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PoD > Therapeutic Options > Flashcards

Therapeutic Options Flashcards

1
Q

Prevention methods

A
  • Diet
  • Stop people smoking
  • Screening
  • Genetics
  • Medication
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2
Q

Diet in prevention

A
  • Inconsistent evidence, lots of confounding factors
  • CRC is probably linked with red meat consumption
  • Breast cancer: probably a link with saturated fat intake
  • Physical activity decreases risk
  • Current advice: 5 or more portions of fruits and vegetables a day, avoid obesity, take regular exercise 30 minutes a day
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3
Q

Screening in prevention

A
  • Risks are involved with screening, so you may cause harm
  • E.g. breast screening might perform a mammectomy on a patient who has a lump that may never turn into cancer
  • High quality evidence for smear tests, CRC (faecal occult blood test), breast cancer
  • Controversial: PSA blood test for prostate cancer, MR/CR or breath test for lung cancer
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4
Q

Genetics in prevention

A
  • CRC and familial adenomatous polyposis coli (FAP)
  • Autosomal dominant
  • Screening families for APC mutations
  • Regular colonoscopy
  • Offer panprotocolectomy when adenomas found
  • Breast cancer: BRCA1, BRCA2
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5
Q

Medication in prevention

A
  • Also known as chemo-prevention

- More controversial

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6
Q

Primary medication in prevention

A
  • Oesophageal cancer: high rate in parts of chine, they tried anti-oxidant supplements but there was no benefit
  • Breast cancer: at risk women, prophylactic tamoxifen (higher risk of getting endometrial cancer with this)
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7
Q

Secondary medication in prevention

A
  • Previous head and neck or lung cancers
  • Give anti-oxidant supplements
  • No benefit
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8
Q

Treatment

A
  • Local or regional treatment: surgery or radiotherapy

- Systematic therapy: hormonal, chemo, immunotherapy

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9
Q

Surgery treatment of cancers

A
  • Need anatomical clearance
  • Get all the cancer out
  • 50% of cancers cured this way
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10
Q

Radiotherapy treatment of cancers

A
  • Needs anatomical coverage
  • Can treat inoperable lesions
  • Can treat things you can’t remove and/or allow surgery to be possible
  • Approx. 40% of cancers cured by this
  • Can be combined with chemo: anal cancer, rectal cancer, oesophageal cancer
  • Palliation
  • Maintain function and/or appearance
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11
Q

Palliation

A
  • Reduce pain
  • Bleeding
  • Swollen limbs
  • Aims to improve symptoms
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12
Q

Maintaining function with radiotherapy

A
  • Gullet cancer, you can’t remove it so you need to maintain function
  • Ear lesion, you can keep your ear with radiation therapy
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13
Q

5R’s of radiobiology

A
  • Radiosensitivity
  • Repair
  • Re-population
  • Re-oxygenation
  • Re-assortment
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14
Q

Radiosensitivity

A
  • How sensitive the tumour is going to be to treatment
  • Can anticipate outcome
  • Certain drugs have been proven to increase radiosensitivity
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15
Q

Repair

A
  • Radiation damages cells to a sublethal level, often the cell pathways repair themselves have been suppressed in malignant tumours
  • The degree of suppression will affect the repair half-life and how effective the treatment is
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16
Q

Re-population

A
  • Cells will all be in different parts of the cell cycle
  • S phase: typically radioresistant
  • Late in G2 or M phase are relatively sensitive
  • Idea is you catch them at some point in the cycle when they’re in a more sensitive phase
17
Q

Re-oxygenation

A
  • Tumours can be acutely or chronically hypoxic, this makes the resistant to radiation
  • The aim of radiation is to make them oxic as oxic cells can be killed
18
Q

Re-assortment

A
  • Cells are in a cycle and you catch some cells at different stages, some are sensitive to radiotherapy and some aren’t
  • G2 and M are good, late S isn’t so good
19
Q

Systemic therapy

A
  • Beneficial for widespread disease
  • Can result in widespread toxicity
  • Palliation in about 50% of cancers
  • Potential to be very specific
  • Therapeutic index: aim is to have the anti-tumour effect curve and normal tissue toxicity as far apart as possible. Separates side effects and anti-tumour effects
20
Q

Hormonal therapy

A
  • ‘Specific’ or ‘targeted’ therapy
  • Benefits in breast cancer (oestrogen receptor positive and tamoxifen) and prostate cancer (luteinising hormone-releasing hormone antagonists)
  • Trials in prevention for high risk groups e.g. tamoxifen
21
Q

What are the 4 basic types of chemotherapy?

A
  • Curative
  • Palliative
  • Adjuvant
  • Neoadjuvant
22
Q

Curative chemotherapy

A
  • Only about 3% of cancers, testicular, lymphomas
  • Can be used with radiotherapy
  • Important to use biomarkers to see what genes the tumours have, assess treatment methods
23
Q

Palliative therapy

A
  • Accounts for around 50% of chemotherapy

- Aim is to relieve symptoms

24
Q

Adjuvant

A
  • When there is no longer evidence of pathology

- Can reduce risk of recurrence. Based on population statistics rather than the individual

25
Q

Neoadjuvant

A
  • Aim is to improve survival and reduce morbidity
  • Precedes surgery or radiotherapy
  • Before people have surgery to see how the cancer is going to behave and decide whether to do local or systematic therapy
  • Can be used to assist the surgery by ensuring cancer cells are removed in the operation and not in the bloodstream
26
Q

Immunotherapy

A
  • Specific and non-specific types
  • Antibodies can target cancer, you can have a combination of mouse and human antibodies… one half of the antibody could be targeting one part and the other half of the head could be targeting another
27
Q

Types of immunotherapy

A
  • Monoclonal antibodies
  • Programmed cell death pathway (PD-1)
  • Chimeric antigen receptor (CAR) T-cells
28
Q

Programmed cell death pathway (PD-1)

A
  • Uses immune system to attack ‘foreign’ cancer cells
  • Cancer hides behind inhibitors, this drug allows the immune system to see the drug
  • It can make things worse if you have co-morbidities
  • being used in lung cancer and melanoma
29
Q

Chimeric antigen receptor (CAR) T-cells

A
  • Artificial T-cell receptors, using retroviral vectors to give a specific cell killing function directed against cancer cells
  • Very new
  • In lymphomas and leukaemias, not solid cancers
  • Side effects: you’re taking lymphocytes out of circulation
  • You put them back via T cell adoptive transfer
30
Q

CAR T-Cells monitoring

A
  • Disease response: CT scans, bone marrow biopsies, peripheral blood flow cytometry
  • CAR T-Cell persistence: Immunohistochemistry of bone marrow biopsy, RT-PCR and flow cytometry of blood and bone marrow aspirate
31
Q

Designer therapies

A
  • Specific, based on molecular science
  • You look at intracellular growth points
  • EGFR inhibitor - in lung cancer need to have a specific mutaiton

PoD (33 decks)

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