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66 Cards in this Set
- Front
- Back
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Cancer is not controlled by what normal physiological changes?
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- increased growth factors
- increased cyclin-dependant kinases - Altered gene expression - decreased contact inhibition |
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Cancer is the number ___ cause of death?
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Number 2 cause of death; not much progress in how we can help pts with cancer
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Top 3 cancers for men and women
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Prostate/Breast
Lung Colorectal |
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Definition of hyperplasia?
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A reversible increase in size or number of cells that retain their function
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Definition of metaplasia?
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An protective, adaptive substitution of one differentiated cell for another due to chronic irritation. Some loss of function
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Definition of dysplasia
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A reversible loss of uniformity and architectural orientation
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Definition of neoplasia
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Irreversible uncoordinated growth; immortalized cells. Due to decreased response to suppressor genes (p53 or cyclin-dependant kinases)
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Difference between benign and malignant cells
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Benign: localized, encased in fibrous capsule, that can be removed by surgery and the patient usually survives
Malignancy: Spreads to and destroys adjacent tissue without a capsule that can metastasize and cause the death of a patient |
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Difference in each of the Grades in tumor differentiation
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1: no loss of differentiation
2: increased growth but only moderately differentiated 3: increased variation, doesnt resemble tissue of origin 4: very poor differentiation, highly variable, metastatic |
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Differences in cancer vs normal cells
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Cancer cells can be well or non-differentiated
Can be slow or fast growing Can be localized or disseminated |
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Tumors can originate from
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a SINGLE cell
If you leave a single "clone-ogenic" tumor cell because it has the potential for unlimited replication |
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Tumor cells have ____ kind of growth
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Gompertzian cell growth - grow until nutrients run out (need blood vessels)
Therapy has first order cell kill (constant fraction of cells killed) |
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General treatments for tumors:
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1. Surgery - for well-localized well differentiated tumors
2. Ratiation for localized tumors that are not easily removed 3. Chemotherapy for systemic effects against metastatic cells; will target all rapidly dividing cells. |
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Chemo will target:
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all rapidly dividing cells including:
hair, RBC, WBC, epithelial cells, sperm |
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What kind of dosing schedule for chemotherapy? why?
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intermittent therapy to give the body a chance to recover (blood cells)
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what drugs work in the M stage? how?
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Mitotic inhibitors against tyrosine kinase
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What drugs work between G2 and S stage?
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Bleomycin and etoposide
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What drugs work in the S phase?
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DNA synthesize inhibitors
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What drugs are nonspecific to the cell cycle?
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Alkylating agents, intercalating agents
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Would you use combination therapy? why or why not?
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Yes; minimizes resistance and minimizes toxic effects (b/c you can use less concentrations of each drug)
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Why would you use adjuvant therapy?
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want to give a drug for antiemetic effects, and to stimulate bone marrow growth
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What cells have the highest growth rates?
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neoplastic cells - for desired effects
Bone marrow cells - myelo and immune suppression GI tract - ulceration Hair - alopecia Reproductive cells - decrease sperm, menstrual irregularities,sterility |
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Two general types of chemo:
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synthetic and natural
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Synthetic Chemo Groups of Agents
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Alkylating agents
Antimetabolites |
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General MOA of alkylating agents
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Alkylate purine/pyrimidine bases to block DNA synthesis
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General MOA of antimetabolites
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structural analogs of purine/pyrimidine/cofactors needed for DNA synthesis (Substitute for base pair)
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Natural Chemo Groups of agents
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Plant Alkaloids
Antiobiotics Biological response modifiers Hormonal agents Immunostimulants |
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General MOA of plant alkaloids
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Inhibit mitotic spingle formation or inhibit Topoisomerase II
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General MOA of Antibiotics
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Bind or intercalate DNA base pairs, breaking DNA strands
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General MOA of Biological response modifiers
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Attempt to target cancer cells specifically via antibodies, kinase and growth factor inhibition
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General MOA of Hormonal agents
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Inhibit hormonal sensitive tumor growth
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General MOA of Immunostimulants
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stimulate immune system
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Alkylating Agent Groups:
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1. Nitrogen Mustards
2. Nitrosoureas 3. Others 4. Platinum coordination complexes |
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Name Nitrofen mustards
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Mechlorethamine
Cyclophosphamide Ifosfamide Chlorambucil Melphalan |
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Name Nitrosoureas
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Carmustine
Lomustine |
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Name other Alkylating agents
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Dacarbazine
Procarbazine Temozolomide Busulfan |
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Name platinum coordinating complexes
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Cisplatin
Carboplatin |
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General properties of alkylating agents
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- Cytotoxic to rapidly dividing cells
- Not cell cycle specific - ALL mutagenic, carcinogenic, teratogenic - Significant bone marrow suppression - Epithelial cell damage - Amenorrhea, decrease sperm - CNS mediated N/V - Secondary tumors - All can cause pulmonary fibrosis - Immunosuppression |
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General MOA of Alkylating agents (7)
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1. Form carbonium ion
2. Alkylating Nitrogen atom on guanine or agenosine or cytosine 3. Formation of cross-links with adjacent bases to decrease DNA replication 4. Cross links will increase DNA strand breaks and increase p53 gene activity 5. Anormal pairing of G with T (misreading) 6. Depurination (remove purine from sugar background) 7. Increased ring cleavage to decrease purines for synthesis |
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General properties of nitrogen mustards
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Strong vesicants
target rapidly dividing cells |
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Mechlorethamine used in? S/E?
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Given IV
Quickly activated and inactivated Used in Hodgkins (MOPP) S/E: N/V, bone marrow suppression, Decrease reproductive functions Tx extravasation with Na Thiosulfate |
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Cyclophosphamide given? used in? S/E?
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Given oral or IV
*Requires metabolic activation Breast, lung, testicular, ovarian, sarcoma, non-Hodgkin's, CLL, Lymphoma S/E: N/V alopecia, cystitis, pulmonary fibrosis |
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Cyclophosphamide given in combo with ____ to stop ____?
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Cyclophosphamide given with Mercaptoethane sulfonate to stop cystitis (Binds acrolein)
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Ifosfamide used in? Added S/E?
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*Requires CYP3A4 activation
Less potent Used in Sarcoma, testicular cancer Added S/E of Neurotoxicity (hallucination, confusion, depression) Also use Mercaptoethane sulfonate to stop cystitis |
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Melphalan used in? Given as? Specific S/E?
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Used in multiple myeloma, ovarian, marrow ablation for transplants
Given orally, IV S/E: bone marrow suppression, less N/V, No alopecia, leukemias |
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Chlorambucil used in? given? Toxicities?
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Used in CLL
Given orally S/E: GI, pulmonary fibrosis, seizures, dermatities, bone marrow suppression |
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Properties of Nitrosoureas, used in? S/E?
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Non-enzymatically activated
Used in brain tumors(lipophilic), melanoma, non-Hodgkin's S/E: High likelihood of secondary leukemias (3-5 yrs), renal toxicity |
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Dacarbazine/Procarbazine given? Activation? Used in?
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Dacar - IV
Procar - Oral Activation by P-450 system Used in Hodgkin's disease and malignant melanoma In ABVD and MOPP |
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Procarbazine toxicities:
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- Bone marrow suppression
- alopecia - flu-like syndrome - *CNS depression - Renal and hepatotox - *Leukogenic - *Immunsuppressant - Infertility * = Just Procarbazine |
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Dacarbazine Toxicities:
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- *Severe N/V
- Bone marrow suppression - alopecia - Flu-like syndrome - Renal and Hepatotox - Infertility |
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Active compound from Dacarbazine?
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Diazomethane (MTIC)
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Temozolomide DOC for?
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Malignant gliomas used with radiation
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Temozolomide Mechanism?
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activated to MTIC, cytotoxic agent
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Altretamine used in? common S/E?
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activated to alkylating agent
Second line in ovarian cancer S/E: myelosuppression, neurotoxicity (ataxia, depression, confusion, hallucination) |
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Thiotepa converted to? MOA? used in? special S/E?
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converted to TEPA
MOA: Cross links DNA Used in: bladder, breast, hodgkin's, bone marrow transplants S/E: hematological, coma, seizures |
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Busulfan used in? With?
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Used for acute myelosuppression, CMA
Used with Cyclophosphamide before bone marrow transplant |
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Busulfan major S/E?
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pulmonary fibrosis, secondary malignancies
**Busulfan lung in 3 years, can be fatal |
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Cisplatin MOA?
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water activated to cross link Nitrogen on G or A within same strand
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Cisplatin used in? reacts with? importance?
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used in bladder, cervical, ovarian, testicular, melanoma
reacts with sulfhydral groups *Sensitizes some tumors to radiation |
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Cisplatin toxicities?
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SEVERE N/V
Nephrotoxicity Ototoxicity mild bone suppression |
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Cisplatin limiting toxicity?
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Nephrotoxicity
Need to hydrate the patient, can use amifostine as a renal protectant agent |
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Carboplatin used in?
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Used in ovarian, lung, bone marrow ablation
Requires activation |
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Carboplatin Tox?
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Moderate N/V (but seen in most pts)
Myelosuppression (dose limiting) |
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Oxaliplatin used in?
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GI, colorectal cancer, head + neck cancer, testicular, breast
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Oxaliplatin major tox?
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peripheral neuropathy
anaphylactic shock |
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How does resistance develop to Alkylating agents?
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1. Decreased ability to enter cells
2. Decreased activation and conversion of prodrugs 3. Increased intracellular glutathione to bind 4. Increased DNA repair mechanisms Develops rapidly when used alone |
