Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cancer > Therapy > Flashcards

Therapy Flashcards

1
Q

Tamoxifen

A

Used to treat: Breast Cancer.

  • Oestrogen antagonist, acts at oestrogen receptors on cells
  • ↓ risk of recurrence by ~50%, ↓ mortality by ~34%, ↓ risk of contralateral breast cancer by 40-50%

Side effects:
o Hot flushes
o Weight gain
o Sweats
o ↑ risk of developing endometrial cancer
o ↑ risk of developing a blood clot

Mechanism of action:

  1. Enters the cell by passive diffusion
  2. Binds to the estrogen receptors (ER)
  3. The receptor can still bind the DNA but adapts a conformation that prevents the recruitment of cofactors
  4. ER dependent gene transcription is inhibited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anastrozole

A

Used to treat: Breast Cancer.

  • Aromatase Inhibitor
  • Block conversion of androgens from adrenal cortex → oestrogens in peripheral tissues (skin, fat, muscle)
  • Only effective in postmenopausal women
  • Anastrozole – agent of choice in postmenopausal women (ATAC trial compared it to tamoxifen – anastrozole significantly prolonged disease-free survival & had fewer adverse effects)

Side effect
- ↓ bone mineral density \ all patients have bone density scan when treatment is started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Letrozole

A

Used to treat: Breast Cancer.

  • Aromatase Inhibitor
  • Block conversion of androgens from adrenal cortex → oestrogens in peripheral tissues (skin, fat, muscle)

• Only effective in postmenopausal women

Side effect:
- ↓ bone mineral density \ all patients have bone density scan when treatment is started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Exemestane

A

Used to treat: Breast Cancer.

  • Aromatase Inhibitor
  • Block conversion of androgens from adrenal cortex → oestrogens in peripheral tissues (skin, fat, muscle)

• Only effective in postmenopausal women

Side effect:
- ↓ bone mineral density \ all patients have bone density scan when treatment is started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the chemotherapy regime used in breast cancer patients?

A

FEC100.

Flurorouracil (5-FU)
Epirubicin
Cyclophosphamide

Side effects:

  • Nausea & Vomiting
  • Bone marrow suppression
  • Mucositis
  • Cardiac arrhythmias & cardiomyopathy
  • Alopecia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the common pharmaceutical care issues with FEC100?

A
  • Check doses & BSA against FEC protocol
  • Check FBC (neuts > 1.0, platelets > 100)
  • Check renal function
  • Check LFTs (may need to ↓ epirubicin & fluorouracil dose if LFTs are deranged)
  • Ensure antiemetics are prescribed & dispensed
  • Monitor cumulative dose of epirubicin
  • Older pts – may need ECHO prior to chemo. Caution in pts with cardiac disease
  • Ensure patient understands how to take antiemetics (start day before chemotherapy)
  • Ensure patient is vigilant for signs & symptoms of infection as there is a risk of neutropenic sepsis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Trastuzumab (Herceptin)

A

Used to treat: Breast Cancer.

• Recombinant humanised monoclonal antibody which targets HER2 protein

  • Approx. 20% of pts overexpress HER2 – poor prognosis
  • Pts with HER2 overexpression of 3+ or greater benefit from trastuzumab

Side Effects:

  • Cardiotoxicity (4%)
  • Nausea & Vomiting
  • Diarrhoea
  • Myalgia/arthralgia
  • Rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When and how long do you use hormonal therapies for in breast cancer?

A

5 years after surgery (adjuvant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the main hormonal therapies used in breast cancer?

A

Tamoxifen, Anastrozole, Letrozole, Exemestane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Everolimus

A

Used to treat: Breast Cancer.
New agent

Selective mTOR inhibitor
- mTOR is a key serine-threonine kinase which is upregulated in breast cancer

Licensed to treat ER/PR+ve, HER2/Neu -ve advanced breast cancer, in combination with exemestane, in postmenopausal women after hormonal therapy hasn’t worked

Oral agent

Side effects:

  • Stomatitis
  • Rash
  • Fatigue
  • Diarrhoea
  • Infections
  • Nausea
  • Decreased appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Eribulin

A

Used to treated advanced breast cancer

Inhibitor of microtubule dynamics. It binds to the plus ends of existing microtubules. -> triggers apoptosis following mitotic blockade

Used as monotherapy for patients who have progressed after at least two chemotherapeutic regiments for advanced disease.

Side effects:

  • Anorexia/weight loss
  • Constipation/diarrhoea
  • Peripheral neuropathy
  • Fatigue
  • Alopecia
  • Myelosuppression (neutropenia common)
  • Myalgia/arthralgia

Neutrophil count, WBCs and PLTS need to be monitored on day 1 and day 8 of treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What chemotherapy regimes are used for Colorectal cancer? and when are they used?

A

What?
- Oxaliplatin de Gramont aka FOLFOX (Oxaliplatin + 5-FU + Folonic acid)
or
- XELOX (Capecitabine in combination with oxaliplatin)

When?
- Adjuvant in Duke’s C (not recommended for Duke’s A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fluorouracil (5-FU)

A
  • 5-FU is converted intracellularly to metabolites that bind to enzyme thymidylate synthase, inhibiting synthesis of thymidine, DNA & RNA
  • To ↑ efficacy of 5-FU, folinic acid given.
  • Folinic acid ↑ & prolongs inhibition of TS → improved clinical outcome
Side effects of 5-FU:	
o	diarrhoea
o	stomatitis
o	nausea & vomiting
o	bone marrow suppression
o	“hand-foot syndrome” (PPE)
o	excessive tear shedding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Oxaliplatin

A
  • 3rd generation platinum derivative
  • Cross-links DNA, prevents replication & cell division
  • Less nephrotoxicity than other platinums (e.g. cisplatin) but 95% of patients suffer neurological side effects
- Side effects:	
o	peripheral neuropathy
o	acute pharyngolaryngeal dysasthesia (1-2%)
o	bone marrow suppression
o	mild alopecia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Oxaliplatin de Gramont (FOLFOX) regime

A
  • Chemo given every 2 weeks for 12 cycles as outpatient
  • Oxaliplatin 85mg/m2 over 2hrs IV infusion
  • Calcium folinate 350mg over 2hrs IV infusion
  • Fluorouracil 400mg/m2 IV stat
  • Fluorouracil 2400mg/m2 IV infusion over 46hrs in portable infusion device
  • Need Hickman (central) line or PICC line
  • Infusion important in colorectal cancer as tumour cells have low growth fraction
  • Also, fluorouracil is S-phase specific & has short t1/2 of 10 mins
  • Clinical evidence also supports infusional approach. However, ↑ incidence of hand-foot syndrome with infusional fluorouracil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main issues with infusion devices?

A
  • Anxiety for patients
  • Disposal of cytotoxic waste in patient’s homes
  • Time-consuming to fill (around 30 mins per device)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Capecitabine

A

• Oral chemotherapy – often used in combination with oxaliplatin (= XELOX regimen) instead of the “de Gramont” component

Advantages of oral chemotherapy:
o Less invasive & distressing for patient
o No issues with sterility / short expiry date
o Reduces pharmacy costs & time
o Patients can administer medicines themselves at home

  • Capecitabine is prodrug of 5-FU
  • 3 step activation process, 2 of which occur preferentially in tumour cells
  • Given bd for 14 days out of 21
  • Side effects:
    o diarrhoea (50%) – treat with loperamide
    o hand-foot syndrome (45%) – treat with moisturisers, dose reduction
    o nausea & vomiting (35%) – treat with antiemetics
    o stomatitis (20%) – treat with mouthwashes e.g. chlorhexidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Summary of treatment of colorectal cancer

A
  • Surgery still used to relieve obstruction / symptoms
  • Resection of liver metastases (11% of patients)
  • 5-FU based regimens e.g. oxaliplatin de Gramont, capecitabine
  • Other drugs e.g. irinotecan – topoisomerase I inhibitor (enzyme involved in unwinding of DNA during DNA replication)
  • Duke’s A: surgery only
  • Duke’s B: surgery + adjuvant chemotherapy in some cases (patients with risk factors such as vascular invasion of tumour, poorly differentiated tumour)
  • Duke’s C: surgery + adjuvant chemotherapy
  • Duke’s D (metastatic): surgery to relieve obstruction if needed, palliative chemotherapy +/- monoclonal antibodies to relieve symptoms & prolong survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bevacizumab (Avastin)

A

Used to treat: Advanced colorectal, non-small cell lung and breast cancers.
- New therapy

  • Vascular endothelial growth factor (VEGF) inhibitor
  • Inhibits binding of VEGF to its receptor on tumour cell surface
  • VEGF usually stimulates new blood vessel formation & is essential for tumour development
  • Inhibiting formation of blood vessels -> inhibits tumour growth
  • Bevacizumab is licensed in combination with fluorouracil/capecitabine-based chemotherapy.
  • It is given as an IV infusion every 2 or 3 weeks
Serious side effects:	
o	GI perforation (2%)
o	Haemorrhage (1-5%)
o	Hypertension (34%)
o	Arterial thromboembolism (4%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cetuximab

A
  • Monoclonal antibody targeting EGFRs
  • Can be used to treat colorectal cancer that has spread and also as a potential first-line strategy alongside chemotherapeutic agents.
  • Should stop treatment with cetuximab after 16 weeks
Side effects:
o	Allergic reactions
o	Skin changes (acne-like rash)
o	Tiredness
o	Nausea
o	Diarrhoea
o	Sore mouth, eyes or nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the diagram for treatment of SCLC

A

See separate sheet

22
Q

Describe the diagram for treatment of NSCLC

A

See separate sheet

23
Q

What is the usual first line chemotherapy regime for treatment of SCLC?

A

Cisplatin/carboplatin-based chemotherapy

24
Q

What is the usual second line chemotherapy regime for treatment of SCLC?

A

Anthracycline-containing regimen
or
Further platinum chemotherapy (if good response to first line)

25
Q

What adjuvant chemotherapy is normally used for NSCLC (post-surgery)?

A

Given as adjuvant therapy post surgery to eradicate cells that are not removed during surgery

Cisplatin-based chemotherapy regimen

26
Q

Give an example of a cisplatin based chemotherapy regimen

A

Cisplatin & vinorelbine

Given every 21 days for maximum of 4 courses
Inpatient stay in hospital for hydration

Side effects:

  • Nausea & vomiting
  • Bone marrow suppression
  • Mucositis
  • Constipation
  • Alopecia
  • Peripheral neuropathy
  • Nephrotoxicity & ototoxicity
27
Q

What are the pharmaceutical care issues associated with chemotherapy with cisplatin & vinorelbine?

A
  • Check FBC, BSA & doses
  • Check renal function – GFR must be > 55ml/min. Must be formally measured before treatment, Recalculate before each cycle & if GFR ↓, follow guidance in protocol
  • Ensure antiemetics for highly emetogenic chemotherapy are prescribed
  • Ensure pre & post hydration prescribed (3L IV fluids before & after cisplatin)
  • Ensure urine output of ≥100ml/hr during & for 6-8hrs post cisplatin administration
  • Patients may need additional diuresis if urine output inadequate or weight gain (fluid retention)
  • Monitor patient for cisplatin-induced wasting of electrolytes – Mg, Ca & K. Supplements may be needed
  • Vinorelbine – vinca alkaloid, must be diluted to 50mls with NaCl 0.9%
28
Q

What chemotherapy regime is used for advanced/metastatic NSCLC?

A

Cisplatin & pemetrexed
or
NICE recommend -> Cisplatin & gemcitabine, paclitaxel or docetaxel

29
Q

What is the maintenance treatment in advanced NSCLC?

A

Pemetrexed is recommended as an option for the maintenance treatment of people with locally advanced or metastatic NSCLC (NOT squamous cell carcinoma) if disease has not progressed immediately following platinum-based chemotherapy in combination with gemcitabine, paclitaxel or docetaxel.

30
Q

Afatinib

A

New targeted therapy for NSCLC

Afatinib is an oral TKI which targets the EGFR receptor

Approved by NICE in 2014 for locally advanced/metastatic NSCLC which is EGFR mutation +ve (~10% of patients)

EGFR mutations trigger growth & spread of NSCLC

Side effects:
o Diarrhoea
o Skin reactions (acne-like rash, erythema)
o Stomatitis
o Paronychia (inflammation of skin around nails)
o Hepatotoxicity

31
Q

Erlotinib (Tarceva)

A

oral TKI which targets the EGFR receptor

Licensed for 1st line treatment of locally advanced or metastatic NSCLC or 2nd line after failure of previous chemotherapy

Side effects:
o	Diarrhoea
o	Skin reactions (acne-like rash)
o	Tiredness
o	Mood changes
o	Nausea
o	Stomatitis
o	Higher risk of infection
32
Q

Rituximab

A

A monoclonal antibody that targets CD20 on the surface of leukaemia and lymphoma cells

Used in the treatment of chronic lymphocytic leukaemia and non-hodkin’s lymphoma

First‑line treatment of patients with diffuse large B-cell, CD20‑positive, non-Hodgkin’s lymphoma in combination with CHOP or other anthracycline‑based chemotherapy regimens.

Side effects:

  • Increased risk of infection
  • Nausea and Vomiting
  • Fatigue
  • Skin rash
  • Can affect blood pressure
  • Rhinitis
  • Loss of fertility
33
Q

How does ‘watchful waiting’ work in prostate cancer?

A
  • Well differentiated localised cancer in pts who are elderly, have
34
Q

How do hormone therapies work in prostate cancer?

A

They block the androgen drive that sustains most prostate cancers

Androgens - mainly testosterone produced in testes. 10% of androgens are produced by adrenal gland.

Androgens are metabolised to DHT which is an active metabolite

35
Q

Describe the production of androgen

A

Testosterone from testes is under control of luteinizing hormone (LH) released from pituitary gland when stimulated by LHRH from hypothalamus

LHRH – short t1/2, released in pulsatile manner

Pulsatile release is important as receptors for LHRH will become desensitised if they are permanently occupied

36
Q

Goserelin

A

LHRH analogue

Disrupts the normal pulsatile release of LHRH

Side effects:

  • Impotence
  • Loss of libido
  • Gynaecomastia
  • Breast tenderness
  • Hot flushes
  • Depression & mood changes
  • Fatigue
37
Q

Triptorelin

A

LHRH analogue

Disrupts the normal pulsatile release of LHRH

Side effects:

  • Impotence
  • Loss of libido
  • Gynaecomastia
  • Breast tenderness
  • Hot flushes
  • Depression & mood changes
  • Fatigue
38
Q

What is the main problem with LHRH analogues (Gosereline and Triptorelin) and how do you avoid it?

A

Initially ↑ LH release followed by ↓ LH & testosterone.

Initial ↑ LH can cause transient increase in tumour volume (= tumour flare) which can worsen symptoms if not blocked

-> therefore give androgen blocking drug e.g. bicalutamide for 1st few wks

39
Q

Bicalutamide

A

Androgen Blocker

Competes with DHT at receptor level

Side effects:

  • Impotence
  • Loss of libido
  • Gynaecomastia
  • Breast tenderness
  • Hot flushes
  • Depression & mood changes
  • Fatigue
40
Q

Cyproterone

A

Androgen Blocker

Competes with DHT at receptor level

Side effects:

  • Impotence
  • Loss of libido
  • Gynaecomastia
  • Breast tenderness
  • Hot flushes
  • Depression & mood changes
  • Fatigue
41
Q

How do you treat metastatic prostate cancer?

A

First line Abiraterone or Enzalutamide

Then chemotherapy (Docetaxel & Prednisolone regimen)

42
Q

Abiraterone

A

Inhibits androgen production from testes, adrenal glad and prostate tumour cells.
Also gives good reduction in pain

Licensed 1st line where chemotherapy is not yet clinically indicated i.e. patient is asymptomatic/mildly symptomatic

Side effects:

  • Peripheral oedema
  • Hypokalaemia
  • Hypertension
  • UTI
  • Elevated LFTs (monitor every 2 weeks for first 3 months)

Only funded through the CDF

43
Q

Enzalutamide

A

Inhibits binding of androgens to receptors, nuclear translocation and binding to DNA

  • Licensed 1st line where chemotherapy is not yet clinically indicated i.e. patient is asymptomatic/mildly symptomatic
  • Also licensed for use when docetaxel therapy has failed

Side effects:

  • Headache
  • Hot flushes
  • Memory problems
  • Visual hallucinations
  • Risk of seizures

Only funded through the CDF

44
Q

What is the chemotherapy regime used in prostate cancer?

A

Docetaxel and prednisolone

Every 21 days for up to 10 cycles

Docetaxel disrupts the microtubular network of cells so mitosis cannot occur -> cell death

Side effects:

  • Bone marrow suppression
  • Severe alopecia
  • Nausea and Vomiting
  • Myalgia
  • Fluid retention -> (premed with dexamethasone)
  • Hypersensitivity -> (premed with dexamethasone)
45
Q

What are the main pharmaceutical care issues with the chemotherapy regimen used in prostate cancer? (Docetaxel & Prednisolone)

A

Check BSA & doses against protocol

Check FBC – neuts ≥ 1.5 & plts ≥ 100 before each course of chemo

Ensure pt has taken pre-med (dexamethasone 8mg bd for 3 days starting day before chemo)

Check LFTs – ↓ docetaxel dose if impaired

Ensure antiemetics for mild to moderately emetogenic chemo prescribed e.g. metoclopramide 10mg tds prn or domperidone 10mg tds prn

Ensure patient understands when to take dexamethasone & prednisolone & that both are steroids

46
Q

What is the chemotherapy regime used in malignant melonoma and when is it used?

A
  • Dacarbazine (an alkylating agent)
  • Used in advanced/unresectable melanomas (Stage 4)
  • However, there is no significant effect on overall survival and so not really used.
47
Q

Ipilimumab

A

Recombinant human monoclonal antibody that binds to and blocks CTLA-4. This potentiates the antitumour T-cell response

Approved for previously untreated malignant melonama or after prior therapy

Side effects:

  • Diarrhoea
  • Rash
  • Itchiness
  • Fatigue
  • Nausea & Vomiting
  • Decreased appetite
  • Abdominal pain
  • Colitis, hepatitis
48
Q

Vemurafenib

A

Oral tyrosine kinase inhibitor of BRAF

BRAF is a gene that is constitutively active in melanomas and causes proliferation and tumour growth

Only suitable for patients with the BRAF mutation. Approved by NICE for patients with advanced MM who have the BRAF mutation

Side effects:

  • Fatigue
  • Joint pain
  • Rash
  • Sensitivity to the sun
  • Nausea
  • Alopecia
  • Itchiness
  • Headache
  • Development of minor skin cancers (check for new patches on skin)
49
Q

Dabrafenib

A

Oral tyrosine kinase inhibitor of BRAF

BRAF is a gene that is constitutively active in melanomas and causes proliferation and tumour growth

Only suitable for patients with the BRAF mutation. Approved by NICE for patients with advanced MM who have the BRAF mutation

Side effects:

  • Fever
  • Fatigue
  • Joint pain
  • Rash
  • Sensitivity to the sun
  • Nausea
  • Itchiness
  • Headache
  • Development of minor skin cancers (check for new patches on skin)
50
Q

Pembrolizumab

A

Anti-PD1

Blocks the PD1 receptor

Indicated for previously untreated advanced MM or following ipilimumab/BRAF inhibitor

Side effects:

  • Fatigue
  • Cough
  • Nausea
  • Itchiness
  • Decreased appetite
  • Constipation
  • Arthralgia
  • Diarrhoea
  • Immune-mediate adverse reactions (e.g. colitis, hepatitis)
51
Q

Summary of treatments in advanced/unresectable MM

A

See seperate sheet

Cancer (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions