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35 Cards in this Set
- Front
- Back
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Adjuvant vs Neoadjuvant Therapy (general)
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Adjuvant: eliminate undetectable mets after removing primary tumor
Neoadjuvant: eliminate undetectable mets before removal of primary tumor |
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Chemotherapy (Cytotoxic) Agents vs Targeted (Biologic) Therapies (general)
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Chemo: targets DNA or other cell processes used in cell replication (such as mitotic spindle)
Targeted/biologic Tx: targets markers expressed on cancer cells, genes, or intracellular pathways inappropriately activated or inactivated (tumor suppressors) in cancer cells, or elements of stroma that support tumor growth/mets |
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Common toxicities of chemotherapy.
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Effects on cell proliferation: Myelosuppression (cytopenia)
Hair loss, mouth/anal sores, diarrhea (due to thinning of bowel wall) Nausea (natural response to poisons), vomiting, anorexia Tumor lysis syndrome (breakdown of cancer cells more rapidly than body can handle; metabolite imbalances) |
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How long after chemo administration is cytopenia seen? Why isn't it develop right away?
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Takes about a week to see drop in WBC count. Causes system to 'restart' and WBC production resumes after 10-14 days.
Chemo only affects cells that are replicating/dividing. WBCs stop dividing (replicating DNA) at the metamyelocyte stage. So cells that were already metamyelocytes at time of administration will continue to differentiate. |
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Antimetabolites:
MOA |
Target S phase of cell cycle; inhibit synthesis of DNA
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Topoisomerase Inhibitors:
MOA |
Target S phase of cell cycle
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Antimicrotubule Inhibitors:
MOA |
Target M phase of cell cycle
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Intercalating Agents:
MOA |
Target S phase of cell cycle
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Alkylating Agents:
MOA Toxicities |
Attach alkyl group to DNA, usually 7-nitrogen of guanine:
(unbolded): -DNA fragmented by repair enzymes trying to excise altered nucleotides -forms cross-links for cDNA strand, preventing DNA transcription/replication. Toxicities are the same as chemo: myelosuppression, nausea, vomiting, anorexias, mucositis (mouth sores) |
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Cyclophosphamide:
Drug Class |
Alkylating agents - Nitrogen Mustards
require hepatic metabolism to active form toxic byproducts may cause bladder irritation and hemorrhagic cystitis |
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This drug requires hepatic metabolism to its active form.
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Cyclophosphamide
Ifosfamide |
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This drug can cause bladder irritation and hemorrhagic cystitis.
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Irrirates bladder and causes hemorrhagic cystitis via creation of toxic byproducts!
Cyclophosphamide Ifosfamide also have typical chemotx toxicities (myelosuppression, nausea, vomiting, alopecia) |
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Chlorambucil:
Drug Class Toxicities |
Alkylating agent - Nitrogen Mustard
Toxicities same as alkylating agents: myelosuppression, nausea/vomiting, anorexia |
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Melphalan:
Drug Class Toxicities |
Alkylating agents - nitrogen mustards
Typical toxicities: myelosuppression (can be prolonged if sem cells damaged), nausea/vomiting, anorexia ALOPECIA is RARE |
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This drug rarely causes alopecia.
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Melphalan
Busulfan (Bendamustine NEVER causes alopecia) |
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Bendamustine:
Drug Class Toxicities |
Alkylating agent- Nitrogen mustard
Typical toxicities for alkylating agent: myelosuppression, n/v/anorexia NO ALOPECIA |
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This drug never causes alopecia.
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Bendamustine
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Busulfan:
Drug Class Toxicities |
Alkylating agent - Alkylsulfonate
Typical Toxicities: myelosuppression, n/v/anorexia, alopecia rare PULMONARY FIBROSIS |
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This drug can result in pulmonary fibrosis.
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Busulfan
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Camustine:
Drug Class Toxicities |
Alkylating agent - Nitrosureas
Myelosuppression (often prolonged) |
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Lomustine:
Drug Class Toxicities |
Alkylating agent - Nitrosureas
Myelosuppression (often prolonged) |
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Procarbazine:
Drug Class Toxicities |
Non-classic alkylating agent
Tox: myelosuppression, hypertensive crises when eating tyramine-rich foods (aged cheeses/meats, overripe fruits, wine) |
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Ingestion of aged cheese, meat, fruit, or wine is contraindicated in this drug.
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Procarbazine--bc can cause hypertensive crisis
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Methotrexate:
Drug Class MOA Toxicities |
Antimetabolite: Anti-folates
Blocks enzyme whose product is needed for thymidine (and thus DNA) synthesis Tox: Myelosuppression, n/v/a |
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6-mercaptopurine:
Drug Class Toxicities |
Antimetabolite: Purine Analogue
Tox: myelosuppression, tumor lysis syndrome, veno-occlusive disease of liver |
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6-thioguanine:
Drug Class Toxicities |
Antimetabolite: Purine Analogue
Tox: myelosuppression, tumor lysis syndrome, veno-occlusive disease of liver |
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This drug's toxicity can be increased by administration of allopuriniol.
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6-MP: 6-mercaptopurine
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5-fluoruracil:
Drug Class MOA |
Antimetabolite: Pyrimidine Analogue
When bioactivated, binds thymidylate synthetase, depleting cell of thymidine and preventing DNA synthesis |
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Capecitabine:
Drug Class Indications |
Anti-pyrimidine
Oral pro-drug (converted to 5-FU by liver) used to tx BrCa, ColorectalCa, and other GI cancers |
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Cytarabine:
Drug Class Toxicities |
Pyrimidine
CNX tox, cerebellar damage |
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This drug can result in cerebellar damage.
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Cytarabine (Ara-C)
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Gemcitabine:
Drug Class |
Antimetab: Pyrimidine analogue
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Hydroxyurea:
MOA Indication Toxicities |
Antimetabolite: anti deoxyribonucleotide
INhibits ribonucleotide reductase, depleting cells of deoxyribonucleotides (so it's an antimetabolite) used to bring down blood counts acutely in acute leukemias, CML also to reduce frequency of crises in sickle cell Tox: myelosuppression |
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Thalidomide:
MOA Indications Toxicities |
Unclear, may suppress angiogenesis
Multiple myeloma Tox: birth defects |
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Lenalidomide:
MOA Indications Toxicities |
MOA: unclear, may suppress angiogenesis
Tox: myelosuppression, birth defects |
