9: Medical Oncology

Question 1

What type of treatments fall under Medical Oncology?

Answer 1

Chemotherapy, targeted therapy, immunotherapy, and hormone therapy

Question 2

What are the patient-related factors that help determine the type of treatment?

Answer 2

type of cancer
tumor size, location and if it has mets
age/general health
PMH/Social History
previous cancer treatments
genetic testing
cancer pharmacogenomics

Question 3

Define and state Effect on response for - Tumor Burden or tumor load

Answer 3

Def: the size of the tumor or the amount of the cancer in the body

Effect: as tumor mass increases in size, its growth rate can slow, thus reducing the effectiveness of cancer treatments

Question 4

Define and state Effect on response for - Tumor Growth Rate

Answer 4

Def: the proportion of cancer cells within the tumor that are growing and dividing to form new cancer cells

Effect: Rapidly growing tumors usually are more responsive to treatment

Question 5

Define and state Effect on response for - Drug Resistance

Answer 5

Def: The failure of cancer cells to respond to a drug used to kill or weaken them

Effect: Cancer cells may be resistant at the beginning of treatment or may develop resistance after exposure to treatment

Question 6

Goals of Cancer Therapy Approaches: Prevention

Answer 6

Use of medicines or other agents to reduce the risk of cancer or delay its development

Ex: Hormone therapy to reduce Breast CA in high risk patient or the immunization of adolescents for HPV

Question 7

Goals of Cancer Therapy Approaches: Preventative Surgery

Answer 7

Use of surgery to reduce the risk of cancer or delay development

Ex: total colectomy in a person who has APC gene or bilat mastectomy if premenopausal woman that has strong family hx

Question 8

Goals of Cancer Therapy Approaches: Adjuvant Therapy

Answer 8

Use of additional treatment after the primary therapy to reduce the risk of cancer recurrence and to decrease the incidence of met disease

Ex: chemo after a lobectomy for lung CA

Question 9

Goals of Cancer Therapy Approaches: Definitive therapy

Answer 9

Use of radiation as the primary treatment modality, with or without chemo

Ex: radonc for prostate CA

Question 10

Goals of Cancer Therapy Approaches: Neoadjuvant Therapy

Answer 10

Use of one or more treatment modalities before the primary therapy to reduce the size of the primary tumor, improve the effectiveness of surgery, and decrease the incidence of met disease

Ex: CCRT before esophagogastrostomy to treat esophageal CA

Question 11

Goals of Cancer Therapy Approaches: Palliation

Answer 11

Use of cancer treatment modalities, when disease cure and control cannot be achieved, to relieve side effects and symptoms caused by cancer and other serious illnesses, and to improve quality of life

Ex: RT for bony mets

Question 12

Goals of Cancer Therapy Approaches: Prophylactic Therapy in Radiation Therapy

Answer 12

Use of RT to relieve symptoms, such as pain, bleeding, neurological compromise, or airway obstruction to improve QOL or treat life-threatening problems

Ex: Whole brain RT in asymptomatic patients diagnosed with cancers that have high risk of brain mets (like small cell lung)

Question 13

Chemotherapy interfere with cell division. What are the different phases it can interfere with?

Answer 13

G0 - Resting phase
G1 - Postmitotic phase
S - synthesis phase
G2 - premitotic phase
M - mitotic phase

Question 14

What type of chemo agents are cell cycle-nonspecific?

Answer 14

Alkylating Agents
Antitumor antibiotics
hormone therapies
nitrosoureas

Question 15

What type of agents are cell cycle specific agents for the synthesis phase (2)?

Answer 15

antimetabolites and camptothecins

Question 16

What type of chemotherapy agent(s) is cell cycle specific agents for the mitosis phase?

Answer 16

plant alkaloids and taxanes

Question 17

How is chemo administered? What are the 3 factors?

Answer 17

Administered in many ways: oral, intraperitoneal, intravenous, intrathecal, intraventricular, intrapleural, intratopical, subcutaneious or intramuscular, and topical

Factors:
Frequency of cycles (daily, weekly, every 14 or 21 days, monthly, continuously)
Length of cycles (minutes, hours, days)
number of cycles (as determined by research/clinical trials)

Question 18

What is personalized medicine in cancer treatment?

Answer 18

Also called precision medicine - uses a patient’s genetic information to prevent, diagnose, or treat cancer.

Question 19

What’s an example of a genetic variation that impacts dosage of 5-FU?

Answer 19

DPD (dihydropyrimindine dehydrogenase) deficiency – an enzymes

Someone with DPD deficiency will have more serious/life threatening reactions to 5-FU side effects

Question 20

Define Targeted Therapy

Answer 20

Drugs or other substances that are specific to a certain tumor type or they concentrate on a the genetic change instead of the type of cell.

Targeting specific Genes or the proteins found in cancer cells

OR acts on the tissue environment related to cancer cell growth and survival, such as blood cells

Question 21

Does Targeted Therapy have less side effects?

Answer 21

In theory, but in practice its been noted to have less toxic to normal cells but just very different – more vascular, coagulatory, dermatologic, immunologic, ocular and pulmonary toxicities

Question 22

Define Immunotherapy

Answer 22

also known as biological therapy or biotherapy - treatment to boost or restore the ability of the immune system to fight cancer, infection, and other diseases by including, enhancing or suppressing an individual’s own immune response

Question 23

What are the 4 different types of Immunotherapy?

Answer 23

Nonspecific – stimulates a broad-based immune response

Oncolytic Viral Therapy - genetically modified virus to kill cancer cells (T-VEC—first and only one approved by FDA at this time)

Chimeric Antigen Receptor T-Cell Therapy (CAR-T) - obtaining patient’s own T-cells through apheresis, genetically modified in lab by adding the CAR to their surface and given back to the patient — only approved for acute lymphoblastic leukemia in kids and advanced large B-cell lymphoma in adults.

Cancer Vaccines - preventative vaccines to avoid cancer in the future, given to healthy people. Only 2 so far – Hep B Vaccine for liver CA prevention and HPV vaccines for cervical, oral and anal CAs

Question 24

Define Hormone Therapy

Answer 24

also called endocrine therapy — used to treat hormone-sensitive cancers (breast, ovarian, prostate) by…

stopping/reducing the body’s ability to produce hormones,
interfering with or blocking hormone receptors,
and substituting chemically similar agents for active hormones but that can’t be used by the tumor