alkylating agents - active in both cycling and resting cells but most toxic in rapidly dividing cells |
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Term
| What type of drug are mechlorethamine (nitrogen mustard), cyclophosphamide (Cytoxan), ifosfamide (Ifex), cisplatin (Platinol), and carboplatin (Paraplatin)? |
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Definition
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Term
| Which drug(s) are prodrugs which are converted by hepatic metabolism to several active and inactive metabolites; one of the metabolites, acrolein, can cause hemorrhagic cystitis so hydration is necessary, and their side effects are n/v and myelosuppression? |
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Definition
| cyclophosphamide (Cytoxan) and ifosfamide (Ifex) |
|
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Term
| What is a cytoprotectant that binds to the acrolein molecule and deactivates it? |
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Definition
|
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Term
| Which agent can be nephrotoxic so IV hydration/mannitol should be considered and is highly emetogenic? |
|
Definition
| cisplatin (Platinol) - a platinum analogue, alkylating agent |
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Term
| Which two drugs are derivatives of cisplatin engineered to improve efficacy and decrease toxicities? |
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Definition
| carboplatin (Paraplatin) and oxaliplatin - platinum analogues, alkylating agents |
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Term
| What unique adverse effect does oxaliplatin cause? |
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Definition
|
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Term
| What type of agents are structurally related to normal cellular components and interfere with the availability of normal purine or pyrimidine precursors by inhbiting their synthesis or competing with them in the process of DNA or RNA synthesis? |
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Definition
|
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Term
| When do antimetabolites exert their effect? |
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Definition
| in the S-phase of the cell cycle |
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Term
| What type of agent are fluorouracil (5FU), uracil, thymine, cytarabine (Ara-C), cytidine, methotrexate, and gemcitabine? |
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Definition
|
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Term
| Which type of agent intercalates within the DNA molecule, interferes with transport process across cell membrane, and generates oxygen free radicals? |
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Definition
|
|
Term
| What type of agent are doxorubicin and daunorubicin? |
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Definition
|
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Term
| What is the most severe adverse effect of anthracyclines? |
|
Definition
| irreversible and dose-dependent congestive cardiomyopathy which is a result of generation of free radicals which cause cardiace cell damage. |
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Term
| What important factors should you consider regarding athracyclines and cardiotoxicity? |
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Definition
| monitor LVEF routinely (MUGA or 2d ECHO) - radiation of thorax increases risk - cumulative lifetime dose limit - consider using dexrazoxane (Zinecard) a cytoprotectant which prevents free radical formation or lipsomal doxorubicin (Doxil) which is less cardiotoxic |
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Term
| What is a vesicant hazard regarding anthracyclines? |
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Definition
| inadvertant extravasation can cause severe local tissue necrosis and ulceration which often requires surgical attention. place mediport to prevent. |
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Term
| What are 4 other toxicities of anthracyclines? |
|
Definition
| alopecia - myelosuppression - mucositis - nausea |
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Term
| Which type of mitotic inhibitors promote de-polymerization and destabilization of tubilin? |
|
Definition
| vinca alkaloids - vincristine, vinblastine, and vinorelbine |
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Term
| Which type of mitotic inhibitors promote polymerization and overstabilization of tubulin? |
|
Definition
| taxanes - paclitaxel and docetaxel |
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Term
| Which agent is used in a variety of hematologic and solid tumors, its main DLT is neurotoxicity, and is fatal if given intrathecally? |
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Definition
| vincristine (Oncovin) - a vinca alkaloid mitotic inhibitor |
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Term
| Which agent is usd in lymphoma, breast, bladder, ovarian and testicular cancers, and its main DLT is myelosuppression? |
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Definition
| vinblastine (Velban) - a vinca alkaloid mitotic inhibitor |
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Term
| Which agent is used in NSCLC and breast cancer and causes myelosuppression and peripheral neuropathy? |
|
Definition
| vinorelbine (Navelbine) - a vinca alkaloid mitotic inhibitor |
|
|
Term
| What adverse effect do all vinca alkaloid mitotic inhibitors have? |
|
Definition
| vesicant hazards and require dose modfication in hepatic dysfunction |
|
|
Term
| What are DNA topoisomerases? |
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Definition
| enzymes which allow the coiling and uncoiling of DNA strands which is needed during the replication and transcription of DNA |
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Term
| What type of agent are etoposide (VP-16), topotecan (Hycamptim), and irinotecan (Camptosar) and what cancers are they used for? |
|
Definition
| topoisomerase inhibitors. VP-16 for SCLC - Hycamptim for SCLC, ovarian - Camptosar for colon |
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Term
| Which agent is generally well tolerated and considered synergistic with platinum analogues? |
|
Definition
| etoposide - a topoisomerase inhibitor |
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Term
| Which agent was first approved for colorectal cancer, DLT is myelosuppression, it produces severe diarrhea in some pts and atropine is used as a premedication? |
|
Definition
| irinotecan - a topoisomerase inhibitor |
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Term
| What are three types of hormonal therapy used to treat breast cancer? |
|
Definition
| 1) oophorectomy or ovarian ablation with Zoladex. 2) Antiestogens - classical antagonist (Tamoxifen). 3) Aromatase inhibitors - prevent peripheral estrogen synthesis in postmenopausal women only (Femara, Arimidex, Aromasin) |
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Term
| Which agent used for hormonal breast ca tx can only be used for 5 years? |
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Definition
| Tamoxifen, an entiestogen. after 5 years it causes breast cancer |
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Term
| What type of agents are engineered to bind to specific receptors located on the surface of malignant cells which are responsible for signaling cell growth and regulation? |
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Definition
|
|
Term
| How does the binding of monoclonal antibodies produce antitumor effects? |
|
Definition
| prevents receptor stimulation which leads to cell growth - binding causes apoptosis - attracts "natural killer" cells - can fuse moab to cytotoxic complex ("Magic bullet") |
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Term
| Which type of targeted therapy are Herceptin (breast), Erbitux (colon, head/neck), and Vectibix (colon)? |
|
Definition
| epidermal growth factor inhibition |
|
|
Term
| What type of targeted therapy are Tarceva (lung, pancreas) and Gleevec (CML, GIST)? |
|
Definition
| tyrosine kinase inhibition |
|
|
Term
| What type of targeted therapy is Avastin (colon, lung, breast, brain in metastatic setting)? |
|
Definition
|
|
Term
| When does a pt's ANC usually reach its lowest level? |
|
Definition
| about 7-8 days after treatment. <0.5 prone to serious infection - neutropenic pxns |
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|
Term
| When does febrile neutropenia occur? |
|
Definition
| when a pt has a fever and a significant reduction in their WBCs. pts should be promptly assessed and empiric abx tx started |
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Term
| What are filgrastim (Neupogen), short acting qd, and pegligrastim (Neulasta), longer 2wks, used for? |
|
Definition
| WBC colony stimulating factors used to shorten duration and lessen degree of WBC decline |
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|
Term
| What is the most distressing symptoms commonly reported by chemo pts? |
|
Definition
| nausea. protracted vomiting may lead to dehydration and electrolyte depletion |
|
|
Term
| What are Compazine and Phenergan used for? |
|
Definition
| at home antiemetics (PO or PR) |
|
|
Term
| What is used on days 1, 2, and 3 to prevent n/v? |
|
Definition
|
|
Term
| What is the most sensitive signal during the first 24hrs after chemo and what is used to prevent it from causing n/v? |
|
Definition
| serotonin (5-HT3) - 5-HT3 receptor antagonists used IV 1st line to prevent n/v. |
|
|
Term
| What are four common 5-HT3 receptor antagonists? |
|
Definition
| Granisetron (Kytril) - ondansetron (Zofran) - dolasetron (Anzemet) - palonsetron (Aloxi) |
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