Resources - nccn.org
cancer.org
LESSON 1: Cell cycle - g1- increase in size
s- dna replicated
g2- cell enlarge and ready to divide
m phase- 2
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mitosis - 4 stages, prophase, metaphase, anaphase, telophase
-chemo targets certain points in the process
apoptosis - programmed cell death
hematopoiesis - formation of blood cells & how cells differentiate
-myeloid: pre cells mature into RBCs, platelets and WBCs
-lymphoid: pre cells- mature into WBCS
Principles of Biotherapy: p51-95 immunology - -defense against foreign organisms, homeostasis (destroy aged cells), surveillance
immune responses - innate: primary line of defense, non specific, no memory
adaptive: secondary line of defence with specific memry
cytokines - -effect growth and differentiation of WBC
-interferons, tumor necrosis factors, growth factos and interleukins
-small protein molecules released by cells throughout body providing comunication between cells of the immune system
-regular antiboddy production and function of b cells
vaccines for cancer prevention - -hep B prevents hepatitis and hepatocellular carcinoma
-hpv vaccine
filgrastim aka neupogen - SC or IV to derease infection in patients with neutropenic fever associated with myelosuppressive anticancer treatments for nonmyeloid malignancies
tbo-filgramstim/ pegfilgrastim - reduce duration of neutroenia in patients with non myeloid malignancies
palifermin - IV to dec incidence of oral mucositis in patients with hem malignanies before BMT
sargramostim - aka leukine - patients with AML following chemo to shorten neutrophil recovery and reduce incidence of infection
IFN gamma - reduce frequency and severity o infections related to granulomatous disease
aldeleukin - treat renal cell carcinoma and metastatic melanoma
oprevelkin - prevent severe thrombocytopenia and refuce need for platelet transfusions in patients with nonmyeloid malig
plerixafor - with filgrastim to mobilize hematopoeitc stem cells for collection from peripheral blood of patients
sipuleucel - castrate resistant prostate cancer
rituximab - rituxan- treatment of relapsed or refractory low grade follicular b cell NHL_ first line traetment in combo with chemo in patients with response
-can treat severe rheumatoid arthritis
-can have severe reactions (hypotension, urticaria, angiodema, hypoxia, rigors, dyspnea, chills, fever, nausea, rash, renal tox)
-premed with tylenol and benadryl
-slow infusion to resolve some side effects, side effects reduce with each infusion
immune system - 1st line: skin , ucous membrane, gut flora
second line: phagocytes:
3rd line antibodies, t and b cells
malignant tumor (cancer) - cell strcuture different from parent tissue, cell division uncontrolled, loosely adherent, invade neighboring tissue, establish blood vessels
Approaches to treatment - cure: prolonged absence of disease
control: no further growth
and palliation : comfort
neoadjuvant - therapy in the first step to shrink a tumor before the main treatment) surgery is given
-chemo, radiation, hormone therapy
adjuvant - therapy given afer primary treatment to lower risk of cancer coming back
-chemo, radiation, hormone, targeted and biologic therapy
myeloblation - obliteration of bone marrow with chemo in prep for blood stem cell or bone marrow trasnplant to destroy blood forming cells in the marrow and reduce tumor burden - destroy immune system so it cannot attack donated cells after transplant
nonmyeloblative - not as intense, chemo doses are not as intense
LESSON 2: Alkylating Agents - -cytoxan
-ifosframide
-bendamustine
platinum based chemo - consideration on age, kidney function, and concurrent use of radiation. both can cause nausea, vomiting, hearting loss, kidney function damage, electrlyte disturb. CBC chem panel and mag checked
-cisplatin: admin over longer period of time. nausea can last over a week
-carboplatin- risk with age >65, harder on kidney function. over shorter period of time, nausea within first 24 hours. neuro tox
cyclophasmide - hair loss 10-14 days post treatment
-can be given peripherally
-hemmorhagic cystitis - hydration is key, high dose may need bladder protection
-easier to give than iphosphamide
iphosphamide - neuro changes can occur- personality changes can occur, neuro checks before
central line only
-need a bladder protective agent 100% of the time
nitrosureas - cross blood brain barrier - can treat brain tumors. alkylating agents
-pulmonary monitoring
Lesson 3: Antimetabolites - -azacitidine
-capacitabine
-fluorouracil
-cytarabine
-decitabine
-methotrexate
inhibit DNA and RNA synthesis - can cause myelosuppression, GI toxicities, phospotsensitiivty, hand foot syndrome, vigorous I V hydration to prevent tumor lysis
5 fluorouracil (5 FU) - -IV oral topic and opthalmic formalation
-can cause hyperpigmentation, increased mucositis, photosensitivity, diarrhea
-capcytobine is the oral form - needs to be taken 2x day, hand foot syndrome can occur
-INR monitoring
methotrexate - antimetabolite, cell cycle specific to S phase
-cleared in kidneys - effects: hepatotox, renal tox, mucositis, nausea, myelosuppression, pneumonitis, photosensitivity, neurotoxicity, infertility [Show Less]