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14 Onco > Principles of Systemic Therapy > Flashcards

Principles of Systemic Therapy Flashcards

1
Q

indications for systemic therapy

A
  • primary treatment
  • adjuvant
  • neoadjuvant
  • palliation
  • radio-sensitization
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2
Q

local treatment modalities for cancer

A

surgery, radiotherapy

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3
Q

systemic treatment modalities for cancer

A

conventional chemotherapy, targeted therapy, hormonal therapy, biological therapy

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4
Q

gompertzian growth curve

A

growth fraction: % of cells that are in active cell division

growth rate: rate of growth of tumor cells, peaks before tumor is clinically detectable

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5
Q

phases of gompertzian growth curve

A
  • lag phase
  • logarithmic phase
  • plateau phase
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6
Q

t/f chemo acts mainly on cells actively dividing or growing

A

true, best in cells in logarithmic phase

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7
Q

at around ___ of maximum, growth becomes clinically detectable

A

75%, it takes only a few more divisions before it becomes lethal

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8
Q

logarithmic kill model

A
  • when chemo is administered, a constant fraction of tumor cells will die (3 log cell kill)
  • 1 log regrowth in between sessions
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9
Q

3 checkpoints for successful replication in the cell cycle

A

between g1 and s, end of g2, directly in m phase

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10
Q

targets of cytotoxic drugs

A

antimetabolites, antibiotics, alkylating agents: s phase (get incorporated into dna leading to mutations and cell death)

vinca alkaloids, taxanes: m phase (attach to mircotubules during mitosis)

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11
Q

what are alkylating agents

A
  • cell cycle phase nonspecific (throughout cell cycle)

- busulfan, carmustine, cisplatin, cyclophosphamide, ifosfamide, melphalan

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12
Q

what are antimetabolites

A
  • interfere with purine and pyrimidine synthesis, active in s phase
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13
Q

what are mitotic inhibitors

A
  • inhibits mitosis by disaggregating microtubules (vinca alkyloids)
  • disruptive polymerization (toxoids)
  • active in m phase
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14
Q

what are antibiotics

A
  • bind to dna to generate free radicals that consequently cause dna damage
  • affect key enzyme in dna synthesis
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15
Q

principles of combination chemo

A
  • prevention of resistant clones
  • cyototoxic to both resting and dividing cells
  • biochemical enhancement of effect
  • rescue from adverse effects of treatment
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16
Q

5fu and ___ have an enhancement effect, while ___ with leucovorin have a protective effect in primary cns lymphomas

A

5fu + leucovorin in colon cancer: enhancing

methotrexate + leucovorin: rescue from adverse effects

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17
Q

other types of cytotoxic drugs

A

l asparagine depletion - l asapraginase
ribonucleotide reductase inhibitor - hydroxyurea
non-classic alkylating agents - procarbazine
topoisomerase II - etoposide and teniposide

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18
Q

how can chemotherapy be given

A

iv, opd, during in-patient confinement, oral (ex. capecitabine)

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19
Q

rationale for hormonal therapy

A

targeting tissues whose growth and function are under endogenous hormonal control (derived from tumor receptor status)

20
Q

t/f hormonal therapy is less toxic and more cytostatic than chemotherapy

A

true

21
Q

what is additive hormonal therapy

A
  • corticosteroids, estrogen, progesterone, androgens
  • hormones on top of endogenous hormones
  • higher doses of steroids (dexamethasone and prednisone) are lymphotoxic
  • use of corticosteroids for lymphoma
22
Q

what is ablative hormonal therapy

A
  • antagonize effects of existing hormones
  • breast = antiestrogen, prostate = antiandrogen, gonadotropin analogs
  • surgeries: oophorectomy, ochiectomy
23
Q

estrogen signaling

A

read

24
Q

drugs for er (+) patients

A
  • tamoxifen: blocks estrogen receptors by competitively binding to ER
  • aromatase inhibitors: block conversion to active estrogen
25
Q

t/f hormonal therapy only works for er or pr positive patients

A

true

26
Q

how to detect er / pr positivity

A

immunohistochemistry (dark brown stains)

27
Q

t/f all biologic therapies are targeted therapies

A

false, interferons and interleukins are nonspecific

28
Q

marker for aggressive disease in breast cancer

A

her2

  • dimerizes with other proteins of the same family
  • forms cascade of signals that lead to activation of transcription factors
29
Q

biological therapies against her2

A

trastuzumab, pertuzumab, t-dm, lapatinib

30
Q

what is trastuzumab

A

can attack her 2 at specific sites to block signaling

31
Q

what is pertuzumab

A

attacks her2 on different domains, prevents the dimerization to other her molecules

32
Q

challenges of targeted therapy

A
  • requires careful selection
  • more cutaneous and gi side effects (due to egfr)
  • higher cost
33
Q

example of small molecule tyrosine kinase inhibitor

A

imatinib (gleevec)

  • competitively inhibits atp binding site of bcr-abl, pdgfr, and ckit (proteins in cml and gi stromal tumors)
  • oral
34
Q

effectiveness of imatinib

A

inhibition of bcr-abl resulted in

  • more complete responses
  • better progression free survivial rates
  • better overall survival
35
Q

t/f imatinib is more toxic than standard chemo

A

false, more severe side effects in chemo

36
Q

other kinase inhibitors

A

table 1

37
Q

what are monoconal antibodies

A

target cancer cell specific antigens to induce an immune response against the target cell

(can be modified to deliver a toxin, radioisotope, or cytokine)

38
Q

examples of monoclonal antibodies

A

table 2

39
Q

what is egfr

A
  • focus is crc

- activates kras-braf-mek pathway -> proliferation and cell survival

40
Q

moa of cetuximab and panitumumab

A
  • inhibit egfr molecule from dimerizing and activating downstream pathways (control proliferation)
41
Q

biomarker for resistance to egfr drugs

A

kras mutation (does not need upstream activation)

42
Q

example of immune checkpoint blockade

A
  • ctla4 and pdl1

- pembrolizumab

43
Q

what is car t cell therapy

A
  • collect patient’s t cells
  • add cars on t cells
  • proliferate t cells
  • incoulate to patient
44
Q

vaccine approved for prostate cancer

A
  • dendritic cell vaccine
  • sipuleucel t
  • harvest dendritic cells and train to present antigens
  • mature and return to patient (can better recodnize tumors)
45
Q

contraindications to systemic therapies

A
  • infection
  • previous chemotherapy given <2 wks
  • major surgery <2 wks
  • leukopenia and thrombocytopenia
  • severely debilitated patients
  • 1st tri pregnancy
  • poor pt follow up
  • psycholocial problems
46
Q

recist criteria

A
  • complete remission
  • partial remission (decrease by at lest 50%)
  • stable disease (regression <50% or no change in size)
  • progression (increase by at least 25%)
47
Q

performance status scale

A

ecog (0-5) and karnofsky (100-0)

14 Onco (27 decks)

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