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What two characteristics to most cancer drugs have in common?
- Affect DNA synthesis or synthesis of components necessary for mitosis
- generally not effective in G0 phase
Describe the two drug classifications for cytotoxic agents?
- Cell Cycle Phase Specific (CCSS): most effective on small, rapidly growing tumors and schedule dependent (continuous or frequent doses)
- Cell Cycle Phase Nonspecific (CCNS): most effective on large slower tumors and dose dependant (large doses given infrequently)
T/F: CCNS acts independently of where the cell is in its cycle.
Define "Growth Fraction (GF)".
The ratio of proliferating vs. non-proliferating cells
Define "Tumor Doubling Time (TDT"). Why is it important?
how long it takes for the tumor to double in size. Burkett's Lymphoma has the fastest with 24 TDT, Important because the more it divides the easier it is to kill.
Below which log power can our immune system usually fight off the tumor?
What log power is the limit of clinical detection for a tumor in which you can palpate it?
109 = 1cm3
Describe the first order kinetic principle.
A given dose will kill a certain percentage of tumor cells regardless of how many are present.
Describe the Exponential or Long-kill potential.
We hope to get 99.9% of the tumor killed; we cannot get all of it killed - we hope our immunity can take care of the rest.
What is Nadir?
The point when neutrophils are at their lowest after treatment.
Why are neutrophils affected so badly with chemo drugs?
Because they divide and multiply so quickly, same reason our hair falls out
How do you calculate Absolute neutrophil count? What is the normal ANC? What is the hold number?
- multiply percentage of Bands and Segments to the WBC count.
- Normal is 1500
- Hold is 1000; do not give chemo if under 1000
Why do we look at the ANC before chemo?
Because if the ANC is too low the person could die from infections
Why is diarrhea a common side effect?
Because the cells in the gut divide quickly and slough off causing diarrhea
What is the MOA of Cytoxan?
Miscodes DNA and radiomimetic (breaks DNA molecule and prevents cross-linking)
How do you remember Doxorubicin?
Rubi from AA Vacations in Costa Rica Monthly for Free. (Rubi = turns urine/skin red; AA = antitumor antibiotic; V = vesicant; C =cardiomyopathy 300mg lifetime; R = radiation rash recall; M = mucositis; Free = produces free radicals)
What does the S phase of cell division do?
Makes components for cell division
How do you remember things about Methotrexate?
- Don't give Meth to Kid (neys) = causes renal toxicity
- MethotrexATE inhibits reduction of folATE.
How do you remember Cytarabine?
Blind (conjunctavitis) and Febrile (fever) Tara fell (cerebellar toxicity, balance) on her tingly hands (peripheral neuropathy) climging the pyramid (Pyrimidime).
How do you remember Vincristine?
My aunt Cristine at the vehicle factory has diarrhea doesn't assemble white cars.
How do you remember Taxol?
The shock (anaphylaxis) of My (mitotic inhibitor) uncle Taxol's divorce (disassembly of microtubules) from Cristine (she stopped assembly, he stops disassemly) still haunts him (pain can come back years later).
How do you remember Tamoxifen?
Tampon is similar to the name; think women, anti-estrogen, hormones, hot flashes, water retention
What does SERM stand for? What
Selective Estrogen Receptor Modulator. It BLOCKs growth stimulus which is good, and it ACTIVATES bone density (good), but also increases risk for endometrial cancer and DVTs.
How do you remember Herceptin?
Herceptin, HER2 receptors, Heart, Hypersensitivity
What do targeted drugs do?
Focus in on a receptor. Ex: Herceptin
What does a biologic response modifier do? Example?
stimulate host immune response against tumor; Interferon alfa-2b
How do you remember IntronA?
(In robot voice) IntronActivate your biologic immune response against the flu and depression tumors.
How do you remember Gleevec?
Glee makes me want to kill myself. (Gleevec inhibits tyrosine kinase, an enzyme that ultimately blocks apoptosis promoting abnormal cells.)
How do you calculate dosage?
- 1. Calculate body surface area by multiplying weight times height in inches
- 2. divide that by 3131 and then take the square root.
- 3. Multiply that number by the milligrams in the order
What drug is given intrathecal? What does that mean?
Methotrexate: in the subarachnoid space
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