Oncolytic agents + Cancer treatment Flashcards
(55 cards)
What is the general MOA of cytotoxic antineoplastics?
Where did the original concept come form?
Inhibits the mitotic process in the cell by various mechanisms
- DNA or enzymatic inhibition
- inhibition of mitotic spindle formation
Original concept
- concept came from observing effects of mustard gas on WBC count
Which part of the cell cycle do most chemotherapy agents work in?
Why do we give chemo in cycles? (2)
Most work in the S phase (DNA synthesis)
- We give in cycles as some tumour cells will be resting in G0 Phase
- Too toxic to give less frequent than 2-3 weeks
How do we dose most chemotherapy
BSA in m2
When do we give cytotoxic antineoplastics as a single agent rather than combined
Intent of treatment is palliative
What classes are examples of cytotoxic antineoplastics (4)
- Alkylating agents
- Antimetabolites
- Topoisomerase
- Antimicrotubule
Differentiate between the targeted therapies: monoclonal antibodies vs tyrosine kinase inhibitors (3)
Monoclonal antibodies
- Work EXTRAcellularly
- bind to signalling receptors
- Prevent ligand signalling
Tyrosine kinase inhibitors
- Work INTRAcellularly
- Prevent binding of ATP
- prevent phosphorylation of proteins
- Acts as a cellular on/off switch
What do the following nomenclature mean
-Omab
-ximab
-zumab
-Umab
-Omab: Full mouse
-ximab: Part human part mouse
-zumab: Mostly human with some mouse
-Umab: Fully human
What is a drug-antibody conjugate?
- A monoclonal antibody attached to a chemo molecule
- Monoclonal antibody binds to tumour cell and selectively exposes it to the chemo cell
How do non-TKIs generally work (3)
- Inducing apoptosis
- inhibiting DNA repair
- Blocking aspects of cellular metabolism
Which class of drugs are considered non- TKIs (4)
PARP inhibitors
Proteasome inhibitors
mTOR inhibitors
BCL-2 inhibitors
How do checkpoint inhibitors normally work?
Cancer cells are able able to avoid detection by immune system. They tell the immune cell that they belong
- These drugs prevent tumour cells from “turning off” the immune cell by intercepting this communication
What classes are considered checkpoint inhibitors
CTLA-4 inhibitors
PD1 and PD-L1 inhibitors
What cancers are hormonal agents used in?
Breast cancer
- some express estrogen receptors
Prostate cancer:
- Almost all express androgen receptors
What agents are used for estrogen deprivation (4)
Tamoxifen
Aromatase inhibitors
Fulvestrant
GnRH agonists
What are drugs of choice in premenopausal and post-menopausal women with breast cancer
Premenopausal
- Tamoxifen
- Can use in post-menopausal
Post-menopausal
- Aromatase inhibitors
- NOT used in pre-menopausal
What drugs are the aromatase inhibitors (3)
Anastrozole
Exemestane
Letrozole
How do aromatase inhibitors work
Binds to the aromatase enzyme in the pocket where androgen would have bound to prevent that conversion to estrogen
How does tamoxifen work
SERM
- blocks estrogen in breast cancer tissue, and brain
- Has estrogenic action in liver, endometrium, and bone
What is the general workup once diagnosis is made (6)
- Pathologist grade the tissue sample and report genetics
- Scans (CT, MRI) to fully stage the patient
- Oncologist will order treatment
- Baseline CBC, LFTs, alk phos, platelet counts
- Physical exam
- Family history
What is the general rule of treatment for:
early stage patients
Stage 2
Metastatic
Early stage
- radiation then surgery
Stage 2:
- chemotherapy and then surgery
Metastatic
- Agents less toxic to maintain QoL
What are the general treatment plans for Hematologic malignancies
Radiation and cytotoxic drugs (chemo)
- then a stem cell transplant to give back patients bone marrow
Which Hematologic malignancies have the goal of curing (2)
Acute leukemia
Aggressive histology lymphomas
Which Hematologic malignancies have the goal of long-term remission (i.e not curable) (2)
Chronic leukemias
Indolent lymphomas
Multiple myeloma
What is there a higher risk of in liquid tumours vs solid tumours (3_
increase rate of Anti-infectives (higher rates of febrile neutropenia)
Inc coagulation and bleeding
Tumour lysis synrome
