Anti-Cancer Agents

Question 1

Neoadjuvant therapy

Answer 1

given prior to the surgical procedure, to shrink the cancer so that the surgical procedure may not need to be extensive

Question 2

Adjuvant therapy

Answer 2

Given to destroy left-over cells that may be present after the tumor is removed. Prevents reoccurrence

Question 3

Maintenance therapy

Answer 3

Given in low doses to assist in prolonging remission

Question 4

First line therapy

Answer 4

Through research studies and clinical trials, been determined to have the best probability of treating a given cancer

Question 5

Second line therapy

Answer 5

Given if a disease has not responded or reoccured after first line chemotherapy. Also called salvage therapy

Question 6

Palliative therapy

Answer 6

Given specifically to address symptom management without expecting to significantly reduce the cancer

Question 7

PK

Answer 7

-most anti-cancer agents have narrow TI and wide inter-individual PK making them ideal candidates for TDM

Question 8

Absorption

Answer 8

• N/V (dec)
• Prior surgery, radiotherapy or chemo affecting GI tract (dec)
• DDI (inc/dec)
• GI peristalsis (inc/dec)

Question 9

Distribution

Answer 9

• Bodyweight loss (dec)
• Dec body fat (dec)
• Hypoalbuminanemia (inc)
• Protein binding (inc)
• Peritoneal or pleural effusions (inc)

Question 10

Elimination

Answer 10

• Renal dysfunction (dec)
• Hepatic dysfunction (Dec)
• Induction of metabolism (inc)

Question 11

PK variability: DDI

Answer 11

-CAM interactions

Question 12

PKPD/TD

Answer 12

-toxicity is good means drug is efficacious

Question 13

PD Interaction

Answer 13

-A positive PD drug interaction has been found between 5-FU and folinic acid (leucovorin)
-PD DDI between platinum agent (cisplatin or carboplatin) and taxane (paclitaxel or decetaxel)
led to dec in formation of platinum adducts in patient DNA, which is the primary lesion in carboplatin antitumour activity

Question 14

Wrong dose

Answer 14

• Overdose and excessive toxicity

- underdosing and reducing drug effect

Question 15

Dose selection/individualization

Answer 15

Conventional method: BSA based

• Priori dosage determination based in patient characteristics
• dose adaption: LSM and TDM

Question 16

Carboplatin

Answer 16

• mainly eliminated by kidneys

- renal cl is related directly to GFR

Question 17

Priori Dose Adjustment

Answer 17

• Renal function
• Liver function
• Propensity for toxicity
• elderly and obesity
  
  • limitation of calculated BSA at 2.2 m^2
• pharmacogenetics

Question 18

LSM

Answer 18

• limit frequency of blood sampling needed for the quantification of AUC
• need to be applied and prospectively validated in treatments using the same anticancer agents, doses, administration schedules and duration of infusion

Question 19

TDM

Answer 19

• optimum period for measuring MTX conc and determining the risk of toxicity is between 24-48 h after the start of infusion
• MTX levels >1 uM at 48h require additional rescue dose
• MTX conc are measured 48h intervals thereafter the leucovorin dose adjusted until MTX falls below 0.1 uM