Term
| What is the difference between "adjuvant" and "neoadjuvant" cancer therapy? |
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Definition
1) Adjuvant is post-surgery treatment
2) Neo-adjuvant is pre-surgical chemo to shrink tumor |
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Term
| What cell cycle stages are affected most prominently by chemotherapetuic agents that inhibit DNA synthesis or cause DNA damage? |
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Definition
| Rapidly dividing cells are hit >>>> dormant cells in Go |
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Term
How does 5-flourourcil work to treat cancer?
What about Capecitabine? |
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Definition
Anti-metabolic
1) Pyrimidine analogue that is converted to GdUMP by thymidylate synthase and incorporated into BOTH DNA and RNA, affecting both synthesis and function
2) Orally administered prodrug that is converted to 5-FU in tumors |
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Term
| How does Gemcitabine inhibit cancer growth? |
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Definition
Converted to F-dCTP and is incorporated into DNA (vs. DNA and RNA for 5-FU)
Terminates growing DNA chain and is resistant to repair. |
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Term
What drug is described by each of the following mechanisms
1) Incorporates in DNA and RNA, halting synthesis and function
2) Forms bulky DNA adducts
3) Incorporates into growing DNA chain, halting growth and resisting repair.
4) Interferes with microtubule synthesis/degradation, inhibiting cell division |
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Definition
1) 5-FU
2) Oxaliplatin (platinum coordination complex)
3) Gemcitabine
4) Paclitaxel/docetaxel (anti-mitotic) |
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Term
Which of the following drugs requires pretreatment with anti-histamines or glucocorticoids and why?
1) 5-FU
2) Docetaxel
3) Gemcitabine
4) Ironotecan |
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Definition
2) Anti-mitotic agents that inhibit microtuble synthesis/degradation
- Reduce adverse hypersensitive reactions to vehicles used for insoluble anti-mitotics |
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Term
What are the major limitations of using Irinotecan and Epirubicin to treat colorectal cancer?
How do their mechanisms of action differ? |
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Definition
1) Topoisomerase inhibitors act on S phase and require LONG exposure for any benefit
2)
- Irinotecan stabilizes covalent complex between nicked DNA strand and topoisomerase, forming dsDNA breaks during synthesis (S phase) and cell death.
- Epirubicin forms tripartite complex with DNA and topoisomerase II blocking re-ligateion of dsDNA breaks generated during replication |
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Term
| Why might you give Mitomycin C to treat cancer? |
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Definition
| Antibiotic used in combination with other agents that alkylates DNA, leading to inhibited synthesis and formation of ssDNA and dsDNA breaks |
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Term
| What are the most common risk factors associated with esophageal adenocarcinoma and esophageal squamous cell cancer? |
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Definition
1) Adenocarcinoma is GERD/Barett's
2) Squamous is smoking/alcohol |
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Term
What are the major risk factors/treatment for each of the following?
1) Liver cancer
2) Biliary track and Gallbladder cancer
3) Small bowel cancer
4) Anal cancer |
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Definition
1) Hep C in Men more than women (targeted chemo with
multi-kinase inhibitor "sorafenib")
2) Gallstones/ more in women- Cisplatin and gemcitabine
3) Adenocarcinoma of dueodenum in CD patients: surgery
4) HPV-16- Mitomycin/5-FU |
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Term
| Why is early diagnosis so critical in pancreatic cancer? |
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Definition
Current chemo agents are used only for palliative support because of advanced stage at detection!
Need biomarkers |
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Term
| What is the mainstay treatment for Colorectal cancer? |
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Definition
Anti-metabolite with agent to increase effectiveness
- Combination of Leucovorin (reduced folic acid)/5-FU/Oaliplatin (FOLFOX)
- Leucovorin enhances inhibitory effects of 5-FU
**Oxaliplatin is sometimes replaced with ironotecan (FOLFIRI)** |
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Term
Why is cetuximab used in colorectal cancer?
Why does bevacizumab show promise? |
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Definition
EGFR is over-expressed in 60-80% of tumor cells, so it makes sense as a targeted chemotherapy agent.
Bevacizumab is againsr VEGF-R and also shows promise. |
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Term
| Why is Pemetrexed sometimes given with Gemcitabine to treat pancreatic cancer? |
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Definition
| Pemetrexed triggers induction of enzymes involved in salvage nucleoside pathway to compensate for inhibition of thymidylate synthase by Gemcitabine (depends on ENT1 transporter because of hydrophillicity) |
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Term
Why are NSAIDs considered to be potential chemo-preventative agents for colorectal cancer?
What limits their use? |
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Definition
1) Inhibit inflammation that predisposes patients to cancer.
2) Adverse CV effects |
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