principles of cancer treatment

Question 1

what is systemic anticancer therapy? 4 of them

Answer 1

• Cytotoxic chemotherapy
• Biological (targeted) therapies
• Hormonal therapies
• Immunotherapy

Question 2

what is the general principle of cancer chemo?

Answer 2

Chemotherapy is a chemical that is toxic to multiplying cells (in the cell cycle)

Question 3

Do all chemotherapy drugs work the same way?/place?

Answer 3

Different chemotherapy drugs affect different stages
of the cell cycle
Hence chemotherapy protocols often have a
combination of treatments

Question 4

what does FOLFOX contain?

Answer 4

• Oxaliplatin (alkylating agent) – non cell cycle
  specific
• Fluorouracil (antimetabolite) – cell
  cycle specific

Question 5

what is cell cycle non-specific chemo?

Answer 5

• Kills cell at all phases of cell cycle, including resting
• Often given as a large bolus dose on day 1
  works even when cells are resting and not dividing- will kill cells no matter what phase they are in

Question 6

what is cell cycle specific chemo?

Answer 6

• Kills cell at specific point in cell cycle
• Often given more than once over several days
• Can be given as continuous infusion over several days
  this is a more targeted type of chemo

Question 7

what level does chemotherapy need to reach in order to work?

Answer 7

Chemotherapy needs to reach a high enough level in the blood to kill cancer cells but not too much so that the patient cannot tolerate it

Question 8

what is the benefit of repeated administration of chemotherapy?

Answer 8

Repeated administration results in a proportional cell kill
* Tumour burden may be reduced to undetectable levels
* Further courses required to reduce tumour cell count to an absolute minimum

Question 9

when can cancer relapse?

Answer 9

when there is a few cells remaining and the body’s immune system cannot destroy it.
these cells regrow

Question 10

how do we monitor the toxicity associated with chemotherapy?

Answer 10

frequent blood counts
close clinical support

Question 11

why do we monitor toxicity?

Answer 11

as chemo will damage healthy cells too

Question 12

what are the 4 different aims of chemo?

Answer 12

curative
adjuvant- after definitive treatment
neoadjuvant- prior to procedure eg shrink tumour
palliative- control symptoms and improve QOL

Question 13

when does curative chemo work best?

Answer 13

in acute leukaemia

Question 14

what do you have to consider when balancing the risks and benefits?

Answer 14

are they well enough to have this chemo?
how can they manage their side effects?

Question 15

how do cells become resistant to chemo?

Answer 15

some cells that are left over are able to mutate and develop resistance to the drug/ learn how to repair their DNA breaks

Question 16

how long is chemo usually given for?

Answer 16

usually 3-4 week time period

Question 17

what does the number of cycles depend on?

Answer 17

depends on treatment intention and may vary for different cancers

Question 18

how does metabolism and excretion vary between patients?

Answer 18

• Renal and hepatic function
• Absorption orally
• Drug interactions

Question 19

how does toxicity vary?

Answer 19

• May be related to efficacy
• Treatment intention important when assessing
  toxicities

Question 20

what do we have to monitor during chemo?

Answer 20

monitor the response to treatment
toxicity review

Question 21

how would you monitor the patients response to treatment?

Answer 21

• Dependent on:
  – Disease
  – Treatment intention
• Tumour markers
• Imaging

Question 22

how would you review a patients toxicity?

Answer 22

• Full blood count
• U&Es
  – Renal function
  – Liver function tests
• Symptom review
• Weight
• Doses adjusted depending
  on response to treatment
  and blood profile

Question 23

how can hormone therapy be used?

Answer 23

Can be used for hormone driven cancers
* To shrink a tumour
* To slow down or stop growth (instead of surgery or
radiotherapy), or reduce symptoms
* Combined with other treatments
* To make cancer less likely to return/spread
* To reduce the risk of breast cancer in healthy ‘at risk’
women

Question 24

what is the general principle of hormone therapy?

Answer 24

Either reduce amount of hormone or antagonist at hormone receptor

Question 25

how long do you give hormone therapy for? give an example

Answer 25

unlike chemo, tend to give for longer time periods eg-surgery and adj chemo and tamoxifen- reducing the risk of returning for 10 years - combination for best result

Question 26

what is targeted therapy?

Answer 26

Targets the changes in cancer cells that help them grow, divide, and metastasise

Question 27

what are the variable MOA of targeted therapy?

Answer 27

– Induce immune response – Inhibit cancer cell growth – Inhibit angiogenesis – Release cytotoxic agents at site of action – Induce apoptosis – Inhibit hormone dependent growth

Question 28

what is the benefit of targeted therapy?

Answer 28

More precise treatment with (hopefully) fewer side effects

Question 29

what are the two main types of targeted therapy?

Answer 29

Monoclonal antibody- MAB Small molecule

Question 30

how does monoclonal antibody targeted therapy work?

Answer 30

* Some block receptors on surface of cancer cell * Some activate WBC (immunotherapy) * Manufactured using living cells (biological therapy) * Some delivery chemotherapy to cancer cells * Normally IV every one to three weeks

Question 31

how does small molecule targeted therapy work?

Answer 31

* Less specific than antibodies * Most block kinase (tyrosine kinase inhibitors) * Normally taken orally every day

Question 32

what is immunotherapy and what are the 3 main groups?

Answer 32

* Treatment that works via the immune system * Three main groups: * Monoclonal antibodies * Checkpoint inhibitors * CAR T cell therapy

Question 33

how does immunotherapy work?

Answer 33

normal T cells- normally help to identify and kill cancer cells checkpoints turn T cells on and off cancer cells can affect this function- as they keep them turned off

Question 34

what is CAR T cell therapy?

Answer 34

removing normal T cells and reintroducing into blood in hope they can fight cancer

Question 35

what is radiotherapy?

Answer 35

Radiotherapy uses high-energy rays, such as x- rays, to treat cancer It destroys cancer cells in the area where it is given, but can also destroy healthy cells in that area

Question 36

why may radiotherapy be given?

Answer 36

– Radical – Chemoradiation – Adjuvant – Neoadjuvant – Palliative

Question 37

what are the two types of radiotherapy?

Answer 37

external beam- using machine to aim beams at cancer internal beam- from inside the body- eg radioactive liquid-iodine- accumulates in thyroid

Question 38

when may surgery be used?

Answer 38

– diagnose cancer – remove cancer – find out how big the cancer is and if it has spread to other parts of the body – control symptoms of cancer – restore parts of the body (for example, bladder reconstruction) – improve the appearance of part of the body (for example, breast reconstruction)