What is systemic therapy?
Drug used to destroy cells throughout the body
Destroys normal cells too
Used for cnacer that have metastasized
Damage DNA or DNA synthesis or cell division
What is the chemotherapy cell cycle?
works in one or multiple phases
not effective in G0 (resting phase)
chemo works best with large numbers of actively dividing cells
Cell cycle non-specific:
functions ithout regard to the cell cycle, destroys all of them
What is the cell kill hypothesis?
A fraction of cells are destroyed with each round of chemotherapy until total destruction is reached
Gives the basis for repeated doses over time or the "Course" of therapy
What are the principles of chemotherapy?
Combination therapy: multiple doses of chemo, based on protocols by type of cancer, metastais, pt health
Tumore Burden: low (small & fast growth)
Adjuvant therapy: multiple types of therapy
Problems" mucous membranes, bone marrow, hair
Benefits must outweight the toxic effects: teach patients and inform them that they have been improced and that certain cancers are treated better
What is NADIR?
Time of maxiumum effect on bone marrow activity (usually 10-14 days)
Major dose limiting side effect
May need intervention such as colony stimulating factor
What is tumor responsiveness?
Some types of tumore are not as responsive to drug therapy
Brain has BBB
Liver detoxes before get there
How is the types of chemo selected?
based on tumor sensitivity
What are the goals of chemo?
Control (remission): keep small, not divide
Palliation (comfort care): minimize side effects, not usually used this way
What are the routes of admission?
Oral: horomones, to stop growth, compliance is an issue, take at home
IV: most frequent, need good access, may have tissue damange
Intra-arterial: liver & billiary, need to bypass venous system
What are the classifications of Antineoplastics?
Alkylating agents: oldest, nitrogen mustard, bad side effects, cross-linking in DNA
Antimetabolites: trick body to think they are metabolites, halts division
Antitumor Antiobiotics: developed from antibiotics, non-phase specific, bind and damage DNA, block transcription, prevent division, normally paired with other drugs
Plant Alyloids: phase specific, derived from plants, cause crystalizing in spindles so spindles cant divide
Topoisomerase inhibitors: subtype of plant alkyloid
What are Hormones in classifiation of antineoplastics?
Tumore must be horomone dependent for this to work.
Can work by manipulating the environment by preventing uptake, competing and inhibiting
What is the biological response modifier in classification of antineoplastics?
Not curative, supportive
Modifies biological response to tumor cells
Boosts persons immune system by improving recognition, supporting immune system, providing protection from side effects
What is gene therapy in the classification of antineoplastics?
Helps to alter tumore cell to make it easier to destroy
bood immune system recognition and activity
Targeted therapy: combination of biological and gene therapy, monoclonial antibodies (problem with allergic reaction), antisenses drugs
What is the potential for tissue damage?
What are possible side effects and management?
Myelosuppression: effect on bone marrow, neutropenia, thrombocytopenia
Stomatitis (mouth), Mucositis (mucous membrane), Esophogitis
What are oncological emergencies?
Sepsis and septic shock
Spinal cord compression
Superior Vena Cava Syndrome
TUmor Lysis Syndrome