Chapter 8 - Malignant Disease Flashcards

1
Q

Chemotherapy can be given out of two general intents. What are these?

A

1) curative approach

2) palliative approach - e.g degenerate disease with no cure, aiming to prolong disease progression and lessen symptoms

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2
Q

What is neoadjuvant chemotherapy?

A

Initial treatment with chemo aimed to shrink the primary tumor, rendering local therapy less destructive and/or more effective

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3
Q

What is adjuvant chemotherapy?

A

usually refers to surgery followed by chemo (or radiotherapy) to help decrease the risk of the cancer recurring (coming back).

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4
Q

What are the most common side effects of cytotoxic drugs?

A

Extravasation of IV drugs - leakage of cytotoxics into the extravascular compartment may cause severe local tissue necrosis

Oral mucositis (sore mouth)

Tumour lysis syndrome (TLS) - occurs when a large number of tumour cells are killed rapidly, releasing intracellular ions and contents - leads to hyperuricaemia, hyperkalaemia, hyperphosphataemia, hypocalcaemia and acute renal function.

Hyperuricaemia

Bone marrow suppression

Aloepecia

Thromboembolism - cancer is a risk factor itself but chemotherapy may increase risk

Nausea/vomiting

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5
Q

Which cytotoxics are most commonly associated with oral mucositis as a side effect?

A

flurouracil, methotrexate and the anthracyclines

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6
Q

Which types of cancers would you expect to see TLS/ hyperuricaemia occur most with?

A

Lymphomas and leukaemias - vast number of tumour cells present

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7
Q

Which drug is used for prophylaxis of TLS/ hyperuricaemia?

A

Allopurinol

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8
Q

All cytotoxics cause bone marrow suppression as a side effect, except 2. What are these two cytotoxics?

A

Vincristine and bleomycin

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9
Q

A patient with a WCC of less than ………………… and is undergoing chemotherapy is considered to be neutropenic.

A

1.06 x 10^9

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10
Q

Which cytotoxics are associated with mild emotengenic symptoms?

A

Flurouracil, etopside and methotrexate (100mg/m^2)

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11
Q

Which cytotoxics produce high risk emetogenic symptoms?

A

Cisplatin, dacarbazine and high dose cyclophosphamide

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12
Q

For patients undergoing low risk emotegenic chemotherapy, which antiemetics are favoured?

A

Dexamethasone
Or
Lorazepam

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13
Q

For patients undergoing highly emotengenic chemotherapy, which antiemetics are used?

A

5HT3-Antagonists (e.g ondansetron) in combo with
Dexamethasone
Aprepitant

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14
Q

Which side-effects are specifically associated with anthracycline use?

A

Cadiotoxicity

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15
Q

What drugs are classed under anthracyclines?

A

Danorubicin
Doxorubicin
Epirubicin
Idarubicin

Mitoxantrone - anthracycline derivative

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16
Q

Topoisomerase 1 is an enzyme essential for DNA replication. What are the topoisomerase 1 inhibitors?

A

Irenotecan

Topotecan

17
Q

What affects the choice of adjuvant therapy when deciding chemotherapy for breast cancer?

A
  • safety and efficacy of drug
  • oestrogen receptor status
  • human epidermal growth factor 2 status (HER2)
18
Q

For pre-menopausal women with oestrogen receptor positive breast cancer, which chemotherapy agent is usually preferred and why?

A

Tamoxifen

Tamoxifen acts primarily as an antioestrogen, preventing oestrogen binding to the oestrogen receptor - therefore preventing tumour proliferation.

Tamoxifen can be used in both pre and post menopausal women

Other agents such as aromatase inhibitors (e.g letrozole) are used in post-menopausal women instead of pre-menopausal women as they encourage ovarian stimulation of oestrogen, even though they reduce oestrogen production from other tissues and organs in the body.

19
Q

What is generally first line therapy for the treatment of breast cancer in post-menopausal women?

A

Aromatase inhibitors e.g letrozole, anastrazole

20
Q

For women who have HER2 positive breast cancer, which chemotherapy agent is used for first line treatment?

A

Trastuzumab