What are the 4 major types of cancer drug therapy?
Chemotherapy
Immunotherapy
Targeted therapy
Hormone therapy
What is the conventional or cytotoxic chemotherapy therapeutic goal
Kill cancer cells by halting cell division
Chemotherapy drugs that kill cancer cells only when they are dividing and in a specific part of the cell cycle are called ____?
Cell-cycle specific
What are cell-cycle specific chemotherapy drugs?
Kill cancer cells when the cells are at a specific part of the cell cycle
Chemotherapy drugs that kill cancer cells when they are anywhere in the cell cycle are called ____?
Cell-cycle non-specific
What are cell-cycle non-specific chemotherapy drugs?
The kill cancer cells anywhere in the cell cycle
What is the major mechanism of action for chemotherapy drugs?
Interfere with DNA synthesis
Interesting with cell replication resulting in cell death
True/False: cell cycle non-specific agents are active regardless of the phase of the cell cycle, as long as the cells are dividing
True
True/False: cell cycle specific agents require cells to be in a certain part of the cell cycle
True
True/False: cell cycle specific agents are most effective against rapidly gorwing tumors
True
What is neoadjuvant chemotherapy?
Make a tumor smaller prior to surgery or radiation therapy
What is adjuvant chemotherapy?
Destroy cancer cells that remain AFTER treatment with surgery or radiation therapy
True/False: neoadjuvant chemotherapy is given after surgery or radiation
False; neoadjuvant is given BEFORE surgery or radiation
True/False: adjuvant chemotherapy is given prior to surgery or radiation therapy
False; adjuvant chemotherapy is given AFTER surgery or radiation to kill remaining cancer cells
Palliative chemotherapy ______(does/does not) have curative effect.
Does not
Salvage chemotherapy is given to patients who are ______(responding/not responding) to or not tolerating primary chemotherapy
Not responding
What is the mechanism of action for immunotherapy?
Uses checkpoint inhibitor to increase our natural immunity ability to destroy cancer cells.
Bind to PDL1 on tumor cell or PD-1 receptors on T cell
Which cancer drug therapy uses checkpoint inhibitor?
Immunotherapy
What is checkpoint inhibitor?
Blocks Programmed death ligand receptor on tumor cells so they cannot bind to T cell
What is targeted chemotherapy ?
targets the changes in cancer cells that help them grow
Which cancer drug therapy utilizes biomarker testing of tumor to ID the presence of various aggressive growth factors that can be inhibited with medications?
Targeted therapy
True/False: EGFR overactivity causes new cancer cells to form quickly
True
True/False: VEGF triggers angiogenesis
True
What is hormone therapy?
Treatment that slows or stops the growth of breast and prostate cancers
What is a common name stem for platinum chemotherapy drugs?
Ends in -platin
The name stem -platin is which type of chemotherapy drug?
Platinum
What are the agents of platinum drugs?
Cisplatin
Carboplatin
Oxaliplatin
Which of the platinum drugs are commonly used for in lung cancer
Cisplatin
Carboplatin
Which type of cancer is oxaliplatin used for?
Colorectal cancer
Cisplatin and Carboplatin are most commonly used for _______ cancer
Lung
True/False: platinum drugs are non cell-cycle specific
True
What is the mechanism of action for platinum drugs?
Intracellular activation via aquation of leaving groups
Binds to proteins, lipids, RNA and mitochondrial DNA – inhibiting DNA synthesis
Which chemotherapy binds to proteins, lipids, RNA, mitochondrial DNA in order to stop DNA biosynthesis?
Platinums
True/False: carboplatin is less nephrotoxic than cisplatin and often given to patient who cannot tolerate cisplatin
True
What are common toxicities for cisplatin?
Nausea/vomiting
Nephrotoxicity
Cation wasting
Increase LFTs and bilirubin
Auditory impairment
True/False: nausea and vomiting is a common side effect for cisplatin
True
True/false: Cation wasting: commonly Ca2+ and Na+ , is associated with cisplatin use
False ; Cation Wasting most commonly refers to Mg2+ and K+
Which cations do “cation wasting” refer to?
Mg2+
K+
What are common side effects seen with carboplatin use?
Hematologic effects- carboplatin affects bone marrow
Myelosuppression
True/False: carboplatin use affects bone marrow
True
What are common side effects with oxaliplatin use?
Neuropathy
True/false: neuropathy is often seen with oxaliplatin use
True
Which platinum drug is usually associated with nausea and vomiting?
Cisplatin
Which platinum drug is usually associated with cation wasting?
Cisplatin
Which platinum drug is usually associated with elevated LFT and bilirubin?
Cisplatin
Which platinum drug is usually associated with auditory impairment?
Cisplatin
Which platinum drug is usually associated with nephrotoxicity?
Cisplatin
Which platinum drug is usually associated with neuropathy?
Oxaliplatin
Which platinum drug is usually associated with myelosuppression?
Carboplatin
True/False: when Nausea/vomiting is a side effect (ie. With cisplatin), premedication is also warranted
True
What are the agents used as premedication to mediate n/v?
Dexamethosome 4mg PO BID, 3 days after chemo
Antiemetics PRN L prochlorperazine, ondansetron, lorazepam
True/False: nephrotoxicity (ie with cisplatin use) can cause renal tubular damage
True
To combat nephrotoxicity side effect, cisplatin is usually given with ______
IV hydration
True/False: with oxaliplatin use, patients often get cold sensitivity secondary to neuropathy
True
What are some major toxicities with cisplatin use?
Seizure
Visual impairment
Hypersensitivity
Encephalopathy
What are some major toxicities with carboplatin use?
Visual impairment
Hypersensitivity
What are some major toxicities with oxaliplatin use?
Neuropathy
Hemolytic anemia
Hypersensitivity
Pulmonary fibrosis
True/False: cisplatin is dosed using Calvert equation (area under curve)
False; it is carboplatin that is dosed using that
What is a common name for microtubule inhibitors?
Taxanes
What is the mechanism of action for taxanes?
Inhibit depolymerization and enhances polymerization of microtubules
What is microtubule?
Maintain cell shape
Component of mitotic spindle
True/False: taxanes are cell cycle specific drug
True
Which cell cycle does taxnes target?
G2/M phase
“Mitotic spindle poison” is the mechanism for which anticancer drug?
Taxanes
What are the agents for Taxanes?
Paclitaxel
Protein bound Paclitaxel
Docetaxel
Cabazitaxel
Cremophor vehicle is in which drug?
Paclitaxel
True/false: Paclitaxel is associated with hypersensitivity reactions
True
True/False: Paclitaxel is associated with myelosuppression
True
Which anticancer drug often results in abnormal EKG changes: sinus bradycardia?
Paclitaxel
True/false: albumin-bund paclitaxel is associated with hypersensitivity reactions
False; albumin bound is the only taxane that does not have any infusion reactions
True/False: Docetaxel is associated with hypersensitivity reactions
True
What are common toxicities with taxens?
Myelosuppression
Neuropathy
Hypersensitivity reactions
Diarrhea
Some nausea/vomiting
True/False: taxanes are metabolized by the liver CYP450, so need to watch for drug-drug interaction
True
True/false: taxnes are associated with diarrhea
True
Which Taxane is not associated with hypersensitivity reactions?
Albumin-bound paclitaxel
What are major toxicities with paclitaxel?
Cardiac toxicity
Stevens-johnson syndrome
Hypersensitivity reactions
Seizure
Pulmonary embolism
What are major toxicities with album paclitaxel?
Cardiac toxicity
Pulmonary embolism
What are major toxicities with docetaxel?
Fluid retention
Stevens-Johnson syndrome
Pulmonary embolism
Colitis
Which taxane has a major toxicity risk for Stevens-Johnson syndrome?
Paclitaxel
Docetaxel
True/False: paclitaxel, docetaxel, and album-bound paclitaxel have pulmonary embolism as one of the major toxicities risk
True
True/False: administer taxanes after platinum compounds
False; taxanes should be administered BEFORE platinum compounds
What is the difference between topoisomerase I and II inhibitors?
Topoisomerase I breaks one strand of DNA
Topoisomerase II breaks two strands of DNA
True/False: topoisomerase I inhibitor is a cell cycle non-specific anticancer drug?
False; topoisomerase I is cell cycle specific
Which cell cycle does topoisomerase I inhibitor drugs specific to?
S- phase specific
What is a prototype of topoisomerase I inhibitor?
Camptothecin
Topotecan
Irinotecan
True/false: camptothecins irreversibly bind to topoisomerase I
True
What is the route of administration for Topotecan, and which one is more commonly used?
IV and oral
IV is more commonly used
What is an adverse reaction with oral Topotecan use?
Diarrhea common with oral form
What type of drug is topotecan and camptothecin?
Topoisomerase I inhibitors
What type of drug is irinotecan?
Topoisomerase I inhibitor
What are adverse reactions associated with irinotecan?
Abdominal pain
Cramping
Diarrhea
True/false: irinotecan is associated with diarrhea
True
Which metabolite is responsible for cytotoxicity in irinotecan activation?
SN-38
(don’t really know what this question is even asking)
True/false: too much diarrhea for too long could kill you, like in the case with irinotecan use
True; due to electrolyte abnormalities, dehydration, sepsis
True/false: topotecan and irinotecan both have myelosuppression as a side effect
true
which of the two causes more nausea: topotecan or irinotecan
irinotecan
What are the two forms of topoisomerase II inhibitors?
Alpha and beta
Which cell cycle do alpha form of topoisomerase II inhibitor target?
G2/M phase
Which cell cycle do beta form of topoisomerase II inhibitor target?
Throughout the cell cycle
True/False: Topoisomerase II prevent cells from going into meiosis
False; its mitosis. Topoisomerase II inhibitors arrest cells in G2 phase
True/False: topoisomerase II inhibitors bind directly to DNAA
False; they do not bind directly to DNA
What is a prototype for topoisomerase II inhibitor?
Etoposide
What are some common toxicities for etoposide?
Myelosuppression
Mild n/v
Diarrhea
Fever/chills
Hypersensitivity reactions
What are major toxicities for irinotecan?
Diarrhea
GI perforation
Interstitial lung disease
What are major toxicities for topotecan?
Diarrhea (though rare)
Interstitial lung disease
What are major toxicities for etoposide?
Hepatotoxicity
CHF
Stevens Johnson syndrome
True/false: all topoisomerase inhibitors are associated with dose limiting myelosuppression
True
True/false: etoposide is associated with hypersensitivity reactions
True
True/false: irinotecan carries the risk of secondary malignancies
False; etoposide carries the risk of secondary malignancies