Cancer Treatment (Chemotherapy) Flashcards by Unknown Unknown

Chemotherapy - aims

To prolong survival
To maintain good quality life
To minimise side-effects

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Rank Haemopoietic, Mast cell tumours and Sarcomas based on chemosensitivity

Drugs work best on rapidly dividing cells:
Haemo
Mast cell tumour
Sarcomas

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Two types of chemotherapy treatments

Conventional (Max tolerated dose MTD)
Targeted therapies

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Outline conventional chemotherapy treatment

Works on rapidly dividing cells in a non-specific way
Does not differentiate between tumour and normal cells
Minimises side-effects by allowing normal cells to recover between doses

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Why should I use a combination of chemotherapy drugs to treat lymphoma

different drugs should have a different mode of action
affect different phases of the cell cycle
and have different methods of resistance

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What do I need to ensure when giving a combination of chemo drugs to patient with lymphoma

Drug toxicities do not overlap
Drugs do not interfere with each other

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Why should I use an established protocol in chemotherapy

Ensure each drug is effective against tumour
Avoid overlapping toxicities/ drug interactions
Ensure adequate time for cells to recover

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Are side effects from chemotherapy common in animals?

Usually minimal because protocols adapted to animals
Occasionally can be severe
Need good knowledge of hazards and careful monitoring to prevent side-effects!
Need to educate clients as to what to look out for!

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Most common side effects of chemotherapy

Bone marrow suppression,
Alopecia,
GI upsets,

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Outline chemotherapy for lymphoma

Treat any concurrent disease first
Eg Antibiotics for skin infection,iv saline diuresis for hypercalcaemia
Use specific chemotherapy
Induce clinical remission with high doses
Continue with maintenance (lower doses)
Intensify protocol if response not complete or change protocol to different drugs
Monitor for side-effects

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What could I do if there is no evidence chemotherapy is working for patient

add a boost eg L-asparaginase or change protocol

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What should I do if animal is showing sign of side effects after last dose

consider dose reduction, more GI protectants /anti-nausea drugs
OR change drugs /protocol
OR stop treatment

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What are the drugs in COP protocol

Cyclophosphamide
Vincristine (Oncovin)
Prednisolone

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Outline the induction phase in the COP protocol

Continuous every other day tablet administration /weekly injections
High doses of drugs for 1st 6-8 weeks to induce remission

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Outline maintenance phase after induction in low dose COP protocol

Alternate week therapy (week of drugs, week of no drugs, week of drugs etc)
then 1 week in 3, 1 week in 4 etc for up to 2 years if the animal survives that long
Change cyclophosphamide to chlorambucil after 6 months to reduce risk of haemorrhagic cystitis developing.

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What could cyclophosphamide cause in the long term

Haemorrhagic cystitis

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Prevention of haemorrhagic cystitis

Give cyclophosphamide tablets in a.m.
Encourage drinking and urination (Prednisolone is helpful!)
Monitor urine for traces of BLOOD by dipstick (cheap) or urinalysis (precise)
Administer a diuretic (furosemide) at time of administration if infrequent use of cyclophosphamide eg CHOP

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Treatment for haemorrhagic cystitis

Stop cyclophosphamide
Culture urine ± give antibiotics for secondary infection
Substitute chlorambucil /melphalan for cyclophosphamide in protocol.

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When is high dose COP protocol suitable

Useful for cats where 50mg tablet size can be difficult to dose accurately or for animals/owners that want fewer visits

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What is the CHOP protocol

Cyclophosphamide
Hydroxydaunorubicin = doxorubicin (Adriamycin)
Vincristine (Oncovin)
Prednisolone
Induction phase over 10 weeks is essentially 2 cycles of 4 drugs, given as weekly pulses

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What chemo drug is cardiotoxic

Hydroxydaunorubicin = doxorubicin (Adriamycin)

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Prevention of cardiotoxicity in chemotherapy

Assess cardiac function prior to 1st dose and continue to monitor after 4-6 doses
Baseline echocardiography measurements of
- Fractional shortening (Contractility)
- Ejection fraction
Do not exceed cumulative dose 180mg/m2
Consider less cardiotoxic equivalent drugs

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What chemo drug could cause hypersensitivity

Study These Flashcards

Occurs occasionally with Doxorubicin, L-asparaginase

What side effects are caused by hypersensitivity

Study These Flashcards

Vomiting, restlessness, pruritus, wheals, oedema
Dyspnoea, mouth breathing (cat)

Prevention of side effects caused by hypersensitivity

Use Antihistamine premedication Ensure correct route of administration (sc or im for L-asp) Administer very slowly for doxorubicin

Treatment for hypersensivity

STOP drug admin IV fluids Antihistamines Dexamethasone Adrenaline Avoid using the drug again

Things to monitor when using CHOP protocol

Haematology (neutropenia) - Baseline before treatment - Weekly Urine (haemorrhagic cystitis) - Baseline - After each cyclophosphamide admin/prior to next Echocardiography (heart contractility) - Baseline - At 4th Doxorubicin treatment

Level of neutrophils to stop/reduce giving chemo

Lower than 2.5

What is Acute tumour lysis syndrome

Large tumour burden - rapid cell kill in 1st week Rapid release of ions, i-cellular products HyperK+, hyper PO4-, hypoCa2+ Metabolic acidosis, uric acid production Acute renal failure Improves after 1st week

Name of protein causing chemodrug resistance

Multidrug resistance protein 1 (MDR1) –also called P-glycoprotein (p170) encoded by (MDR1) gene

Drugs affected by P-glycoprotein (p170)

Vinca alkaloids Anthracyclines (Dox, Mitox), Actinomycin D

Drugs not affected by P-glycoprotein (p170)

Alkylating agents (melphalan, lomustine) Carboplatin

Relapse therapy for Lymphoma

Start induction phase again – go back to beginning Use novel drug (single agents) Use novel potent drug combinations

Mean survival after diagnosis of lymphoma with no treatment

1-2 months

Mean survival after diagnosis of lymphoma with steroids

2-3 months

Mean survival after diagnosis of lymphoma with COP protocol

6-9 months

Mean survival after diagnosis of lymphoma with CHOP protocol

10-12 months

Acute lymphoblastic (ALL) chemotherapy treatment

Similar to high grade LSA Lymphoma protocols if sufficient neutrophils Prognosis poor

Chronic lymphocytic (CLL) chemotherapy treatment

Similar to low grade LSA (mature lymphocytes, slowly dividing) No treatment needed in some cases (mild) OR Chlorambucil, Prednisolone

Solid tumours are sensitive to chemotherapy (T/F)

False!

Treatment for solid tumours

Use surgery (or radiotherapy) to remove the tissue bulk and stimulate division of any residual tumour cells Use adjuvant chemotherapy for residual primary tumour (microscopic) Use adjuvant chemotherapy to delay growth of subclinical metastases

Haemangiosarcoma

highly malignant cancer arising from cells that normally create blood vessels. It most commonly affects the spleen, liver, right atrium of the heart, and skin

Treatment for haemangiosarcoma

Chemotherapy with single agent Doxorubicin q3 weeks for 4-6 doses to delay metastasis

Survival time for haemangiosarcoma with just surgery

1-3 months

Survival time for haemangiosarcoma with surgery and chemo

5-7 months

What protocol for haemangiosarcoma?

VAC protocol used by some centres (Vincristine, Adriamycin, Cyclophosphamide) Metronomic cyclophosphamide +NSAID therapy also tried (antiangiogenic and immunomodulatory)

What is Metronomic chemotherapy (MC)

Cytotoxic drugs given at LOW doses on a more continuous DAILY administration protocol rather than as high doses in pulses

Advantages of metronomic chemotherapy

Prevents repair and repopulation of endothelial cells in breaks needed with MTD therapy – anti-angiogenic May also reduce Tregs –immunomodulatory May target dormant cells and cancer stem cells - prevents tumour repopulation Low doses mean fewer side-effects – well tolerated Usually combined with other anti-angiogenic drugs eg COX inhibitors - NSAIDs – piroxicam, celecoxib

Osteosarcomas often metastasis to which organ?

Lungs

Treatment for osteosarcomas

Amputation for primary tumour (possibly limb salvage or radiotherapy for pain relief) Chemotherapy with single agent Carboplatin for 4-6 doses to delay metastasis

Median survival time of bone tumor with no treatment

1 month

Median survival time of bone tumor with amputation alone

3-4 months

Prognosis of osteosarcomas

Rapid euthanasia if no pain relief possible. Rapid metastatic spread if no chemotherapy.

Median survival time of bone tumor with amputation and chemo

>10 months

Summarise Tyrosine kinase inhibitors (TKIs)

Tyrosine kinase inhibitors (TKIs) are a class of medications used in cancer treatment that work by targeting specific enzymes called tyrosine kinases. These enzymes are often overactive in cancer cells, leading to uncontrolled cell growth and proliferation. By inhibiting these enzymes, TKIs help to slow down or stop the growth of cancer cells.

Cancer Treatment (Chemotherapy) Flashcards

(55 cards)