Pharmacology II Final: Anti Cancer Drugs

Off all cancers diagnosed, what percentage can be cured by surgery or radiation ALONE?

25%
75% require systemic chemotherapy

Of all cancers treated with chemotherapy, what percentage are cured / prolonged remission?

10%

Most cases of cancer do not go into remission, rather, drug therapy produces only a _________ of the disease

regression

There were no treatment options for cancer until what year?

1940

For solid cancers, _____ of patients can be cured effectively when the tumor has NOT metastasized

1/3

True or False: Most currently available anticancer drugs only interfere with malignant cell unique processes.

False, we are not there yet. Most currently available anticancer cells affect all proliferating cells, but we are getting better at making them more specific.

All antitumor agents have a ______ therapeutic window

narrow

Primary focus of chemotherapy vs. Primary objective

Focus: preventing cancer cells from multiplying, invading, or developing metastasis

Objective: destroy all malignant cells without excessive destruction of the normal cells

Growth rate ______ as neoplasm size increases

decreases

Why? b/c it outgrows the ability to maintain blood supply and not all cells proliferate continuously

What type of cells are most susceptible to cancer therapy: dividing or resting cells? What happens if you stop therapy?

Dividing; the resting cells reactivate when tx ends

Conventional chemotherapy targets have been developed to act on what 3 things?

cell cycle, intracellular microtubules, and DNA

Maximum Tolerated Dose (MTD) protocol

give pt the highest possible dose of chemo to induce overt toxicity, requires a rest period between cycles of therapy

Metronomic chemotherapy protocol

long term low(er) dose over long time w/o extended rest periods

Combination chemotherapy improves responses over single agents, but the _________ must be maintained

dose intensity

For classical chemotherapy to be effective, ________ is required

cell proliferation
(indolent cancers typically resist chemotherapy)

What is the major cause of uncontrolled cancer growth and ultimate death?

drug resistance

Primary Chemotherapy

Chemo is the main modality of Tx, single or combo drugs

Adjuvant Chemotherapy

Add radiation to the chemotherapy (??????) typically for advanced cancer like breast cancer or solid tumors)

Neoadjuvant Chemotherapy

chemo given before surgery to shrink tumors to make sx easier

Concurrent Chemotherapy

simultaneously with radiation

Cell Cycle specific drugs are effective against

hematologic malignancies in solid tumors with large growth fraction

Non cell cycle specific drugs are effective against

solid tumors with low growth fraction as well as solid tumors with high growth fractions

______ drugs are given after a course of _______

CCS , CCNS

What tissues are high growth fraction?

bone marrow, hair follicles, intestinal

Gompertzian Growth Model

exponential early growth of cancer that slows down at later stages of development

Smaller tumors typically grow ______ but have a ______ percentage of cells dividing

slowly, large

Medium tumors typically grow ______ but have a ______ percentage of cells dividing

quicker than small, small

Large tumors typically grow ______ but have a ______ percentage of cells dividing

slowly, small

Most anticancer drugs are ineffective in advanced cancers which have a very ________ growth fraction

low

True or False: Debunking procedures make tumor again responsive to drugs by inducing remaining cells to divide.

True

True or false: if a drug is capable of killing 99.999% of tumor cells, with a log 5 kill, results in clinical remission or symptomatic improvement.

True

True or false: A single clonogenic malignant cell can produce progeny and kill the host.

True

What is the most frequent treatment LIMITER of chemotherapy where the doctor may decide to pull back on treatment?

bone marrow depression

Uncontrolled nausea and vomiting from chemotherapy can lead to loss of ______ and _____ which impairs nutrition and leads to reduced quality of life and nonadherance to treatment

fluid and electrolytes

True or False: Nausea and vomiting cannot be prevented during chemotherapy

False, 70-80% can be prevented with antiemetic

Patients with ______ have a lower resistance to infection and must be monitored for signs of infection during chemotherapy

leukopenia (too few WBC)

Leukopenia

Abnormally low white blood cell count (<4000/ul)

Thrombocytopenia

low platelet count (below 100,000)

Anemia Hgb level

<8 g/dl

Anemia symptoms

FATIGUE, headache, dizziness, lightheadedness, shortness of breath, pallor, hypothermia, pale nail beds, pale conj

Most common side effect of cancer and its treatment

Fatigue

Does exercise help or worsen fatigue associated with cancer treatment?

Helps

Alopecia

hair loss (65% for chemotherapy)

Does methotrexate cause severe or gradual alopecia?

gradual

Hair loss may begin within _______ of starting treatment and regrowth is expected within ________

7-10 days, 3-6 months

Stomatitis

inflammation of the mouth

Why is stomatitis problematic? How can it be treated?

hurts too much to eat
-use cold foods, suck on ice chips, prescribe topical lidocaine to decrease discomfort

What foods should be avoided with severe diarrhea?

spicy, greasy, raw fruit, raw vegetable, nuts, caffeine, seeds, popcorn, alcohol

Dysgeusia

altered taste (metallic or bitter or no taste at all)

True or false: chemotherapy can directly cause decreased cardiac, pulmonary, and renal output

True

How many chemo treatments for peripheral neuropathy to occur?

5+

As toxicity increases, the patient complains of muscle pain, weakness, and disturbances in what visual component?

depth perception (makes it hard for them to walk independently)