Principles of Chemo Flashcards
(88 cards)
1
Q
Common causes of cancer in males and females
A
- prostate/breast
- lung
- colon
2
Q
Common causes of cancer death in males and females
A
- lung
- prostate/breast
- colon
- pancreas
3
Q
Major environmental factors associated with cancer
A
- smoking
- obesity
- infectious agents
- inactivity
- RX drugs (hormones, IS, anticancer)
4
Q
Tobacco use is associated with ____% of cancer deaths
A
30%
5
Q
6 hallmarks of cancer
A
- sustain proliferative signaling
- evade growth suppressors
- resist cell death
- enable replicative immortality
- induce angiogenesis
- activate invasion and metastasis
6
Q
What allows cancer cells to become immortal?
A
telomerase
7
Q
2 emerging hallmarks of cancer
A
- deregulating cellular energentics
2. avoiding immune destruction
8
Q
2 enabling characteristics of cancer
A
- genome instability and mutation
2. tumor-promoting inflammation
9
Q
1st mutation in tumor suppressor gene
A
- active oncogene
- okay because “brakes” still work
10
Q
2nd mutation in tumor suppressor gene
A
No oncogene + no brakes
- okay because no oncogene
active oncogene + no brakes
- NOT GOOD –> cancer!
11
Q
3 tumor cell populations
A
- dividing cancer cells
- temporarily nondividing cancer cells
- permanently nondividng cancer cells
12
Q
Dividing cancer cells
A
very sensitive to our best drugs when optimally employed
13
Q
Temporarily nondividing cancer cells
A
partially to completely insensitive to drugs
14
Q
Permanently nondividng cancer cells
A
of little concern expect for physical presence
15
Q
Rapidly proliferating tissues
A
- bone marrow
- GI mucosa
- hair follicles
- gonadal tissues
16
Q
Which phase of the cell cycle has nondividing cells?
A
Go
17
Q
What phase of the cell cycle is DNA synthesis?
A
S phase
18
Q
Growth fraction
A
proportion of cells in ANY phase of cell cycle
19
Q
S phase population
A
proportion of cells ACTUALLY in S phase
20
Q
Doubling time
A
time necessary for tumor to double in volume
21
Q
Gompertzian cell growth
A
- as tumor increases in size, growth fraction decreases
- max growth rate = 37% of its max size
- cannot detect <10^9 cells
- small tumor is diagnosed, already undergone 30 doublings
22
Q
7 warning signs of cancer (CAUTION)
A
- change in bowel/bladder habits
- sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or hoarseness
23
Q
Diagnosis of cancer
A
presents with nonspecific signs and symptoms
*based on pathology
24
Q
What does caner staging involve?
A
- physical exam
- imaging tests
- biopsies
25
The extent of spread of the cancer determines what?
1. type of treatment
| 2. prognosis
26
Staging determines the size of the tumor at ____
diagnosis
27
TNM staging T
tumor (1-4)
28
TNM staging N
nodes (0-3)
29
TNM staging M
metastases (0-1)
30
Stage I cancer
localized
| no nodes or metastases involvement
31
Stage II and III cancer
evidence in nodes, but no metastasis
32
Stage IV cancer
metastasis
33
When do you worry about micrometases & how to treat?
Stage II-III
when cell count <10^9
surgery +/- radiation +/- chemo
34
Why do we give adjuvant chemo?
Worried about micrometastases
35
When are micrometases clinically evident & how to treat?
Stage IV
| Chemo +/- immunotherapy
36
Goal of cancer treatment
clearly defined (cure vs prolonged survival versus palliation)
37
Pretreatment biomarkers
Prognostic - treat/don't treat
Predictive- response to drug
Pharmacodynamic- what dose?
38
Posttreatment biomarkers
pharmacodynamic
biological progression markers
surrogate clinical endpoints
39
2 performance status scales
1. Karnofsky scale
| 2. ECOG
40
Overall principles of cancer
1. combo therapy kills larger % of cells than single agent
2. intermittent therapy
3. max tolerate dose
4. multiple courses of chemo
41
Why is intermittent therapy used?
to allow bone marrow cells to recover
myelosuppression
~3 weeks
42
2 ways to increase dose intensity
1. dose escalation
| 2. dose density
43
Dose escalation
increase drug dose
| no change in interval between cycles
44
Dose density
no change in drug dose
| decrease interval between cycles
45
How should cell cycle dependent phase-specific drugs be given?
continuous prolonged schedule
| * continuous IV infusion or daily for several days*
46
How should a cell cycle dependent phase-nonspecific drugs be given?
in a large, intermittent dosage schedule (day 1)
47
Why are multiple courses of chemo needed?
First order kinetics
| - each dose kills a constant PERCENTAGE
48
Why are anticancer drugs usually dose according to BSA?
Because the dose is so important
| Can be more accurate
49
complete response in solid tumors
completely gone
50
partial response in solid tumors
gone by 50%
51
stable disease in solid tumors
may have shrunk or grown slightly
52
progressive disease in solid tumors
grown by 50%
53
Adjuvant chemo survival endpoints
1. disease free survival
2. overall survival
* non-measurable disease*
54
Disease free survival
time until recurrence of tumor or death from any cause
55
overall survival
time until death from any cause
56
Chemotherapy for metastatic disease survival endpoint
1. progression free survival
2. overall survival
* measurable disease*
57
Questions to consider with "cure"
1. Has the patient been alive without evidence of cancer for at least several years?
2. Is the patient's cancer curable?
3. Where is the patient on the survival cure?
58
What does the median tell us?
1/2 point patients died
| does not take into account shape of curve
59
When can you maybe use the word "cure"?
when there is a flat line = survival plateau
| CR must be achieved and maintained
60
Normal lifespan: RBC, NT, platelets
RBC: 10 days
NTs: 6-12 hours
Platelets: 10 days
61
Threshold values for neutropenia
<500
62
Threshold values for thrombocytopenia
<10,000
63
Threshold values for anemia
Hemoglobin <8
64
3 cells
RBC, WBC, platelets
65
3 WBCs
Lymphocytes
Granulocytes
Monocytes
66
3 granulocytes
NTs
eosinophils
basophils
67
3 lymphocytes
B, T, NK
68
Pattern of myelosuppression
10-14 days for most drugs
| delayed (4 weeks)
69
Nadir
usually occurs 10-14 days after drug admin
70
Why can the S/S of infection be attenuated or absent?
due to decreased inflammatory response
71
G-CSF
specific regulator of NTs only
72
GM-CSF
stimulate NT, monocytes and macrophages
73
G-CSF or GM-CSF more likely to have flu like symptoms?
GM-CSF
74
What reduces the risk of neutropenia
filgrastim
75
ADE of myeloid growth factors
bone pain - tx with NSAIDs
| flu like symptoms
76
Filgrastim
G-CSF
77
When do you give growth factors?
1 prop: with 1st cycle of cancer; high risk FN
| 2 prop: wait til they develop FN
78
MOA of EPO
angiogenesis or neovascularization
direct tumor cell proliferation
activation of platelets
hypoxic conditions
79
ESAs
- don't improve anemia, QOL
- NOT indicated receiving myelosuppressive therapy when anticipated outcome is cure
- should NOT be administered is Hgb <10
80
BBW EPO
thrombotic events
tumor progression
increased mortality
81
T/f alopecia is dose related and reversible?
true
82
What can help with alopecia
scalp hypothermia or tourniquets
| *except leukemia or scalp metastasis
83
Which group of drugs mainly cause stomatitis
antimetabolites
84
T/f stomatitis is not a dose limiting toxicity
false
| can be
85
Prevention of mucositis
- oral cryotherapy (ice chips)
- Caphosol
- Palifermin
86
Treatment of mucositis
- magic mouthwash, PO, IV opioids
- nystatin, clotrimazole troches, systemic azoles
- Herpes: acyclovir or valacyclovir
87
T/f extravastation is more likely to occur with peripheral lines
true
88
Which 2 drugs mainly cause extravastation?
doxorubicin
| daunorubicin
