Principles of Anticancer Therapy Quiz

Study Notes

Principles of Cancer Chemotherapy

Cancer chemotherapy aims to induce lethal cytotoxic events or apoptosis in cancer cells, halting tumor progression.
Effective anticancer drugs ideally target processes unique to malignant cells, but many currently affect both healthy and cancerous proliferating cells.

Goals of Cancer Treatment

Cure the cancer.
Prolong remission and disease-free periods.
Palliation: reduce tumor size, alleviate symptoms, prolong life.
Adjuvant therapy post-surgery or radiotherapy to minimize recurrence.

Treatment Protocols

Combination Therapy: Uses multiple drugs with different mechanisms to increase effectiveness and minimize resistance.
Pulse Therapy: Involves administering drugs in intermittent short courses, allowing for recovery of normal cells.
Recruitment Therapy: Aims to enhance cellular immunity during treatment.
Rescue Therapy: Mitigates adverse effects of chemotherapy and replenishes deficiencies caused by the drugs.

Clinical Settings for Chemotherapy

Primary Induction Treatment: Initiated for advanced cancers lacking other effective treatments.
Neo-Adjuvant Treatment: Reduces tumor size to facilitate surgical removal.
Adjuvant Treatment: Administered after surgery/radiotherapy to decrease local and systemic recurrence.
Combined Modality Approach: Anticancer drugs are combined with other treatment modalities.

Drug Classification

Cell Cycle-Specific Drugs: Target specific phases of the cell cycle; effective against high-growth fraction malignancies (e.g., antimetabolites, Vinca alkaloids).
Cell Cycle Non-Specific Drugs: Effective against both low-growth and high-growth cells (e.g., alkylating agents, cisplatin, antibiotics).

Drug Resistance

Resistance can be inherent or acquired through mutations, reduced cellular uptake, alternative metabolic pathways, increased inactivation, or decreased activation of prodrugs.
Development of resistance can be minimized by using short-term, intensive, and intermittent combination therapies.

Adverse Drug Reactions

Common toxic effects include:
- Bone marrow depression leading to lymphocytopenia and increased infection risk.
- Gastrointestinal issues: stomatitis, diarrhea, nausea, and vomiting.
- Hair loss (alopecia).
- Hyperuricemia and generalized edema possibly due to corticosteroids.

Established Combination Chemotherapy Regimens

VAMP: Vincristine, Amethopterin (Methotrexate), 6-Mercaptopurine, Prednisolone.
COAP: Cyclophosphamide, Oncovin (Vincristine), Ara-C (Cytarabine), Prednisolone.
POMP: Prednisolone, Oncovin, Methotrexate, Purinethol (6-MP).

Advantages of Combination Therapy

Potentially curative for small tumors; decreasing drug toxicity and resistance.
Administered in pulses to achieve higher response rates and allow bone marrow recovery.
Utilizes agents with different toxicities and mechanisms, enhancing overall efficacy.

Management of Anticancer Drug Toxicity

Combination therapy combines drugs with qualitatively different toxicities to reduce overlapping side effects.
Rescue Therapy Agents:
- Folinic acid to counteract Methotrexate toxicity.
- Acetylcysteine as an expectorant for respiratory clearance.
- Ondansetron for nausea control.
- Allopurinol to manage uric acid levels resulting from cell lysis.
- Bisphosphonates used to treat osteoporosis due to corticosteroid effects.

Description

Test your knowledge on the principles of anticancer therapy, including goals of cancer treatment, treatment protocols, and classification of anticancer drugs. Learn about the common adverse drug reactions and principles of cancer chemotherapy.