Week 9: Cancer Pharm (Part 3)

Prednisone:

Corticosteroid modifier

Tamoxifen/raloxifene:

Estrogen antagonists used for adenocarcinoma of the breast

Exemestane/anastrozole:

Aromatase inhibitors that inhibit estrogen synthesis

Flutamide/bicalutamide:

Anti-androgens used for prostate cancer

Cytokine therapy:

Extension of normal cytokine function to stimulate immune effects against cancer

IL-2 (Proleukin):

T-cell and NK cell activator used for melanoma and renal cell cancer

IFN-alpha (Roferon A/Intron A):

Inhibits tumor cell growth and activates NK cells and APCs; used for melanoma, Kaposi's sarcoma, and hematologic cancers

Monoclonal antibodies:

target cancer cell receptors or ligands

Rituximab:

Monoclonal antibody that blocks CD20 receptor

Trastuzumab:

Monoclonal antibody that blocks Her-neu receptor

Bevacizumab:

Monoclonal antibody that binds VEGF ligand and inhibits angiogenesis

Small molecule inhibitors:

target intracellular cancer pathways such as proteasomes and tyrosine kinases

Bortezomib:

Proteasome inhibitor

Imatinib:

First discovered tyrosine kinase inhibitor

Sunitinib/sorafenib:

Small molecule inhibitors that also inhibit angiogenesis

Tumor vasculature:

poorly organized, abnormal perivascular cells, hyperpermeable, increased interstitial pressure, and decreased drug diffusion into tumor

What is the goal of anti-VEGF therapy like bevacizumab?

Normalize/inhibit tumor vasculature to improve tumor treatment effects

MTD pulsatile chemotherapy:

Maximum tolerated dose given intermittently, classically every 3 weeks

Metronomic chemotherapy:

lower-dose chemotherapy given more frequently, such as weekly or daily

How is antiangiogenic therapy shown in dosing schedules?

Added between metronomic chemotherapy doses to target tumor vasculature

What are adverse effects of cytokines?

Acute inflammatory disease, autoimmune responses, depression, nausea, emesis

What are adverse effects of antibody therapies?

Acute inflammatory disease and anaphylaxis

Bevacizumab adverse effects:

Impaired wound healing, arterial thromboembolic events, neutropenia

Sunitinib/sorafenib adverse effects:

Hypertension, GI disturbances, rash, abdominal pain, hemorrhage/bleeding, xerostomia, stomatitis/mucositis, altered taste, dysphagia

Unexpected effect of antiangiogenic drugs:

Therapeutic doses can be antiangiogenic, but subtherapeutic doses may be proangiogenic

*experimental data idk if he would test this but fun fact?

Imatinib adverse effects:

Skin reaction/erythema multiforme, excessive edema, anemia, hepatotoxicity, GI symptoms including nausea

Imatinib dental implications:

Mouth ulceration, taste disturbance, high bleeding risk, cytopenias including thrombocytopenia, medical consult advised

Preventive/prophylactic cancer vaccines:

Vaccines against causative infectious agents (ex: HPV and Hepatitis B virus)

Therapeutic cancer vaccine:

Vaccine against tumor (ex: prostate cancer vaccine Provenge)

Provenge:

First therapeutic cancer vaccine, FDA approved in 2010, used for prostate cancer

Direct oral toxicities of cancer chemotherapy:

Oral mucositis, salivary gland dysfunction, neurotoxicity, trigeminal nerve neuropathies, taste dysfunction, dentinal hypersensitivity, TMJ dysfunction, myofascial pain

Indirect oral toxicities of cancer chemotherapy:

Myelosuppression, neutropenia/immunosuppression, anemia, thrombocytopenia, infection, GI mucositis, nutritional disturbances, nausea/vomiting, acidic damage, heightened gag reflexes