Chemotherapy in Hematology-Oncology

Question 1

Problems with cancer?

Answer 1

• Surrounding anatomy is compromised
• Hormone synthesis is affected
• Cancer required increased blood flow; necrosis occurs when growth of cancer exceeds growth of vasculature
• Malnutrition

Question 2

Cancer treatment?

Answer 2

Based on primary site (bone cancer as a result of breast cancer is treated as breast cancer)

Question 3

Does staging change throughout treatment?

Answer 3

NO

Question 4

Cure rate of chemotherapy

Answer 4

10-15% of cancers

Question 5

Cancers which respond favorably and have curative potential with chemo?

Answer 5

• Choriocarcinoma
• ALL
• Hodgkin disease
• Burkitt’s lymphoma
• Wilm’s tumor
• Testicular cancer

Question 6

Adjuvant?

Answer 6

Used after surgery to kill any remaining cancer cells that may be undetectable

Question 7

Neoadjuvant?

Answer 7

Chemotherapy given prior to surgery to shrink tumor

Question 8

Palliative?

Answer 8

Relieves symptoms but is not expected to reduce cancer

Question 9

Induction?

Answer 9

Chemotherapy given to induce remission

Question 10

Consolidation?

Answer 10

Also called intensification, goal is to sustain remission

Question 11

Maintenance?

Answer 11

Low dose chemotherapy to prolong remission

Question 12

Classes affecting M phase?

Answer 12

• Vinca alkaloids
• Taxanes
• Antimicrotubule inhibitor

Question 13

Classes affecting S phase?

Answer 13

• Antimetabolites

- Epipodophyllotoxin (Topoisomerase II inhibitors)

Question 14

Classes affecting G2 phase?

Answer 14

• Antitumor antibiotics

- Epipodophyllotoxin (Topoisomerase II inhibitors)

Question 15

Meds causing pulmonary fibrosis?

Answer 15

• Bleomycin (CCS)

- Busulfan (CCNS)

Question 16

Meds causing peripheral neuropathy

Answer 16

• Taxanes

- Platinum analogs (cisplatin)

Question 17

Secondary cancers that respond well to treatment?

Answer 17

Topoisomerase II inhibitors

• etoposide
• teniposide
• mitoxantrone

Question 18

Secondary cancers that DO NOT respond well to treatment?

Answer 18

Alkylating agents/platinum analogs

• mechlorethamine
• chlorambucil
• cyclophosphamide
• melphalan
• lomustine
• carmustine
• busulfan
• cisplatin
• carboplatin

Question 19

Where can chemo drugs be found?

Answer 19

In bodily fluids!

• Disposable gloves
• Everything should be washed separate

Question 20

Glucocorticoids?

Answer 20

Commonly used in leukemias and lymphomas along with other agents

• prednisone
• dexamethasone

Question 21

Estrogen and androgen antagonists?

Answer 21

• Tamoxifen blocks estrogen in estrogen dependent breast cancer
• Flutamide blocks androgens in prostate cancer

Question 22

Gonadoropin releasing hormone analogs?

Answer 22

Used in prostate cancers

• leuprolide
• goserelin

Question 23

Aromatase inhibitors?

Answer 23

Important for the conversion of androgen to estrogen

• anastrozole
• letrozole

Question 24

Interferons?

Answer 24

• Naturally occurring endogenous glycoproteins that are antiviral and antineoplastic
• Fatigue and flu-like symptoms are a problem

Question 25

Tyrosine kinase inhibitors?

Answer 25

- Imatinib (Gleevec) began the revolution - Once a day ORAL medication - Effectiveness of Gleevec depends on whether patient is in accelerated phase, chronic phase, or blastic phase (worse prognosis) - Target BCR-ABL tyrosine kinase inhibitor

Question 26

Bevacizumab side effects?

Answer 26

- Arterial thromboembolic events (MI/stroke) in 4% - HTN - Bowel perforation

Question 27

EGFR inhibitors?

Answer 27

- Acneiform rash | - The worse the rash, the better the treatment is working!

Question 28

Increased risk of squamous cell carcinoma of skin?

Answer 28

- vemurafenib | - dabrafenib

Question 29

Non-hodgkin Lymphoma?

Answer 29

- CHOP and R-CHOP - Monoclonal antibodies - Interferon - Immunomodulators

Question 30

Hodgkin disease?

Answer 30

- ABVD - Stanford V - BEACOPP - Monoclonal antibodies

Question 31

ALL?

Answer 31

- Tyrosine kinase inhibitors | - Effective in patients with Philadelphia chromosome

Question 32

CLL?

Answer 32

Just recognize there are a lot of drugs

Question 33

AML?

Answer 33

Cytarabine and antracyclines are the most commonly used

Question 34

CML?

Answer 34

- Gleevec has changed the world of CML treatment - Tyrosine kinase inhibitors are the mainstay of treatment for CML due to the presence of the BCR-ABL oncogene - If the leukemia produces the T315I mutation that prevents TKIs from being effective, omacetaxine may be used

Question 35

Multiple Myeloma?

Answer 35

LOTS OF REGIMENS Also: Bisphosphonates Interferon

Question 36

Ewing's Sarcoma?

Answer 36

Alternate between two combinations given every 2-3 weeks for about 14-15 cycles - VAdriaC - IE