Chemotherapy

Question 1

What are the aims of cancer treatment?

Answer 1

Curative
Prolong life
Palliate symptoms

Question 2

What is neoadjuvant therapy?

Answer 2

Initial therapy aimed at shrinking primary tumour

Question 3

What is adjuvant therapy?

Answer 3

Definitive treatment of primary disease when there is a high risk of metastatic disease

Question 4

What are the guidelines for handling cytotoxic drugs?

Answer 4

Trained personnel
Designated pharmacy area
Protective clothing
Cover eyes
First aid
Pregnant staff should avoid
Procedures for spillages and safe waste disposal
Monitor exposure

Question 5

What is the NPSA alert for oral cytotoxic?

Answer 5

Incorrect dosing of oral cytotoxics - standards for prescribing and using parenteral cytotoxics should also be the same for oral cytotoxics

Question 6

Do non-specialists have access to treatment plan?

Answer 6

Yes

Protocols include guidance on monitoring and treatment of toxicity

Question 7

How do you dispense cytotoxics?

Answer 7

Confirm dose
Prescriptions should not be repeated
Patient must have written information
Pharmacists need access to treatment plan

Question 8

What are the cytotoxic side effects?

Answer 8

Extravasation of IV drugs
Thromboembolism 
Hyperuricaemia 
Alopecia 
Nausea and vomiting
Bone marrow suppression 
Urothelial toxicity
Oral mucositis
Pregnancy and reproductive function

Question 9

Are cytotoxic drugs teratogenic?

Answer 9

Mostly, yes

Need to exclude pregnancy before treatment and offer contraceptive advice

Question 10

What are the important counselling points for alkylating drugs and procarbazine?

Answer 10

Permanent male sterility
Sperm storage
Women are less affected but may cause early menopause

Question 11

What is tumour lysis syndrome?

Answer 11

Caused by rapid destruction of malignant cells

Question 12

What are the clinical features of tumour lysis syndrome?

Answer 12

Hyper K+
Hyper urea
Hyper PO4
Hypo ca2+

Question 13

Who are the at risk patients of tumour lysis syndrome?

Answer 13

Renal impairment
Dehydration
Hyperuricaemia

Question 14

Which cytotoxic drugs cause thromboembolism?

Answer 14

Tamoxifen
Thalidomide
Linadamide

Malignant disease is a risk factor for VTE

Question 15

How do you prevent oral mucositis?

Answer 15

Rinse mouth
Soft toothbrush
Saline mouthwash
Folinic acid in methotrexate induced adverse effects

Question 16

Why cytot drugs cause oral mucositis?

Answer 16

Anthracyclines

Antimetabolites - fluorouracil, methotrexate, capecitabine

Question 17

What is urothelial toxicity?

Answer 17

Haemorrhagic cystitis

Question 18

What is used to treat urothelial toxicity?

Answer 18

Mesna

Question 19

What causes urothelial toxicity?

Answer 19

Cyclophosphamide

Question 20

Which cytotoxics do not cause bone marrow suppression?

Answer 20

Vincristine

Bleomycin

Question 21

What are the contraindications in bone marrow suppression?

Answer 21

Infections

Avoid live vaccines

Question 22

What is the treatment of bone marrow suppression?

Answer 22

Withdraw or reduce dose until bone marrow recovers

Question 23

How do you treat fever with neutropenia?

Answer 23

Broad spectrum antibiotic
Filgrastrim

Avoid paracetamol as delays starting antibiotic

Question 24

How do you treat symptomatic iron deficiency anaemia?

Answer 24

Erythropoietin

Red blood cell transfusions

Question 25

When is hyperuricaemia normally present in malignant disease?

Answer 25

High grade lymphoma and leukaemia Worsened by chemotherapy and associated with renal failure

Question 26

How do you treat hyperuricaemia?

Answer 26

Allopurinol 24 hours before treating tumours Febuxostat 2 days before if allopurinol contraindicated Rasburicase if associated with blood cancer

Question 27

Which are the mildly emetogenic cytotoxics?

Answer 27

Methotrexate Vinca alkaloids Fluorouracil

Question 28

What are the moderately emetogenic cytotoxics?

Answer 28

Taxanes Doxorubicin Cyclophosphamide High dose MTX

Question 29

What are the highly emetogenic cytotoxics?

Answer 29

Cisplatin | High dose cyclophosphamide

Question 30

What is the treatment for anticipatory nausea and vomiting associated with cytotoxic treatment?

Answer 30

Lorazepam

Question 31

What is the treatment for acute (< 24 hours after treatment) nausea and vomiting associated with cytotoxics?

Answer 31

Low risk of emesis- dexamethasone or lorazepam | High risk of emesis - 5HT3 antagonist, aprepitant + dexamethasone

Question 32

What is the treatment for delayed nausea and vomiting associated with cytotoxic treatment?

Answer 32

Moderately emetogenic drugs - dexamethasone + 5HT3 antagonist Highly emetogenic drugs - dexamethasone + aprepitant

Question 33

What is extravasation of IV drugs?

Answer 33

Severe local tissue necrosis if they leak from the veins into the surrounding subcutaneous or subdermal tissue Can lead to amputation

Question 34

What cytotoxics cause extravasation?

Answer 34

Vinca alkaloids | Anthracyclines

Question 35

What are the cytotoxic antibiotics?

Answer 35

Radiomimetics Avoid concomitant radiotherapy due to toxicity

Question 36

What are the anthracyclines?

Answer 36

Doxorubicin - reduce dose if high bilirubin Epirubicin Idarubicin Daunorubicin

Question 37

What are the side effects of anthracyclines?

Answer 37

Cardiotoxicity- dose related, higher risk if given with herceptin Red urine

Question 38

What formulation of doxorubicin reduces incidence of cardiotoxicity and extravasation?

Answer 38

Liposomal formulations

Question 39

What are the side effects of liposomal doxorubicin?

Answer 39

Hand and foot syndrome - macular, red skin eruptions To prevent cool the hands and feet

Question 40

What is the treatment for anthracycline induced side effects?

Answer 40

Dexrazoxane

Question 41

What are the antineoblastic antibodies?

Answer 41

Bleomycin

Question 42

What are the side effects of bleomycin?

Answer 42

Pulmonary fibrosis Respiratory failure in anaesthesia Hypersensitivity Dermatological toxicity

Question 43

What are the vinca alkaloids?

Answer 43

``` Vincristine Vinblastine Vindesine Vinflunine Vinorelbine ```

Question 44

What is the route of administration of vinca alkaloids?

Answer 44

IV only Intrathecal causes fatal neurotoxicity

Question 45

What is the NPSA alert for vinca alkaloids?

Answer 45

Adult and teenagers unit receive doses in 50ml mini bag Children’s unit receive doses by syringe

Question 46

What are the side effects of the vinca alkaloids?

Answer 46

CNS toxicity (peripheral/autonomic neuropathy)

Question 47

What are the antimetabolites?

Answer 47

Methotrexate Capecitabine Fluorouracil

Question 48

What are the side effects of the antimetabolites?

Answer 48

Oral mucositis | Myelosuppression

Question 49

Why is folinic acid used with methotrexate?

Answer 49

Speeds up recovery in methotrexate side effects and overdose

Question 50

What are the alkylating drugs?

Answer 50

``` Cyclophosphamide Carmustine Lomustine Mephalan Chlorambucil Ifosfamide ```

Question 51

What are the side effects of the alkylating drugs?

Answer 51

Permanent male sterility | Non-lymphocytic leukaemia

Question 52

What are the aromatase inhibitors?

Answer 52

Anastrazole | Letrozole

Question 53

Can the aromatase inhibitors be used in premenopausal women?

Answer 53

No, they are anti oestrogens

Question 54

What are the taxanes?

Answer 54

Paclitaxel

Question 55

What are the side effects of paclitaxel?

Answer 55

Cardiac disease Pneumonitis Sepsis