Chemotherapy

Question 1

What are the vinca alkaloids (MOA, use, risks)

Answer 1

Vincristine

Vinblastine

Binds to tubulin, inhibiting microtubule formation. Mitotic arrest in metaphase.

Use: chemotherapy

Risks: Peripheral Neuropathy, Hyponatraemia, Constipation, chemo side effects

Question 2

What is Sorafenib? (MOA, use, risks)

Answer 2

A multi-target TKI - VEGF, PDGF, raf.

Used in HCC, renal, thyroid

Risks - HTN, MI, CCF, hand-foot syndrome, QT prolongation, GI upset, pancreatitis, GI perforation, proteinuria, pancytopenia, peripheral neuropathy, thyroid dysfunction

Question 3

Lenvatinib - MOA, use, risks

Answer 3

Multi-target TKI - VEGF, FGFR, PDGF, KIT, RET

Used for HCC, renal and thyroid Ca

Risks - HTN, QT prolongation, HF, MI, Stroke, bleeding, hand-foot syndrome, GI upset, proteinuria, thyroid dysfunction, electrolyte dysfunction

Question 4

What is cyclophosphamide (MOA, use, risk)

Answer 4

An alkylating agent which causes cell death by cross-linking DNA strands. Its immunosuppressive effects are believed to be due to cytotoxic effects on lymphocytes.

Used: immunosuppression for multiple conditions including vasculitis, GN. Chemotherapy in multiple cancers

Risks: infection, bladder cancer, myelosuppresion, haemorrhagic cystitis, heart failure, pneumonitis

Question 5

What are the anthracyclines (MOA, use, risks)

Answer 5

Doxorubicin

Danurubicin

Epirubicin

Idarubicin

Mitozantrone

Intercalaet DNA base pairs and inhibit topoisomerase II. This prevents DNA and RNA formation. Also produces free radicals

Use: chemotherapy

Risks: cardiotoxicity, general chemo, secondary malignancy and MDS

Question 6

What is bleomycin(MOA, use, risks)

Answer 6

Causes single and double strand DNA breaks and generates free radicals.

Use: hodjkin lymphoma and testicular cancer

Risks: pulmonary toxicity, skin reactions, raynauds, mucositis. No myelosupression

Question 7

What gene muation predisposes to severe side effects with capecitabine and 5-FU?

Answer 7

Dihydropyrimidine dehydrogenase (DPD)

Question 8

What gene mutation predisposes to increased toxicity with irinotecan?

Answer 8

UGT1A1 mutation (Gilbert Syndrome)

This enzyme normal inactivated the active metabolite

Question 9

What is cladribine? (MOA, use, risks)

Answer 9

A purine anti-metabolite which is ctotoxic to dividing and non-dividing lymphocytes. CD4 reduced preferentially to CD8

Use: relpasing remitting MS, multiple haematological malignancies

Risks: lymphopenia, infections, ?malignancy