Cancer Chemo

Question 1

best phase of chemo to tx:

Answer 1

log linear growth phase (high growth fraction, short doubling time)

Question 2

growth of tumor cells is _____; fraction of cells killed with each chemo cycle is _____

Answer 2

exponential; constant

Question 3

log kill hypothesis assumption:

Answer 3

homogenous sensitivity to therapy (not true)

Question 4

why is chemo given in rounds?

Answer 4

allow for cell kill and cell regrowth

Question 5

Goldie Coldman Hypothesis

Answer 5

• best strategy for tx is early therapy with combo drugs

- prevention of tumor resistance

Question 6

tx modalities:

Answer 6

single
sequential
combination
systematic modalities (chemo/immunotherapy/hormone)

Question 7

principles of combo therapy;

Answer 7

• combine diff MOA
• avoid overlapping toxicities
• maximize synergistic interactions

Question 8

chemo cycles are based on:

Answer 8

particular drug and tumor type

Question 9

types of therapy used for LIQUID tumors:

Answer 9

induction (wipe out cells)
consolidation
maintenance (long term, low dose)

Question 10

types of therapy for SOLID tumors:

Answer 10

(surgery is best)
adjuvant therapy
neoadjuvant (shrink tumor)
palliation (control)

Question 11

how to measure if chemo worked:

Answer 11

objective measures (complete/partial response, stable/progressive dz)
subjective (symptom control, pain relief, decrease narcotic use)

Question 12

complete response:

Answer 12

disappearance of all tumor

Question 13

partial response:

Answer 13

decrease for at least 50% in diameter of all lesions

Question 14

factors affecting response to therapy:

Answer 14

• dx
• stage/grad of tumor
• tumor burden (size/toxic)
• tumor cell heterogeneity
• drug resistance
• dose and schedule of chemo
• pt factors (Ps, age, genetics)

Question 15

MC chemo sxs:

Answer 15

nausea and vomiting

Question 16

possible anatomical sites involved in n/v:

Answer 16

cerebral cortex
vestibular apparatus
medulla (vomiting center)
stomach (vagal/sympathetic afferent)
SI (serotonin released)

Question 17

approach to n/v:

Answer 17

prophylaxis is KEY

Question 18

types of chemo induced n/v:

Answer 18

acute (first 24 hours)
delayed (3-5 days after)
anticipatory (before chemo)

Question 19

tx for acute n/v:

Answer 19

serotonin antagonists
nk-1 antagonists
corticosteroids
(often in combo)

Question 20

3 major chemo drugs that cause delayed n/v:

Answer 20

cyclophosphamide
doxorubicin
cisplatin
(BIG 3 KNOW THESE)

Question 21

tx for delayed n/v:

Answer 21

corticosteroid
nk-1 antagonists
palonosetron

Question 22

tx for anticipatory n/v:

Answer 22

benzodiazepines