Term
| Definition of Chemotherapy |
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Definition
| The treatment of disease by means of chemical that have a specific toxic effect upon the disease-producing organisms or that selectively destroy cancerous tissue |
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Term
| Main uses of chemotherapy |
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Definition
1. Curative
2. Adjuvant: AFTER sx or radiation therapy; intent is to decrease tumor recurrence or metastasis
3. Neoadjuvant: used before definitive local therapy; reduces bulk of tumor
4. Palliative: aimed at reducing pain and discomfort associated with cancer |
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Term
| Principles of chemotherapy- PK |
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Definition
-protocols generally consist of 6 cycles
-99% of cells are killed with each cycle |
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Term
| Unique pharm of chemo drugs |
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Definition
-toxic to rapidly dividing cells
-Bone marrow
-Alopecia (hair)
-GI
-most cells in body are in a quiescent state and are thus resistant
-narrow margin of safety
-toxic to handlers, carcinogenic |
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Term
Important principles of Chemotherapy Tx
Max effectiveness |
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Definition
-Max therapeutic effectiveness, give the max tolerated dose that produces acceptable toxicity
-toxic dose is often very close to therapeutic dose |
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Term
Important principles of Chemotherapy Tx
Dose reduction |
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Definition
-reductions of ~20% generally reduce efficacy by ~50%
-dose reductions should not be lightly considered |
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Term
Important principles of Chemotherapy Tx
Metabolism of drugs for each p |
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Definition
| -dogs with hepatobiliary dysfxn, may get unacceptable tox of certain drugs |
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Term
Important principles of Chemotherapy Tx
Published doses |
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Definition
-published doses are guidelines ONLY
-diff p's will tolerate diff doses, differently
-geographical differences in tolerance of drugs |
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Term
Important principles of Chemotherapy Tx
Slow growing tumors |
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Definition
| -may be more resistant because more cells in G0 stage |
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Term
Important principles of Chemotherapy Tx
Large tumors |
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Definition
-host a chemo-resistant population of cells that are in resting stage
-the longer a tumor has been present, the higher the risk of a mutation that allows the tumor to possess inherent drug resistance |
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Term
Important principles of Chemotherapy Tx
Combining drugs |
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Definition
| -For some tumors, it may be most effective to combine drugs with different mechanisms |
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Term
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Definition
-potential drug interxns
-herbal/supplement interxns
-genetic differences |
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Term
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Definition
"white feet, dont treat"
Anticancer agents:
-doxorubicin/anthracyclines
-vinca alkaloids
-taxanes
-etoposide |
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Term
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Definition
| -doses are based on body surface area, not weight |
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Term
Drug Classes
Vinca Alkaloids |
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Definition
-periwinkle plant
-bind to microtubules and prevents assembly
-ALL ARE VESICANTS |
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Term
Drug Classes
Vinca Alkaloids
Common drugs |
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Definition
-Vincristine
-canine and feline lymphoma, TVT, IMT
-ILEUS in CATS
-Vinblastine
-canine MCT, feline lymphoma
-Both excreted through hepatobiliary
-decrease doses for those with abnormal bili |
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Term
Drug Classes
Alkylating Agents |
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Definition
-covalent binding of n alkyl group to DNA resulting in DNA crosslinks and adducts
-end result --> interferes with DNA replication and RNA transc
-non-cell cycle specific
-excreted primarily in urine
-some are prodrugs and have to be activated in the liver
-cyclophosphamide
-ifosfamide
-DTIC
-VERY carcinogenic- DONT CRUSH TABLETS
-VERY BONE MARROW SUPPRESSIVE |
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Term
Drug Classes
Alkylating Agents
Cyclophosphamide (Cytoxan) |
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Definition
Toxicity:
-bone marrow
-STERILE HEMORRHAGIC CYSTITIS
-give with LASIX
-carcinogenic
Uses:
-lymphoma,metronomic chemo protocols against solid tumors
Special notes:
-prodrug
-TABLETS SHOULD NEVER BE BROKEN OR CRUSHED!
-NITRILE gloves need to be worn
-long term admin can lead to bladder fibrosis or secondary bladder tumors or secondary hematopoietic neoplasms |
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Term
Drug Classes
Alkylating Agents
Chlorambucil (Leukeran) |
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Definition
Toxicity:
-mildly bone marrow suppressive
-potential NEUROTOX IN CATS
-carcinogenic
Uses:
-sub for cyclophosphamide when sterile hemorrhagic cystitis develops
Special notes:
-refrig
-dont crush tablets |
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Term
Drug Classes
Alkylating Agents
CCNU (Lomustine, Ceenu) |
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Definition
Toxicity:
-SEVERELY BONE MARROW SUPPRESSIVE- cumulative and irreversible thrombocytopenia
-HEPATOTOXIC
Uses:
-MCT, lymphoma rescue agent, histiocytic sarcoma
Special Notes:
-CROSSES BBB
-give with Denamarin to reduce liver tox
-DO NOT OPEN CAPSULES |
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Term
Drug Classes
Alkylating Agents
Mechlorethamine (Mustargen) |
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Definition
Toxicity:
-GI, bone marrow suppression
-very carcinogenic
Uses: multi-drug protocol for lymphoma
Special notes:
-MUST BE VERY CAUTIOUS ABOUT AEROSOLIZATION DUE TO TOXICITY TO HANDLERS |
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Term
Drug Classes
Alkylating Agents
Melphalan |
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Definition
Toxicity:
-strongly bone marrow suppressive
Uses:
-multi-drug protocol for lymphoma
TABLETS SHOULD NEVER BE CRUSHED OR SPLIT! |
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Term
Drug Classes
Alkylating Agents
DTIC (dacarbazine) |
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Definition
Toxicity:
-GI, acute emesis
-myelosuppression
Uses:
-lymphoma rescue, neuroendocrine tumors, melanoma
Special note:
-PRODRUG
-PRE-MED TO AVOID NAUSEA; give slowly over 4 hrs IV
-incompatible with heparin, lidocaine, hydrocortisone |
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Term
Drug Classes
Platinum Agents |
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Definition
-DNA crosslinks and adducts; similar to alkylating agents
-excreted in urine
-not compatible with AL and certain fluids |
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Term
Drug Classes
Platinum Agents
Carboplatin |
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Definition
-EXCRETED RENALLY (reduce doses if patient is renal compromised)
-CUMULATIVE BONE MARROW SUPPRESSION
variable or double nadir
-dilute in D5W |
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Term
Drug Classes
Platinum Agents
Cisplatin |
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Definition
LETHAL TO CATS "splats cats"
-NEPHROTOXIC
-GI TOX
-used in horses |
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Term
Drug Classes
Antitumor Ab/Anthracyclines |
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Definition
-intercalation of DNA base pairs
-FREE RADICAL FORMATION
-topoisomerase II inhibition |
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Term
Drug Classes
Antitumor Ab/Anthracyclines
Doxorubicin |
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Definition
-one of the most widely used
-best drug for LYMPHOMA
-SEVERE VESICANT
-NEUTROPHIL NADIR IN 7-10d
-RENAL TOXIC IN CATS
-CAUSES MAST CELL DEGRANULATION DURING ADMIN (pre-tx with dihenhydramine, admin slowly)
-RED URINE AFTER TX
-hepatobiliary metabolism
-cardiotoxic at doses higher than 180mg/m2 |
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Term
Drug Classes
Antitumor Ab/Anthracyclines
Mitoxantrone |
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Definition
-sub for doxo for animals with heart conditions
-BLUE URINE and SCLERA |
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Term
Drug Classes
Antimetabolites |
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Definition
-nucleotide analogs that incorporate DNA or RNA and therefore inhibit DNA or RNA synthesis
-S phase specific |
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Term
Drug Classes
Antimetabolites
Gemcitabine (Gemzar) |
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Definition
| -rarely used; carcinomas and sarcomas |
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Term
Drug Classes
Antimetabolites
Cytarabine (Cytosar) |
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Definition
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Term
Drug Classes
Antimetabolites
5-Fluorouracil |
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Definition
-FATAL TO CATS
-sometimes used in horse as a topical (not recommended for use because also toxic to humans) |
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Term
Drug Classes
Tyrosine Kinase Inhibitors |
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Definition
-MCT ONLY
-Cost prohibitive
-target tyrosine kinase receptors
-target tumor vasculature |
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Term
Drug Classes
Tyrosine Kinase Inhibitors
Toceranib (Palladia) |
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Definition
-GI tox
-no NSAID's/pred on same day given
-MUST m p's cont |
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Term
Drug Classes
Tyrosine Kinase Inhibitors
Masitinib |
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Definition
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Term
Other commonly used drugs:
Piroxicam |
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Definition
-NSAID
-inhibits Cox-II
Uses:
-canine TCC
-canine oral squamous cell carcinomas
-mammary tumors
-Not useful in cats due to poor absorption |
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Term
Other commonly used drugs:
Corticosteroids |
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Definition
-hematopoietic tumors
-palliative effect for other tumors |
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Term
Other commonly used drugs:
Oncept canine melanoma vaccine |
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Definition
-first canine THERAPEUTIC vaccine for cancer
-HUMAN DNA VAX AGAINST TYROSINASE
-efficacy unknown |
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Term
Other commonly used drugs:
Pamidronate |
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Definition
-bisphosphonate
Uses:
-palliate bone pain
-decrease hypercalcemia
MOA:
-INHIBITS OSTEOCLASTS
*caution in animals with renal dysfxn |
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Term
Other commonly used drugs:
Elspar |
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Definition
-bacterial enzyme
MOA:
-depletes whole body of asparagine which is important in lymphoma and leukemia induction |
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