The Use of Chemical Agents to Destroy Cancer Cells – Flashcards
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Chemotherapy: Major Categories
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Alkylating agents Antimetabolites Antitumor antibiotics Plant alkaloids Targeted Therapy
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1. Most common method 2. Intracavity 3. Intraperitoneal 4. Intrapleural 5. Intra-thecal 6. Topical
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1. IV (small #IM, mostly breast cancer drugs) 2. stomach/bladder (right into the organ) 3. ovarian cancer; right to the organ 4. thorasic cavity (lung cancer) 5. into spinal cord b/c BBB=obstacle 6. skin cancers
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1. Adjuvant chemotherapy 2. Neoadjuvant chemotherapy 3. Combined Modality Chemotherapy 4. Hormonal manipulation
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1. Chemo administered after there's been a procedure (purpose=to seek out rouge cells) 2. Chemo given before procedure to make tumor easier to remove (smaller) 3. Attack cancer from number of different means, e.g. chemo/radiation/etc. 4. Breast cancer+prostate fed by hormones, so stop hormone to stop/slow growth
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Alkylating agents
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Oldest class One of the most effective, particularly in Hodgkin/Non-Hodgkin/multiple myeloma/aggressive tumors Classes -Nitrogen Mustards (Hodgkin/multiple myeloma) -Nitrosoureas -Platinums
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Nitrogen Mustards
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Most effective Examples -Cyclophosphamide (Cytoxan) -Chlorambucil (Leukeran) Drink 1-2L h20 to prevent hemorrhagic cystitis
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Nitrosoureas
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Cell-cycle non specific Lipid soluble (gets into cell quickly and past BBB) Example -Carmustine (BCNU) Adverse effects -Oral stomatitis
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Plantinum
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Not cell-cycle specific Colon/rectal cancers; ovarian cancers Adverse effect: peripheral neuropathy; extremely painful when pt is exposed to cold temps Given before bone marrow transplant (effective/toxic)
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Plantinum examples
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Cisplatin (oldest, highly renal toxic) Carboplatin (older) less toxicity Oxaliplatin (mild renal toxic; colorectal/ovarian Ca)
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Antimetabolites
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Built on folic acid Cell-cycle specific: S phase Most effective; effective in rapidly-growing tumors (breast/colon/rectal) Adverse effects: N&V, bone-marrow suppression, alopecia (moreso), very renal/liver toxic
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Antimetabolite examples
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Methotrexate (Found use in RA, ectopic pregnancy, and severe psoriasis) 5-Fluorouracil (5-FU) Capecitabine (Xeloda) (PO, taken at home)
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Antitumor Antibiotics
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Prevent DNA from replicating itself (not cell-cycle specific, will work anywhere) One of the most toxic of chemotherapy--given IV Given for cancer of head/neck, lymphomas, bone cancer, melanoma
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Antitumor Antibiotic examples
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Doxorubicin--cardiotoxic; HF-like symptoms, like SOB, edema, palpitations Bleomycin--pulmonary toxic; pulmonary fibrosis; **can also induce allergic rx, so may need to premedicate with antihistamine Danorubicin--cardiotoxic; HF-like symptoms, need to listen to apical (palpitations) Valrubicin--bladder cancer treatment (infuse, sit several hours, then drained)
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Plant (Vinca) Alkaloid categories
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*Taxanes *Vincas Podophyllotoxins Camptothecan analog (Derived from teas from periwinkle plant; ineffective for diabetes but good for childhood leukemia)
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Taxanes
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Cell-cycle specific--interfere with microtubules; M phase? Generally not 1st-line drugs Adverse effect: Neurotoxicity (unique); could progress to seizures; regain neuro level once doses are over; *tell pt to write stuff down*
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Vincas
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Cell-cycle specific Indications: used in peds>adults; testicular/neuroblastomas Adverse effects: not as severe bone marrow depression or neurotoxicity ^Good in combo especially with drugs with severe bone marrow depression
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Vinca alkaloid examples
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vinblastine vincristine vinorelbine
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Biologic Response-Modifying Drugs categories
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Colony stimulating factors (the epogen/procrits that support growth of RBC) Interferons (pts develop flu-like symptoms) Interleukin (set of proteins with anti-tumor properties, particularly effective against renal cell carcinoma/melanoma) Monoclonal antibodies (antibody to tumors grown in the lab)
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1. Neulasta 2. Neupogen 3. Neumega
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1. Pts who have reached nadir and can't raise WBCs; generally lasts longer 2. Same form as Neulasta but given weekly (WBC stimulator) 3. Platelet stimulator
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Targeted Therapy drug examples
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Herceptin (HER2)--antibody in breast cancer Rapiva (CD-11A)--inhibits T cell activity, like severely affected psoriasis patients Avastin (VEGF)--anti-angiogenesis
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Monoclonal Antibody examples
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Rituximab (Rituxan)--targets malignant B cells, killing them, body produces healthy B cells (for psoriasis) Cetuximab (Erbitux)--blocks growth of cell membrane Bevacizumab (Avastin)--cuts off blood supply Herceptin--Breast cancer Kadcyla/Perjeta--also given for breast cancer but more advanced cancer not responding to tx
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Colony Stimulating Factors
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Filgrastim (Neupogen)--Same form as Neulasta but given weekly (WBC stimulator) Perfilgrastim (Neulasta)--Pts who have reached nadir and can't raise WBCs; generally lasts longer
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Estrogen blocker
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Tamoxifen--used for estrogen-dependent breast cancer; also reduces occurrence of secondary cancer (daily dose 2-5 years); indicated for >40 and post-menopausal
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Androgen blocker
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Flutamide--blocking androgen supply to stem/stop growth of cancer
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Chemoprotective Agent examples
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Amifostine--often given in conjunction with doxorubicin to prevent cardiotoxic effects Dexrazoxane (Zinecard)--given 30 minutes before/after treatment Leukovorin--"Rescue drug"; one of the first to use; treats high-dose methotrexate
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Hypersensitivity Reactions
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Any drug is capable of giving a hypersensitivity rx Taxols/Platinums = higher risk
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Vesicants
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Extremely damaging to tissue Adriamycin (doxorubicin)--antitumor antibiotic Vinblastine(g)--vinca alkaloid Vincristine(g)--vinca alkaloid
