Cancer Chemotherapy

Question 1

What is the most common malignancy in the pediatric population?

Answer 1

Leukemia (Acute Lymphocytic leukemia)

Question 2

Type of chemotherapy used for systemic cancers:

Answer 2

Induction chemotherapy

Question 3

Type of chemotherapy used for localized cancers:

Answer 3

Neoadjuvant chemotherapy

Question 4

Chemotherapy used as part of a combination of treatment modalities:

Answer 4

Adjuvant chemotherapy

Question 5

The therapeutic goals of chemotherapy:

Answer 5

Cure some malignancies
Decrease the rate of relapse
Palliate symptoms
Reduce the size and extent of the primary tumor

Question 6

These are anti-cancer drugs that act on one or several phases of the cell cycle; as such they are ____.

Answer 6

Cell Cycle Specific Drugs (CCS); schedule dependent drugs

Question 7

Cell cycle nonspecific drugs act ____ the cell cycle; as such they are____.

Answer 7

inside and outside; dose dependent drugs

Question 8

Most CCNS drugs are ____ and antibiotics (except for ___)

Answer 8

Alkylating agents; Bleomycin

Question 9

Cancers with high growth fractions are?

Answer 9

Leukemia

Lymphoma

Question 10

Cancers with low growth fractions are?

Answer 10

Solid tumors:
Ovarian CA
Colon CA
Lung CA

Question 11

Cancer cell growth plateaus due to:

Answer 11

Depletion of nutrients (main cause)
Increase in competition
Confinement

Question 12

The cardinal rule of chemotherapy:

Answer 12

There is an invariable inverse relation between cancerous cell numbers and curability

Question 13

What are some factors affecting cell kill?

Answer 13

Dose intensity
Schedule
Drug Resistance
Tumor site
Patient's health status

Question 14

What is the single drug used to treat choriocarcinoma?

Answer 14

Methotrexate

Question 15

What is the single drug used Burkitt’s lymphoma?

Answer 15

Cyclophosphamide

Question 16

ECV drug regimen hlung cancer?

Answer 16

Etoposide
Cisplatin
Vincristine

Question 17

CMF drug regiment for breast cancer?

Answer 17

Cyclophosphamide
Methotrexate
Fluorouracil

Question 18

Drugs that do NOT cause myelosuppression?

Answer 18

Hormones
Streptozocin
Vincristine
Bleomycin
Asparaginase
Cisplatin

Question 19

Serotonin antagonists used to treat N&V caused by CA treatment?

Answer 19

Ondansetron

Granisetron

Question 20

What is the most common mechanism in multi-drug resistance?

Answer 20

P-glycoprotein mediated efflux of drug from cell

Question 21

Anti-metabolic chemotherapy drugs?

Answer 21

Folic Acid analogs - Methotrexate
Purine analogs - Mercaptopurine
Pyrmidine Analogs - Flurouracil, Cytarabine

Question 22

Source of reduced folates for treating MTX toxic effects?

Answer 22

Leucovorin + Folinic Acid

Question 23

Uses of Methotrexate?

Answer 23

Acute Leukocytic Leukemia (ALL)
Choriocarcinoma
Non-Hodgkins Lymphoma
Psoriasis
GVHD

Question 24

Mercaptopurine is converted to a T-IMP by HGPRT and then replaces what nucleotide purine?

Answer 24

Guanine

Question 25

Similar to 6-MP but is not metabolized by xanthine oxidase and can be given with allopurinol:

Answer 25

Thioguanine

Question 26

5-FU is converted to ___, which binds___, causing "___".

Answer 26

FdUMP; thymidylate synthetase; thymineless death

Question 27

Uses of 6-MP?

Answer 27

ALL AML CML

Question 28

Uses of Flourouracil?

Answer 28

Adenocarcinoma Severe psoriasis Basal cell CA Colorectal CA

Question 29

Hand foot syndrome is associated with which pyrmidine analog?

Answer 29

Flourouracil

Question 30

Cytarabine is used only in which malignancies?

Answer 30

NOT in solid tumors Hematologic Malignancies: AML (single most effective agent) non-Hodgkins Lymphoma ALL

Question 31

Which phase of the cell cycle is most susceptible to alkylation?

Answer 31

G1 and S phase

Question 32

Alkylation may result in:

Answer 32

DNA fragmentation Mispairing Cross linking

Question 33

The major site of DNA alkylation is what?

Answer 33

N7 position of guanine - 2 alkyl groups must alkylate 2 guanine groups

Question 34

Advantages of Cyclophosphamide (alkylating agent):

Answer 34

Favorable therapeutic index Broadest spectrum of activity High bioavailability

Question 35

Antidote to cyclophosphamide?

Answer 35

MESNA+

Question 36

This is the slowest acting nitrogen mustard, used for ____, with ADRs of ___

Answer 36

Chlorambucil; CLL and primary (Waldenstrom) macroglobulinemia; Pulmonary toxicity, secondary leukemia

Question 37

Carmustine and Lomustine are useful for treating___, but have characteristic toxicity of:

Answer 37

Malignant astrocytoma and malignant brain tumors; | Delayed hematopoietic depression

Question 38

Anti-tumor antibiotics?

Answer 38

Dactinomycin Plicamycin Anthracyclines

Question 39

What are the anthracyclines? | What is their MOA?

Answer 39

``` Inhibition of topoisomerase II: Daunorubicin Doxorubicin Idarubicin Eprubicin Mitoxantrone ```

Question 40

MOA and uses of Bleomycin:

Answer 40

Causes DNA fragmentation (unique MOA): Squamous CA of head, neck and lungs Lymphomas Testicular tumor

Question 41

Anti-tumor antibiotic associated with mucocutaneous and pulmonary toxicity:

Answer 41

Bleomycin

Question 42

Adverse effects of doxorubicin (anti-tumor antibiotic):

Answer 42

Irreversible, dose-related cardiomyopathy Local tissue necrosis Red discoloration of urine Adriamycin flare (benign local allergic reaction)

Question 43

Adverse effect of cyclophosphamide which manifests as frank hematuria:

Answer 43

Sterile hemorrhagic cystitis

Question 44

MOA and uses of Dactinomycin:

Answer 44

``` Causes single stranded breaks in DNA: Rhabdymyosarcoma, Wilm's tumor Kaposi sarcoma Ewing's tumor ```

Question 45

Anti-tumor antibiotic associated with local tissue necrosis and radiation recall reaction:

Answer 45

Dactinomycin

Question 46

Antidote to anti-tumor antibiotics in general, and its MOA:

Answer 46

Dexrazoxane; iron chelator

Question 47

Uses of Doxorubicin:

Answer 47

BEST agent for metastatic thyroid CA Acute leukemia Malignant lymphoma Breast cancer

Question 48

Vinca alkaloids bind to __, inhibiting ___ and causing ___ specific arrest:

Answer 48

tubulin; microtubule assembly; M-phase

Question 49

Viscristine adverse affects?

Answer 49

dose-limiting neurotoxicity of the periphery

Question 50

Vinblastine adverse affects?

Answer 50

Myelosuppression (B = bone marrow)

Question 51

Taxanes ___ microtubule assembly and are useful in:

Answer 51

Promote (prevent microtubule disassembly); breast and ovarian cancer

Question 52

Epipodophyllotoxins are derived from the ____ and inhibit ___

Answer 52

American mandrake; topoisomerase II

Question 53

Campthecins are derived from ____ and inhibit ____, which causes ___ specific arrest:

Answer 53

The happy tree; topoisomerase I; S-phase

Question 54

Used in the treatment of endometrial CA?

Answer 54

Megestrol (Progestins)

Question 55

Palliative treatment for advanced breast CA?

Answer 55

Tamoxifens (anti-estrogen)

Question 56

___ is an anti-androgen, used in combination with ___ in the treatment of prostatic CA:

Answer 56

Flutamide; GnRH

Question 57

The cytokine biological response modifiers?

Answer 57

Interferon-a (CML, Kaposi's sarcoma) IL-2 (Renal cell CA, Melanoma) BCG (Urinary CA in situ)

Question 58

Monoclonal antibody BRM?

Answer 58

(MoAbs/Mabs) Ritixumab + Mabthera | Target CD20 B-cell antigen

Question 59

Tyrosine kinase inhibitors (TKIs) inhibit the action of ____, ___, and ____

Answer 59

BCR-ABL c-kit PDGFR- beta tyrosine kinase

Question 60

Examples of CCS drugs:

Answer 60

Antimetabolites Bleomycin Plant alkyloids Hormones

Question 60

Plant alkaloids:

Answer 60

Vinva alkaloids Podophyllotoxins Taxanes Campothecins

Question 60

Cyclophosphamide is activated to ___ and ___ hepatically:

Answer 60

Phospharamide; acrolein