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Principles of Disease > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

What are the different types of treatment available for cancer

A 
Surgery
Radiotherapy
Chemotherapy 
Targeted therapies
Immunotherapy
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2
Q

What types of chemotherapy are there

A

IV or oral for systemic delivery/absorption

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3
Q

How should systemtic therapy be delivered

A

Oral or intravenous route
Regular cycles with timing dependent on the findings from pharmacokinetics (half life, excretion)
May be need for delay if toxicities develop
Intensification previously evaluated: better in non-solid tumours

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4
Q

What methods can be used to access drug activtiy

A

Objective
Improved
Adjuvant
Neoadjuvant

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5
Q

Describe the objective method

A

It shows an objective response in advanced disease via CT scan, PET scan and/or clinical examination
RECIST criteria if radiological

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6
Q

Describe the improved method

A

Shows:
Overall survival (OS)
Progression-free survival (PFS)
Improved quality of life (QoL)

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7
Q

Describe the adjuvant method

A

Shows if treatment improves survival

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8
Q

Describe the neoadjuvant method

A

It may improve survival through increasing operability or reduce the ‘filed’ of radical radiotherapy (treatment before surgery)

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9
Q

Name the catergories that cytotoxic agents be classified into

A 
Alkylating agents
Anti-metabolites
Mitotic inhibitors
Antibiotics
Others
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10
Q

What is the site of action for anti-metabolites

A

DNA synthesis

They impair replication

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11
Q

What is the site of action for alkylating agents

A

DNA

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12
Q

What is the site of action for intercalating agents

A

DNA transcription

DNA duplication

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13
Q

What is the site of action for spindle poisons

A

Mitosis

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14
Q

What is the mode of action for alkylating agents

A

The alkyl group allows covalent bonds with other molecules
DNA helix X-links intra- and interstrand
Attaches to free guanines at N6 on separated DNA strands
Can not act as templates for new DNA formation

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15
Q

What is the structure of antimetabolites

A

Similar chemical structure to essential metabolites required by cell prior to cell division

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16
Q

What is the mode of action for antimetabolites

A

They may be incorporated into new nuclear material or bind irreversibly with vital enzymes to inhibit cell division

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17
Q

Give examples of antimetabolites

A 
Antagonise folic acid (methotrexate)
Antagonise purine (6-mercaptopurine, 6-thioguanine)
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18
Q

What is the mode of action for vinca alkaloids

A

They bind to tubulin and block microtubule formation and spindle formation which is essential for metaphase of mitosis)

19
Q

What are vinca alkaloids

A

They are metaphase arrest agents

20
Q

What is the mode of action for taxanes

A

They promote spindles and ‘freeze’ cells at that stage of cycles

21
Q

Name the categories of antimitotic antibiotics

A

Anthracyclines

Non-anthracyclines

22
Q

Describe the features of antimitotic antibioditics

A

They intercalate and inhibit DNA and RNA synthesis
Membrane binding and increase permeability to various ions
Free radicals disrupt DNA chain and prevent mitosis
Metal ion chelation resulting in cytotoxic compounds
Alylation blocking DNA replication

23
Q

At what stage of the cell cycle do antibiotics work

A

End of G1
S
Beginning of G2

24
Q

At what stage of the cell cycle do antimetabolites work

A

S phase

25
Q

At what stage of the cell cycle do vincaalcaloids work

A

Beginning of M phase

26
Q

At what stage of the cell cycle do mitotic inhibitors work

A

M phase

27
Q

At what stage of the cell cycle do taxoids work

A

End of M

Beginning of G1

28
Q

At what stage of the cell cycle do alkylating agents work

A

The whole cell cycle

G1, S, G2, M

29
Q

What is the aim of combination therapy

A

To increase efficacy

30
Q

What does combination therapy combine

A

Different mechanisms of action

Different mechanisms of resistances

31
Q

What are the principles of combination chemotherapy

A

To combine those with:
Different mechanism of actions
Dissimilar toxicity profile e.g. not both with neurotoxicity (cisplatin and taxane)

32
Q

What should the different mechanisms of action have

A

Synergistic or additive effect

Reduce risk of developing resistance

33
Q

How should the drugs given in combination therapy be given

A

Both given to maximum tolerated dose

34
Q

What are the possible side effects of chemotherapy (at least 5)

A 
Alopecia
Mucositis
Plumonary fibrosis
Cardiotoxicity
Nausea/vomiting
Local reaction
Renal failure
Diarrhoea
Cystisis
Sterility
Myalgia
Myelosupression
Nueropathy
Phlebitis
35
Q

What were the most distressing side-effect of chemotherapy in 1983

A 
Vomiting
Nausea
Alopecia
Thought of coming for treatment
Length of time treatment takes at the clinic
Having to have an injection
Shortness of breath
Constantly tired
Difficulty sleeping
Affects family or partner
36
Q

Side effects of chemotherapy can be…

A

Managed and/or prevented

37
Q

Modern chemotherapy drugs are…

A

More tolerable

38
Q

What other cancer systemic therapies are there

A

Hormonal

Targeted

39
Q

Name some hormonal drugs used

A

Anti-oestrogen - tamoxifen, aromatase inhibitors
Gonadorelin analogue e.g. Goseralin (Zoladex)
Anti-androgen - CPA, flutamide

40
Q

Name some targeted drugs used

A

Gefitinib/Erlotinib for EGFR

Bevacizumab (Avastin) for VEGF

41
Q

Name some immunotherapy drugs

A

Nivolumab, Pembrolizumab, Atezolizumab, Durvalumab, Avelumab which are all PD-1 or PD-L1 inhibitors

42
Q

What combination immunotherapy has been approved for melanoma

A

Ipilimumab

Nivolumab

43
Q

What side effects can occur from immunotherapy

A

Immune mediated (e.g. colitis, pneumonitis, endocrinopathies)

44
Q

In combination therapy what should be considered when choosing drugs

A

Drugs with similar side effects/toxicities should not be combined together

Principles of Disease (41 decks)

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