Chemo and Immunotherapy Flashcards
(72 cards)
1
Q
What systemic therapy can be offered for cancer
A
Chemotherapy
Biologics
Hormonal therapy
Immunotherapy
2
Q
What are aims of Rx
A
Adjuvant
Neoadjuvant
Palliative
Curative or radical
3
Q
What is adjuvant
A
After definite and curative `rx to eradicate micromets
4
Q
What is neoadjuvant
A
Adjuvant Rx given before to improve change of care
5
Q
What are SE of chemotherapy
A
Relate to rapidly dividing tissue as that is what is attacked Vomiting - prophylaxis usually given Alopecia Mouth ulcer Diarrhoea Neuropathy Neutropenia most common 7-14d Thrombocytopenia Infertility - impaired spermatogenesis or oocyte depletion leading to premature failure
6
Q
What are major classes of systemic chemotherapy
A
Alkyslating agent - disrupt DNA integrity Anti-metabolites - disrupt DNA synthesis Mitotic inhibitor Toposomerase inhibitor Other anti-tumour Ax
7
Q
What are antimetabolites and what do they do
A
Disrupt DNA synthesis by interfering with metabolism Methotrexate Fuorouracil (5-FU) 6-mercaptopurine Cytrabine
8
Q
What are aklyating agent and what do they do
A
Disrupt DNA integrity
Cyclophosphamide
Cisplastin
9
Q
What is mitotic inhibitor
A
Vinca alkaloid
Taxanes
10
Q
What is topoisomerase inhibitor / Ax
A
Doxorubicin - inhibit DNA and RNA synthesis
Etoposide
Irontecan
11
Q
Anti-tumour Ax
A
Bleomycin - degrade DNA
Actinomycin
Doxorubicin
12
Q
How are chemo used
A
Most chemo combined into regimens to achieve better kill
Must have different mechanism and no overlapping toxicity
13
Q
What are SE of cyclophosphamide
A
Haemorrhagic cystitis
Myelosuppression
TCC
14
Q
SE of doxorubicin
A
Cardiomyopathy
15
Q
SE of bleomycin
A
Pulmonary fibrosis
16
Q
SE of methotrexate
A
Myelosuppression Mucositis Liver fibrosis Lung fibrosis Teratogenic B12 defiecicny
17
Q
SE of 5-FU
A
Myelosuppression
Mucositis
Dermatitis
18
Q
SE of other anti-metabolites
A
Myelosuppression
Ataxia
19
Q
What does vinblastine / docetaxel do and what are SE
A
Inhibit formation of microtubule Peripheral neuropathy Paralytic ileus Myelosuppression Neutropenia = docetaxel
20
Q
Other chemotherapy agents
A
Cisplastin
Hydroxyurea
21
Q
SE of cisplatin
A
Ototoxicty
Peripheral neuropathy
HypoMg
22
Q
What do biologic agents do and what are there categories
A
Inhibit orogenic stimulus that is driving cancer growth
Monoclonal Ab - imab
Tyrosine kinase inhibitors - inib
23
Q
What is ritixumab useful for
A
Anti-CD20 so useful in NHL - B cell lymphoma which express
24
Q
What has revolutionised CML Philadelphia chromosome +ve
A
Tyrosine kinase inhibitor - Imatinib
25
What causes ligand inactivation
Bevacilumab
| Stops VEGF which is over expressed in many cancer
26
What cause receptor inactivation
Tratuzumab against HER-2
27
What hormone therapy in breast
Anti-oestrogen / SERM - tamoxifen
Aromatose inhibitor
GnRH agonist (goserelin)
28
What hormone therapy in prostate cancer
Androgen suppression - goserelin or orchidectomy
| Anti-androgen
29
What hormone therapy in endometrial
Progesterone
30
What is systemic immunotherapy
Stimulates whole immune system
Interferon
Interluekin
31
What are toxicity interferon
```
Flu like
Nausea
Lethargy
Anorexia
LFT
```
32
What are toxicity IL
Hypotension
Renal failure
Cardiac - may need ITU
33
How do many cancers evade detection
Suppress T cell function through PD-1 on T cell or PDL-1 on tumour
34
What Ab target this
PD-1 Ab - nivolumab / pemprolizumab = immune checkpoint inhibitors
PDL-1 Ab - atezolizumab
Used in solid organ tumour
35
How do you administer
Injection
| IV infusion
36
What are SE related to overactive T cells which are key in killing cancer / SE immunotherapy
```
Dry / itchy skin = most common
N+V
Decreased appettite
Diarrhoea
Fatigue
SOB
Dry cough
```
Infusion reaction
Anaphylaxis
37
How do you manage SE
Corticosteroid
| Monitor LFT, U+E, TFT
38
How does RT work
Produce free radicals which cause DNA damage
Leads to chromosomal aberration
No loss of genetic materally
Lose reproductive capability
39
What is radiation dose
Energy deposited per unit mass = absorbed dose (Gray)
| 1 gray = 1 joule of energy in 1kg
40
What is radiation tolerance
Amount of radiation tissue can receive and still remain functional
41
What is tolerance dose
Dose that there is a high probability of serious Rx compliction
42
What is AIM of Rx
High enough dose to achieve outcome whilst keeping critical nearby structure within radiation tolerance
43
What does radical Rx tend to be
Curative intent
High dose
Low dose fraction as longer timeframe to minimise damage
44
What is palliative Rx
Lower dose
High dose fraction as late effects less relevant
Short time
45
What gives more damage
High dose per fraction
46
How can RT be delivered
```
External beam
Stereotactic - highly accurate form of EBRT for small lesions e.g. intracranial
Brachytherapy sealed source
Brachytherapy unsealed
Radioisotope
```
47
What is external beam
Most common
| Linear accelerator delivers X-ray
48
What can you do for deep tumour
Multiple field technique
| As single radiation would over treat superficial tissue
49
What is bradytherapy sealed source
Radioactive needle or wire implanted into or next to cancer for extremely high dose
50
What is unsealed source
Radioactive isotope delivered by injection or ingestion which concentrates in region
51
What do all patients with metastatic disease of unknown primary get
```
FBC, U+E, LFT,
Calcium
Urinanalysis
LDH
AFP + hCG
CT CAP
```
52
What do specific patient get
```
Myeloma screen if lytic bone
Endoscopy
PSA
CA125 if peritoneal / ascites
Testicular USS
Mammography
```
53
What does a PET scan do
Uses FDG radio tracer allowing 3D image of metabolic activity / uptake of glucose
Combines images with CT
54
What is it useful for
Evaluating primary and metastatic disease
55
What do you do if risk of infertility
Semen cyropersevation
| Embro / oocyte preservation
56
What are early reactions to RT
```
Tiredness
Skin reaction - erythema, desquamation, ulceration
Mucositis
N+V if stomach / liver or brain Rx
Diarrhoea after abdominal or pelbic
Dysphagia following thoracic
Cystitis after pelvic
```
57
What can you do for N+V
Anti-emetic
58
What do you do for mucositis
Avoid smoking
| Anti-septic mouthwash
59
What are late reaction to RT
Secondary cancer
Fibrosis of organs
Reduced fertility
```
Hypopituitarism / hypothyroid
Erectile dysfunction / stenosis following pelvic RT
Benign strictures of GI tract
Radiation proctitis
Pneumonitis Myelopathy
```
60
What are chronic risks of chemo
Organ imapirment - may need ECHO / bone density scan
Reduced fertiltiy
Second cancer
61
What are the RCHOP drugs
```
Rutixumab
Cyclophosphamide
Doxorubicin hydrochlroide
Vincristin
Prednisolone
```
62
What is it used to treat
NHL
63
SE of rutiximab
```
Allergy - fever / rash / anaphylaxis
Severe infections / reactivation
Thrombocytopenia
Liver and lung toxicity
Peripheral neuropathy
Night sweats
```
64
What is metabolically demanding tissue
Brain
Heart
Liver
65
What is mitotically
Bone marrow
Skin
Gut
66
Aim of chemo to target mitotically active cells so SE
Cytopenia and neutropenic sepsis
Sore skin + mouth
N+V+D
67
Why is it important to get rid of all cancerous cells with first round
If relapse will have a selected cell line that is resistant to chemo
68
What are outcomes after Rx
Partial remission
Complete remission where cells undetectable (but still there)
Incurable but can control for long term
69
What is important to remember
Will be cells that never undertake mitosis when getting chemo so never get killed and can come back when start division
70
How do you treat pre-malignant conditions e.g. myelodysplasia
Low dose continuous therapy e.g. hydroxycarbamdie everyday
71
Rx of ALL. /AML
Potentially curable
If relapse = very bad sign
If in remission for a few years chances its gone for good as cells would have come back
72
Rx of CLL / CML
Less chemo sensitive as undergo mitosis less often
Usually monitor till cause problem / system
Rx = usually chemo based
