Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
32 Cards in this Set
- Front
- Back
|
What is the most effective treatment of cancer? Next most effective?
When is chemo useful? |
Surgery. not effective in metastasized diz.
Xrt - more useful in diz w/o dissemination. Disseminated diz. |
|
|
What is the more realistic goal for a majority of cancers?
|
palliative chemo, not curative chemo.
|
|
|
Are anticancer drugs magic bullets? Why?
Why aren't many of the solid tumors amenable to chemo? |
No. they target proliferating cells whether normal or neoplastic.
they are slower growing and harder to penetrate (like pancreatic cancer) |
|
|
Normal cells of the hair follicles, bone marrow and intestinal epithelium are rapidly dividing... this means that they're...
|
.... especially sensitive to inhibition by anti-neoplastic drugs
|
|
|
What is the Growth Fraction?
What does it influence? |
fraction of tumor cells that are progressing through the cell cycle (G1/S/G2/M). Resting cells are in G0.
susceptibility to most anticancer drugs. |
|
|
Growth fraction _____ with size of tumor.
Growth fraction can be ______ by reducing tumor burden with surgery or radiation. |
decreases
increased |
|
|
What is the growth fraction of BM?
|
30%
|
|
|
There are two classes of chemo drugs re: cell cycle -
|
ones that are specific to growing cells, and ones that are nonspecific.
|
|
|
There are two kinds of toxicities of anticancer drugs, name and characterize them.
|
common:
due to normal tissues that proliferate rapidly, bone marrow (myelosuppression), GI tract toxicity, nausea and vomiting, hair follicle toxicity specific: nervous system, cardiac, pulmonary, and urinary toxicities; hypersensitive reactions, carcinogenic properties |
|
|
The goal of induction chemo is to...
maintenance chemo? adjuvant chemo? neoadjuvant? |
induce remission
continue remission attack micrometastases post Surg./Xrt shrink tumors prior to Surg/Xrt |
|
|
The cancers most susceptible to chemo are________ and have ___ growth rates.
|
undifferentiated
high growth rate |
|
|
T / F:
CCNS drugs are useful against cycling cells and resting cells alike. Early detection of a cancer makes it more susceptible to chemo. |
True.
True. |
|
|
Two types of toxicities associated with anticancer drugs?
Characterize them both, and give examples. |
Common and Specific
C: due to normal tiss. that proliferate rapidly - BM, GI, hair follicle S: specific effects related to clearance, interference, etc. - CNS, Cardiac, pulm., urinary, hypersensitivity |
|
|
What is the dose-limiting / treatment limiting factor in most chemo programs?
What is the 'solution'? |
Myelosuppression (BM toxicity)
--> leukopenia --> higher risk of inf. use cytotoxic anticancer drugs in a 'pulse' course every 3-4 wks. |
|
|
What are the two results of myelosuppression that are of greatest clinical concern?
What can help ameliorate these effects? |
low WBC, thrombocytopenia --> lead to infection & hemmorhage.
GM-CSF and G-CSF - granulocyte-macrophage stimulating factors |
|
|
G-CSF stimulates the growth/differentiation of...
Side effects? Is EPO used in myelosuppressed patients as well? |
...neutrophils
well-tolerated; bone pain is the most frequent side-effect yes, because they are frequently anemic as well. |
|
|
GI Tract toxicity occurs most often in the mouth and anus. Why? Are these effects reversible?
|
cells are the most rapidly dividing ones.
Yes, temporary and reversible. |
|
|
Are Antimetics useful in chemo? Why/when?
|
Lessen vomiting in all patients and lessens emesis in about 75%. Given before Chemo.
|
|
|
What is the etiology of the nausea and vomiting seen in chemo patients?
|
stim of the vomiting center or chemoreceptor trigger zone in the CNS.
- NOT due to direct GI effects. |
|
|
Receptors for which two NTs seem to be the most important in triggering nausea and vomiting?
What does ondansetron do? prochlorperazine? metoclorpramide? |
D2 (dopamine)
5-HT 5-HT rec. antagonist dopamine D2 rec. antagonists |
|
|
Is specific nervous system toxicity due to chemo drugs (e.g., vincristine & vinblastine) reversible? What Sx does it cause?
|
Yes, usually.
paresthesias of the hand and feet, loss of deep tendon reflexes, and weakness occur in almost all patients |
|
|
Is specific cardiac toxicity due to chemo drugs (e.g. doxorubicin & daunorubicin) reversible?
What is seen, acute or chronic cardiotoxicity? |
No.
Both. |
|
|
Bleomycin can cause pulmonary toxicity - does it tend to be reversible?
|
No. Lethal in 1% of patients.
|
|
|
Cisplatin can cause Urinary tract toxicity... is it reversible? Are there ways to reduce effects?
|
no.
Aggressive hydration w/ saline infusion plus diuretic is used to reduce effects. |
|
|
Hypersensitive reactions can occur to chemo drugs that are bacterial proteins, like________. How are they overcome?
|
L-asparaginase
use an enzyme from another bacterial strain to overcome this. |
|
|
What is the main late complication of chemotherapy? This is most closely linked to which class of drug?
|
Carcinogenesis of second malignancies.
Alkylating agents. |
|
|
Resistance to anticancer drugs can be _____ or _____.
|
specific or broad (multidrug).
|
|
|
I ATE U [DNA] is good for remembering what? Work the whole thing out.
|
Mechanisms of cancer drug resistance.
Decreased Uptake Increase Efflux (pump out) Inactivation of Drug Decreased Activation of drug alter the target: - mut for of the target enzyme - increased expression of the enz. the drug is inhibiting Increased repair of DNA damage |
|
|
Define MDR in the context of cancer drugs.
Which broad category is MDR most commonly associated with? Which *doesn't* it extend to? Which mechanism typically causes it? |
Characterized by cross-resistance to a group of structurally and mechanistically distinct anticancer drugs
naturally derived agents and antibiotics. antimetabolites and alkylating agents. An efflux pump than can pump a bunch of them out. |
|
|
Do single drugs cure cancer?
What is the significance of 'cocktails'? |
No, with some exceptions.
diminish drug resistance increase cytotoxicity |
|
|
What are the 4 general principles of combination chemotherapy?
|
each drug should be active alone
each should have diff. mech. cross-resistance = minimal diff. toxic effects on normal cells |
|
|
80% of Hodgkin's diz is sent into complete remission, with 50% of those being cured by _____ or _____.
|
ABVD or MOPP.
|
