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Questions and Answers
Which of the following types of drug therapy is specifically designed to target cancer cells during a particular phase of their life cycle?
Which of the following types of drug therapy is specifically designed to target cancer cells during a particular phase of their life cycle?
Antimetabolites are drugs that are identical to normal cellular metabolites and do not interfere with metabolic pathways.
Antimetabolites are drugs that are identical to normal cellular metabolites and do not interfere with metabolic pathways.
False
What is the general mechanism of action for chemotherapy drugs?
What is the general mechanism of action for chemotherapy drugs?
Cytotoxic but not tumoricidal
Cytotoxic substances primarily target cells that are ____________.
Cytotoxic substances primarily target cells that are ____________.
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Match the following chemotherapy drug classes with their corresponding characteristics or mechanisms:
Match the following chemotherapy drug classes with their corresponding characteristics or mechanisms:
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What adverse effect is commonly caused by chemotherapy due to its impact on normal rapidly dividing cells?
What adverse effect is commonly caused by chemotherapy due to its impact on normal rapidly dividing cells?
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What is the term for the adverse effects of chemotherapy that are serious enough to prevent an increase in dose?
What is the term for the adverse effects of chemotherapy that are serious enough to prevent an increase in dose?
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Which subclass of antimetabolites inhibits the synthesis of folic acid for DNA production?
Which subclass of antimetabolites inhibits the synthesis of folic acid for DNA production?
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Methotrexate is used only for treating colorectal cancer.
Methotrexate is used only for treating colorectal cancer.
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Name one adverse event associated with anthimetabolites.
Name one adverse event associated with anthimetabolites.
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The S phase of the cell cycle is primarily targeted by _____.
The S phase of the cell cycle is primarily targeted by _____.
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Match the antimetabolite with its indication:
Match the antimetabolite with its indication:
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What is a common administration route for antimetabolites?
What is a common administration route for antimetabolites?
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Pyrimidine Antagonists disrupt the production of RNA and DNA by acting as synthetic forms of thymine and uracil.
Pyrimidine Antagonists disrupt the production of RNA and DNA by acting as synthetic forms of thymine and uracil.
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What is the purpose of giving Leucovorin during high-dose Methotrexate treatment?
What is the purpose of giving Leucovorin during high-dose Methotrexate treatment?
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Antimetabolites can lead to severe ____ and ____ as adverse effects.
Antimetabolites can lead to severe ____ and ____ as adverse effects.
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Which of the following is a Vinca Alkaloid used in chemotherapy?
Which of the following is a Vinca Alkaloid used in chemotherapy?
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Vincristine is known for causing significant bone marrow suppression.
Vincristine is known for causing significant bone marrow suppression.
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What is the mechanism of action of Topoisomerase I inhibitors?
What is the mechanism of action of Topoisomerase I inhibitors?
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Paclitaxel is derived from the bark of ______ trees.
Paclitaxel is derived from the bark of ______ trees.
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Match the following drugs to their type:
Match the following drugs to their type:
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What is a common adverse effect of Topoisomerase I inhibitors?
What is a common adverse effect of Topoisomerase I inhibitors?
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Irinotecan can cause severe diarrhea as a cholinergic effect.
Irinotecan can cause severe diarrhea as a cholinergic effect.
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What type of cancers are treated with Topotecan?
What type of cancers are treated with Topotecan?
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The antidote for extravasation from chemotherapy is ______.
The antidote for extravasation from chemotherapy is ______.
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What is a specific adverse event associated with Etoposide?
What is a specific adverse event associated with Etoposide?
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What is the primary purpose of supportive drugs in cancer treatment?
What is the primary purpose of supportive drugs in cancer treatment?
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Supportive drugs are considered chemotherapy drugs.
Supportive drugs are considered chemotherapy drugs.
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Name a supportive drug that helps prevent damage from doxorubicin.
Name a supportive drug that helps prevent damage from doxorubicin.
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________ helps clear uric acid from the blood and can prevent Tumor Lysis Syndrome.
________ helps clear uric acid from the blood and can prevent Tumor Lysis Syndrome.
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Match the supportive drugs with their primary protection focus:
Match the supportive drugs with their primary protection focus:
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What is the main mechanism of action of cytotoxic antibiotics?
What is the main mechanism of action of cytotoxic antibiotics?
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Hepatotoxicity is the most common adverse effect of cytotoxic antibiotics.
Hepatotoxicity is the most common adverse effect of cytotoxic antibiotics.
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Name two anthracyclines used in chemotherapy.
Name two anthracyclines used in chemotherapy.
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Bleomycin is known to cause ______ toxicity.
Bleomycin is known to cause ______ toxicity.
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Match the following cytotoxic antibiotics with their characteristics:
Match the following cytotoxic antibiotics with their characteristics:
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Which of the following is a common indication for the use of cytotoxic antibiotics?
Which of the following is a common indication for the use of cytotoxic antibiotics?
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Hormonal antineoplastics are considered a part of chemotherapy.
Hormonal antineoplastics are considered a part of chemotherapy.
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What is a significant adverse event of Daunorubicin and Doxorubicin?
What is a significant adverse event of Daunorubicin and Doxorubicin?
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Many drug interactions with cytotoxic antibiotics, especially with ______.
Many drug interactions with cytotoxic antibiotics, especially with ______.
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What is the primary route of administration for cytotoxic antibiotics?
What is the primary route of administration for cytotoxic antibiotics?
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Study Notes
Antineoplastics Chemotherapy
- Antineoplastics chemotherapy is a treatment for cancer
- Chemotherapy targets various aspects of cancer treatment
- Includes different categories of drugs with specific mechanisms of actions
- The course covers the 2024-2025 curriculum for PHAR1059
Antineoplastic Drug Therapy
- Chemotherapy, hormonal, targeted drug therapies, and supportive drug therapies are types of antineoplastic drug therapies
Chemotherapy
-
General Mechanism of Action: Cytotoxic but not Tumoricidal
- Kills cells, including cancer cells
- Stops cancer cells from dividing and growing
- Shrinks tumors in size
- Not specific to tumor cells
-
General Mechanism of Action: Tumoricidal
- Kills only tumor cells
- More specific and targeted mechanism of action
Chemotherapy (Effects and Pharmacokinetics)
- Effective on rapidly dividing cells
- Narrow margin between therapeutic effects and toxicity
- Many adverse effects
- Drug combinations are often more effective
- Resistance to drugs can develop
- Dosing varies based on cancer type, previous treatment, and administered drugs
- Body surface area (m²) is commonly used to calculate the dose
Chemotherapy (Adverse Effects)
- Describes side effects of a drug or treatment that are serious enough to prevent increasing the dose or level of treatment
- Targets normal rapidly dividing healthy cells. Many adverse effects relate to these cells
- Bone marrow suppression (neutropenia, thrombocytopenia, anemia)
- Hair loss (hair follicles)
- Gastrointestinal issues (diarrhea, mucositis, nausea and vomiting)
- Teratogenic risks versus benefits in pregnancy
- Infertility, IV form risk of extravasation
Chemotherapy - Cell Cycle Specific
- Cytotoxic during a specific phase of the cell cycle
- Frequently used for solid tumors and circulating tumors
- Does not work on resting or dormant phase cells
- Includes several classes:
- Antimetabolites
- Mitotic Inhibitors
- Topoisomerase Inhibitors
- Antineoplastic enzymes
Chemotherapy - Cell Cycle Specific (Classes)
-
Antimetabolites: Structurally similar to normal cellular metabolites; interfere with cellular growth by disrupting synthesis or actions of several component needed for cell reproduction.
- Mechanism: Falsely substitutes purines, pyrimidines, and folic acid
- Mechanism: Inhibits crucial enzymes involved in synthesis of purines, pyrimidines, and folic acid
- Cell-cycle phase target: S phase (DNA synthesis)
- Mitotic Inhibitors: Plant-derived compounds that target various phases of the cell cycle, particularly mitosis (cell division).
- Topoisomerase Inhibitors: Newer class of chemo drugs derived from a Chinese shrub (camptotheca). Binds to the DNA- topoisomerase I complex during the S phase; inhibits proper DNA functioning by slowing/breaking DNA strands
Chemotherapy - Antimetabolites
-
Folate Antimetabolites: Includes Methotrexate, Pemetrexed, Raltitrexed (Tomudex®)
- Mechanism: Inhibits enzyme needed to activate folic acid into its active form (folate), needed for DNA synthesis.
- Result: DNA synthesis is suppressed, leading to cell death
- Indications: Solid tumors of the head, neck, breast, lung & leukemia; lymphomas; Pemetrexed (lung cancer only); and Raltitrexed (colorectal cancer)
-
Purine Antimetabolites: Include Cladribine, Fludarabine (F-AMP), Mercaptopurine (6-MP), Thioguanine (6-TG)
- Mechanism: Act as synthetic forms of adenine and guanine (purines) and disrupt RNA and DNA synthesis
- Indication: Leukemia and Lymphoma
-
Pyrimidine Antimetabolites: Includes Capecitabine, Cytarabine (ara-C), Fluorouracil (5-FU), Gemcitabine
- Mechanism: Acts as synthetic forms of cystine and thymine (DNA) and uracil and cytosine (RNA); incorporate into the metabolic pathways for DNA and RNA synthesis, disrupting RNA/DNA production
- Administration: Mostly intravenous (except capecitabine - oral)
Chemotherapy - Adverse Effects, Specific Antimetabolites
- Nausea, vomiting, diarrhea, hair loss
- Bone marrow suppression (methotrexate)
- Lung and liver damage (methotrexate)
- Neuro damage (methotrexate)
- Peripheral neuropathy
Chemotherapy - Mitotic Inhibitors
- Plant-derived compounds
- Targets various phases of the cell cycle (G2 or during mitosis)
- Slows cell division
- Indications: Variety of solid tumors, some hematological cancers
- Synergistic use with other drugs
Chemotherapy - Mitotic Inhibitors (Subclasses)
- Vinca Alkaloids: Derived from periwinkle and mandrake plants; interfere with mitotic spindle structures during M phase, inhibits cell reproduction, causes cell death, Vinblastine, Vincristine, Vinorelbine
- Taxanes: Derived from bark of yew trees; acts on late G2 phase and M phase; high risk adverse effects during infusion, requires highly trained nurse administration, Paclitaxel, Docetaxel.
Chemotherapy - Mitotic Inhibitors Adverse Effects/Events
- Hair loss
- Nausea and vomiting
- Bone marrow depression
- Nephrotoxicity
- Hepatotoxicity
- High risk of extravasation
- Antidote use/ need is Hyaluronidase SC.
- Warm compresses indicated
Chemotherapy - Topoisomerase Inhibitors
- Topoisomerase II Inhibitors: Etoposide, Teniposide; inhibit topoisomerase II, breaks DNA strands, targets late S phase and G2 phase of cell cycle
- Topoisomerase I Inhibitors: Topotecan, Irinotecan; newer class of chemo-drugs, semi-synthetic drug derived from Chinese shrub; binds to DNA-topoisomerase I complex during S phase, inhibits proper DNA functioning by slowing and breaking DNA strands
- Indications: Ovarian cancers, colorectal cancer, small cell lung cancer.
- Administration: Injectable only
Chemotherapy - Topoisomerase Inhibitors (Adverse Effects)
- Stomatitis
- Hair loss
- Mild gastrointestinal upset (GI)
- Severe diarrhea
- Lacrimation (excessive tears)
- Sweating
- Bone marrow depression
- Cardiovascular Toxicity, Pulmonary Embolism, Cerebral Vascular Accident, Myocardial Infraction
- Special Notes: Etoposide-contains diluent that may cause hypotension, risk of orthostatic hypotension when used for testicular cancer
Chemotherapy - Antineoplastic Enzymes
- Use of enzymes produced in bacteria using recombinant technology
- Make cells unable to synthesize asparagine (required for G1 DNA synthesis and cell survival)
- Indications: Lymphocytic leukemia— Pegasparagase
- Administration: Injectable only
Chemotherapy - Antineoplastic Enzymes (Adverse Effects)
- Allergic reactions are common
- Impaired pancreatic function
- Hyperglycemia
- Pancreatitis
Chemotherapy - Cell Cycle Non-Specific
- Cytotoxic to neoplasms at any phase of the cell cycle
- Includes two broad categories
- Alkylating drugs
- Cytotoxic antibiotics
- Chemotherapeutic agents emerged in the 1940s; the first was an alkylating drug developed from mustard gas (nitrogen mustard).
Chemotherapy - Cell Cycle Non-Specific (Alkylating drugs)
- Alkylation = process where alkyl group moves from one molecule to another in DNA leading to faulty chemical bonds between DNA strands
- Defective DNA leads to DNA damage; prevents reproduction and causes cell death
- Used to treat solid and circulating cancers with three categories.
-
Classic Alkylators (Nitrogen Mustards)
- Cyclophosphamide
- Chlorambucil
- Isofamide
- Melphalan
-
Nitrosoureas
- Carmustine
- Lomustine
- Streptozocin
-
Miscellaneous Alkylators
- Busulfan
- Carboplatin
- Cisplatin
- Dacarbazine
- Procarbazine hydrochloride
- Temozolimide
- Adverse effects Include similar dose limiting effects and nephrotoxicity, neurotoxicity, bone marrow suppression, ototoxicity, pulmonary fibrosis
Chemotherapy - Cell Cycle Non-Specific (Cytotoxic Antibiotics)
- Natural or semi-synthetic substances derived from mold
- Classified by mechanism of action (intercalation—inserts molecules between two DNA strands to cause strand breaks and programmed cell death).
- Inhibit topoisomerase II
- Generate free radicals causing DNA strand breaks resulting in programmed cell death
- Indications: Solid tumors and hematological cancers
- Anthracyclines (Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Valrubicin)
- Other cytotoxic antibiotics (Bleomycin, Dactinomycin, Mitomycin, Mitoxantrone)
Chemotherapy - Cell Cycle Non-Specific (Adverse Events)
- Hair loss
- Nausea and vomiting
- Bone marrow suppression
- Hepatotoxicity
- Pulmonary toxicity (pulmonary fibrosis and pneumonitis)
- Heart failure and cardiomyopathy
- Drug interactions (especially with Digoxin)
Hormonal Antineoplastics
- Often not considered a type of chemotherapy
- Sex hormones accelerate cancer growth
- Mechanism of action targets to block body's sex hormone receptors OR by administering hormones with opposing effects
Hormonal Antineoplastics (Breast Cancer)
- The growth of some breast cancer cells is moderated by estrogen; increasing cancer growth
- "Estrogen receptor-positive breast cancer"
- Blocking estrogen production or utilization can slow growth; Tamoxifen (Nolvadex-D), Toremifene (Fareston)
Hormonal Antineoplastics (Breast Cancer- Modulators)
- Types of Selective Estrogen Receptor Modulators (SERMs)
- Anastrozole
- Exemestane
- Letrozole
- Anti-estrogen effects can be present on breast tissue and may be proestrogenic in uterine tissue
- Prevents Aromatase formation: inhibits the action for synthesis of estrogen and cannot be used with Tamoxifen.
Hormonal Antineoplastics (Prostate Cancer)
- Prostate cancer can be affected by testosterone increasing the growth levels
- Hormones interfere with a production of testosterone ,or compete with androgen receptors
- Androgen Deprivation Therapy
- Bicalutamide (Casodex)
- Flutamide (Eulexin)
- Emcyt (Estramustine)
Hormonal Antineoplastics (Adverse Effects)
-
Female Specific:
- Menopausal-like symptoms
- Hot flashes
- Night sweats
- Irregular periods
- Increased osteoporosis risk
- Increased risk of endometrial cancer
-
General:
- Fatigue
- Infertility; impotence
- Increased blood clot risk ;Increased cholesterol levels that increase cardiovascular risks
Targeted Drug Therapy
- Focuses on cancer drug research
- Uses drugs targeted to specific molecules involved in cancer cell growth, while sparing healthy cells
- Includes Imatinib (tyrosine inhibitor) Vorinostat (histone deacetylase inhibitor)
Targeted Drug Therapy (Immunotherapy)
- Uses the body's immune system to target cancer cells
- Includes:
- Hematopoietic or Colony Stimulating Factors Agents: Increase immunity in patients affected via chemotherapy
- Monoclonal Antibodies (MABs): Trigger immune system to attack/kill cancer cells
- Angiogenesis Inhibitors: Inhibit/restrict growth of the new blood supply to tumors.
- Interferons and Interleukins-2 (cytokines): Improve the immune system to target cancer cells.
- Immunostimulants: Used to stimulate the production of immune cells—or antibodies that target cancer cells
-
CAR-T Cells (Chimeric Antigen Receptor T-cells):
- Modifies patients T-cells in a lab
- Used as a standard treatment for patients with relapsed leukemia, and for new trials with some relapsing solid tumors.
Supportive Drugs
- Used to offset damaging effects of cancer treatment
- Includes:
- Chemo-protective
- Radio-protective
- Cyto-protective
- Not considered a type of chemotherapy treatment
- Protects cells and organs from side effects in combination of chemotherapy and/ or radiation therapy
Supportive Drugs (Specific Drugs and Mechanism of Action)
- Allopurinol (Zyloprim): Prevents uric acid buildup (during leukemia or lymphoma treatment)
- Rasburicase (Fasturtec): Helps clear uric acid from the blood
- Dexrazoxane (Zinecard): May prevent damage from doxorubicin (used to prevent complications of some types of cancer therapy)
- Folinic acid (leucovorin): Protects from damage via methotrexate by increasing the production of blood cells.
- **Colony-stimulating factors (e.g., Filgrastim):**Lowers the risk of low blood cell counts by stimulating the bone marrow increase the production of blood cells.
General Patient Education
- Understanding the treatment protocol (treatment plan); adverse effects
- Educate on signs of infections; bleeding; Anemia
- Prevention of hair loss
- Maintain mouth hygiene
- Prevention of exposure to others with infections
- Manage diarrhea
- Fluid intake management to 3 liters per day
- Precautions to avoid risks of bleeding (ASA or Ibuprofen)
- Contraceptives/ reproductive support prior to treatment
- Use of reliable resources such as Canadian Cancer Society.
Nursing Considerations
- Establish a therapeutic relationship; offer support; labs
- Monitor electrolytes, minerals, uric acid levels,complete blood count (CBC), platelets, bleeding times, liver and renal function
- Check neutrophil counts; signs of infections
- Presence of infection— or Febrile Neutropenia (Fever associated with Neutropenia)
- Monitor tumor markers(tumour marker may be used to monitor the effectiveness of treatment); oral mucosa, swallowing, weight, nutritional status, bowel patterns, N&V
- Signs of infection, bleeding, anemia
- Antiemetics 30-60 minutes before treatment or/and meals
- Be aware of look-alike, sound-alike drug names
- Safe handling and certification, PPE, spill kits
- Monitor IV site closely; extravasation protocols
- Patency of central lines
- Double flush of bodily secretions; reverse isolation protocol when required
- Use reliable resources (Canadian Association of Nurses in Oncology).
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Description
Test your knowledge on chemotherapy and drug therapy focused on cancer treatment. This quiz covers drug classes, mechanisms of action, and adverse effects associated with chemotherapy. Dive deep into the intricacies of how these drugs target cancer cells during various cell cycle phases.
